St Helens Borough Council: local authority assessment

Senior leaders told us about the corporate vision for St Helens as set out in the ‘Our Borough’ Strategy (2021-2030) which identified 6 key priorities, including promoting good health, independence, and care, and creating safe and strong communities. This was further developed in 2024 by St Helens People’s Plan (2024-2027) which saw the local authority working closely with internal and external partners to collate population data and to engage the local community in identifying health inequalities and future needs.

Partners explained how the Bourgh of St Helens had a legacy of inequality issues including poor health and inter-generational unemployment, following the decline of the coal mining and glass industries the local economy was built upon. This had led to a ‘cycle of deprivation’ compounded by the COVID-19 pandemic and cost of living crisis, with higher-than-average rates of suicide, alcohol-specific hospital admissions, domestic abuse, self-harm, and mental health issues. According to St Helens Mental Health and Wellbeing JSNA 2023, hospital admissions as a result of self-harm in 10–24-year-olds were the second highest in the North-West of England and the fourth highest in England in 2020-2021.

Staff and leaders told us St Helens launched their Adult Social Care Strategy – Enabling People to Live Healthier, Happier Lives (2024-2027) in November 2024. The aim of the strategy was to ensure the local authority worked with people, partners, and the local community to make available a range of services, facilities, resources, and other measures to promote independence, and to prevent, delay or reduce the need for care and support. The strategy was coproduced with the local community and partner organisations working with the local authority to ensure it identified any local unmet needs for care and support.

National data provided by ASCS (2024) showed 54.68% of people in St Helens said help and support helped them think and feel better about themselves. This was tending towards a negative variation compared to the England average of 62.48%. Furthermore, 63.86% of people who had received short-term support no longer required support, which showed a negative variation to the average for England of 79.39%. This meant people were more likely to need ongoing support and found the support offered did not always improve their wellbeing outcomes. Data provided by the local authority following our assessment showed the number of people no longer requiring support after receiving short-term support had significantly improved.

Senior leaders told us they worked with the wider council directorates such as Housing, Children’s services, and Public Health, to ensure people were supported to live healthy, happier lives reducing the needs to longer term carer or crisis intervention. The new Adult Social Care Strategy (2024-2027) allowed the local authority to work more closely with the ICS and other partners, pooling resources to improve integrated working and people’s experiences of support services. For example, the new Home First model increased capacity and access to therapy-led rehabilitation assessments and interventions using therapy and intermediate care services to reduce the potential for over-prescription of care and support at the point of hospital discharge.

Staff and leaders told us there was a focus on preventative services, with frontline teams and Contact Cares working closely with community and voluntary organisations as well as leisure centres and faith groups. The move towards locality working and Care Communities was seen by senior leaders as the next step towards understanding local needs and providing early intervention work at the heart of communities. Senior leaders told us they hoped to have independent living centres in the future, enabling people to access support and advice locally whilst displaying the benefits of available services and equipment. However, staff and leaders were uncertain about the new way of working or how localities and Care Communities impacted their roles.

Many staff felt the model was ICB-led and had had little impact within the local authority. Senior leaders told us Care Communities were led by primary care services however the local authority, the voluntary and community sector, and other service providers were equal partners in the delivery of the approach. The joint approach to Care Communities enabled health and social care professionals to share information about complex individuals, escalate concerns, share good practice and problem solve multi-agency care and support concerns. Weekly multi-disciplinary meetings were held, and Care Communities continued to develop and mature. The vision needed more time and further communication to embed the new ways of working.

Partners told us the online Live Well Directory provided advice, guidance events and activities as well as links to wellbeing and health services supporting people to stay safe and live independently. For people who either struggled to access digital services or required further support, the Contact Cares service had Care Navigators who could signpost people to support or refer them to the best sources of information, including Care Act 2014 assessment, home adaptation, aids and equipment, assistive technologies, reablement, and falls clinics. However, feedback from people showed this option was not well known in local communities, leading to the potential for digital exclusion in more deprived areas of the Borough.

People told us specific consideration was given to unpaid carers of a decline in their independence and wellbeing. National data provided by SACE (2024) showed 88.70% of unpaid carers found information and advice provided by St Helens to be helpful. This was tending towards a positive variation compared to the average for England of 85.22%.

People who accessed support said preventative services were having a positive impact on their well-being outcomes. For example, community-based mental health groups were supporting veterans and people with past trauma to reduce social isolation and provide advice and access to practical support to improve their health and wellbeing through access to peer support groups, food banks, and ‘Winter Warmth’ information. Positive life workshops were promoting people’s independence and self-belief through craft and art activities, with ‘Come Together’ hubs giving people opportunities to talk about their lived experiences.

Partners also told us the local authority had commissioned the voluntary and community sector to provide support for people with age-related needs. For example, dementia café's, memory cafés, and social groups offered support for people at all stages of their dementia journey.

St Helens was located within NHS Cheshire and Merseyside ICS and worked closely with Mersey Care NHS Foundation Trust and Bridgewater Community Healthcare NHS Foundation Trust to deliver intermediate care and reablement services. The Executive Director for People (Adults, Children’s, and Public Health) was also the NHS Place Director. Senior leaders told us this demonstrated the ICS’s commitment to working closely with St Helen’s across all aspects of health and social care.

Staff and leaders told us the integrated Contact Cares service operated as the hospital discharge Transfer of Care Hub for Mersey West Lancashire Trust, processing all discharge referrals ranging in complexity from District Nurse liaison referrals to complex multi-disciplinary assessments. The Integrated Discharge team aimed to facilitate safe and timely discharges from the Whiston Hospital, St Helens Hospital and Newton Hospital sites alongside admissions to and discharges from Brookfield intermediate care service.

Senior leaders explained how the UCR team was formed in September 2022 and was integrated with the Mersey West Lancashire Trust’s Frailty Team. Nurses, social work staff and therapists provided a clinical and social care response to people in crisis within a 2-hour timeframe. The aim of this service was to avoid unnecessary hospital admissions and support unpaid carers in crisis.

Partners told us there was a focus on rapid hospital discharge and assessment. Integrated processes were subject to weekly scrutiny via escalation meetings. The Reablement Team and Brookfield intermediate care service provided same day interventions to improve hospital discharge rates. Data shared by the local authority showed for April 2023 to March 2024 Integrated Discharge team achieved 2,865 discharges, which was an average of 55 people discharged per week throughout the year.

National data provided by Adult Social Care Outcomes Framework (ASCOF) 2024 showed 1.14% of people 65+ received reablement or rehabilitation services after discharge from hospital which was a significant negative variation to the average for England of 3.00%. National Short- and Long-Term Support (SALT 2024) data showed 68.75% of people 65+ were still at home 91 days after discharge from hospital into reablement or rehabilitation services. This was a negative variation compared to the England average of 83.70%. The data suggested reablement and rehabilitation services for people 65+ were not always being considered as part of the Home First model and rates of readmissions to hospital or transfers to more complex services for older people were higher in St Helens than the national average.

Data provided by the local authority following our assessment showed readmission rates had significantly improved, including the percentage of people 65+ still at home 91 days after discharge from hospital into reablement or rehabilitation services.

Senior leaders told us they worked with partners to launch the early intervention Home First model. The model was led by Occupational Therapists (OTs) and led to a service redesign and further investment in reablement and intermediate care services using Better Care Funding (BCF). The BCF was a partnership between the NHS, the Department of Health and Social Care, the Ministry of Housing, Communities and Local Government, and the Local Government Association. The goal was to improve the quality of life for people and to reduce pressure on urgent and emergency care, acute care, and social care services. This was achieved by supporting people to avoid long-term residential care and facilitating the transition of people out of hospital. Data provided by the local authority showed St Helens had seen a 30% increase in the number of people being discharged home and a reduction in hospital discharge delays by an average of 3 days.

People told us they were able to access equipment, aids, assistive technologies, and minor home adaptations to maintain their independence and continue living in their own homes. Senior leaders informed us the local authority had a joint community equipment store with Halton local authority which allowed them access to essential, popular equipment and aids, reducing waiting times for these items.

Data provided by the local authority showed 98% of basic equipment deliveries were within the 7-day target period for aids and adaptations. However, more complex, or bespoke equipment, including complex home adaptations could take significantly longer, with a maximum waiting time of 54 working days. Waiting times for equipment or home adaptations were risk assessed and where care needs had been identified, interim arrangements were put in place to manage risks until the equipment, or adaptations were in place.

Staff and leaders explained it was easy to access equipment to support hospital discharges, including assistive technologies which the local authority commissioned from a private provider. Equipment could also be purchased independently by people using services, and direct payments were sometimes used to facilitate this. The Contact Cares team supporting hospital discharge and the UCR service had access to OTs as well as Trusted Assessors. A Trusted Assessor was a suitably qualified person who carries out assessments of health and/or social care needs to facilitate speedy and safe transfers from hospital or to avoid hospital admissions.

Senior leaders told us there had been difficulties with OT provision over the past 12 months, with an external OT provider commissioned to complete assessments to reduce the backlog and allow the local authority time to recruit to vacant posts. As with equipment waiting times, people’s needs were risk assessed whilst waiting for assessments and interim arrangements were put in place where necessary. Data provided by the local authority in December 2024 showed there were 38 people waiting for OT assessments and the commissioned arrangements had successfully reduced the backlog of delayed assessments.

Partners told us frontline teams worked closely with local housing providers to ensure new services were fit for purpose and adapted to meet the specific needs of people using services. The Home Improvement agency provided low-level adaptations to enable people to remain at home following assessment by OTs, with the grants team and technical team progressing Disabled Facilities Grants (DFGs) and the installation of major adaptations such as a stairlift, wet room showers and extensions.

People said access to equipment and home adaptations was good and led to positive outcomes for their lives. For example, one unpaid carer shared how the provision of manual handling equipment to support their loved one at home had not only prevented them being admitted to hospital but had improved their independence and quality of life, leading to more time available for the unpaid carer to have respite from their caring role as well.

People told us they could access information and advice on their rights under the Care Act 2014 and ways to meet their care and support needs. This included unpaid carers and people who funded or arranged their own care and support. National data provided by ASCS (2024) showed 72.80% of unpaid carers in St Helens found it easy to access information and advice, which was a positive variation on the average for England of 59.06%.

People told us the Live Well Directory was easy to access and navigate and alternative ways of requesting information and advice were available through the Contact Cares service. Contact Cares provided information and advice to professionals, people using services and unpaid carers who either called, emailed, or made a request via the local authority’s shared care management system. Senior leaders told us the service dealt with over 90 distinct types of queries ranging from non-complex podiatry referrals to complex adult safeguarding alerts. There was also the facility to seek advice and guidance from Contact Cares Advisors, for example about befriending services for older people or help with domestic tasks not covered under the Care Act 2014.

Partners told us the local authority were aware of the risk of digital exclusion, with people unable to access information and advice online being able to access advice via local libraries, faith centres, and social groups. Leaflets ranging from sensory impairment services to financial support and personal budgets were available in multiple formats and in different languages such as Arabic and Polish.

People told us there was good uptake of direct payments amongst unpaid carers. People and unpaid carers were offered the chance to use direct payments to control how their care and support needs were met, with many accessing one-off payments for leisure activities, short breaks, assistive technologies, and essential white goods.

Staff and leaders explained direct payments were seen as an area of development within St Helens. Whilst unpaid carers in the borough had embraced the benefits of direct payments, a 2024 review identified the uptake by people 65+ receiving adult social care support services was less effective. People who used direct payments used them to access equipment or to fund Personal Assistants (PAs). A PA was someone employed to directly support people in their home or community. They could be employed for a range of tasks, which were agreed at the time of their employment.

Partners told us support was available via direct payments advisors, who offered support and guidance on setting up and running direct payments, including advice on choosing a care agency, the recruitment of PAs, record keeping, and payroll. National data received from ASCOF (2024) showed 55.28% of people using adult social care services in St Helens to access long-term support aged 18 - 64 were receiving direct payments. This was a significant positive variation on the average for England of 37.12%. However, this figure significantly dropped for people aged 65 and over, with only 4.59% of people aged 65 and over accessing long-term support receiving direct payments. This was a significant negative variation compared to the England average of 14.32%.

Staff and leaders told us a recent review of the direct payments process had led to the creation of an action plan, with promotion and marketing a key component of improving the direct payments offer. Data shared by the local authority showed in December 2024 there were 9 people waiting for direct payments to start following an assessment for individual budgets. The median average waiting time was 25 days, with the maximum waiting time 37 days. Whilst people were waiting for direct payments to start, they were either already receiving a commissioned service or were being supported by a family member. Figures provided by the local authority also showed 60 people had stopped using direct payments in 2023-2024. Of these people, 20 no longer required support, 11 had passed away, and the remainder had changed service type.

Partners told us there were a number of ways people could use their direct payments in St Helens, including unpaid carers respite services which were provided at home as well as within residential settings. Most people spent their direct payments on direct support for themselves in their home or to access the community.

People said they also used their personal budgets to make alterations to their housing to better suit their needs and make life easier for themselves or their unpaid carers, therefore reducing the need for personal support. For example, purchasing lightweight, modular ramps to make a house wheelchair accessible, equipment to reduce the risk of falling, or assistive technology to promote independence. Assistive technologies included computer software to read mail rather than paying someone to read it, and alarms to alert if someone was leaving their room at night rather than paying a PA to be there all night. A Technology-Enabled Care Hub based at Brookfields was available for people to view assistive technologies and decide which equipment was best suited to their needs.