St Helens Borough Council: local authority assessment

St Helens worked collaboratively with partners to agree and align strategic priorities, plans and responsibilities for people in the area. The local authority had integrated aspects of its care and support functions with partner agencies where this was best practice and when it showed evidence of improved outcomes for people.

Senior leaders told us there was a ‘whole council’ approach to tackling health and social care inequalities in the Borough. The local authority collaborated with local partners through the Cheshire and Merseyside Health and Care Partnership. This produced an 'integrated care plan,' which ensured health and social care services met the needs of communities through a unified approach to planning and delivering health and social care services.

The local authority worked closely with Cheshire and Mersey ICB to support a place-based approach to integrated commissioning across health and social care. The Executive Director for People (Adults, Children’s, and Public Health) was also the NHS Place Director which enabled integration, governance, and commissioning arrangements, as well as integrated decision making.

Partners told us they worked closely with the local authority to ensure people received the right kind of care and support. All relevant professionals were involved in multi-disciplinary meetings, such as adult social care reviews, to provide the best possible support for individuals and their families. This collaborative approach ensured people receiving support, and their loved ones, were supported throughout their journey.

Staff and leaders told us the local care and support system, 'St Helens Cares', was developing through locality working, with core teams of multidisciplinary health and social care staff from across St Helens working collaboratively. The local authority worked in partnership with local hospital providers, the ambulance service, local police and fire services, community and voluntary services, the local housing trust and education providers. For example, St Helens Active Lives Strategy (2022-2027) set out the local authority’s vision to work in partnership to increase the levels of physical activity across the entire population of the Borough whilst maximising opportunities for people experiencing inequality to participate in activities.

Partners said there was a clear strategy for Contact Cares services to support preventative strategies to reduce hospital admissions as well as supporting hospital discharge pathways. Integrated teams worked together, with clear discharge pathways dependent on the need of the person receiving support. Nurses and social work staff were co-located, with local authority staff and leaders describing having good relationships with health colleagues, enabling them to professionally challenge each other and have their opinions respected.

People told us they received support from multidisciplinary teams to support rehabilitation and reablement following discharge from hospital, with the local authority’s Home First model enabling joint triage and assessment of need to reduce over prescription of support leading to reduced independence and recovery opportunities. CHC processes were made easier by the provision of named workers acting as a link between health and adult social care partners, and peoples experience of step-down services was positive. CHC funds ongoing care outside hospital in a person’s home or in a care home for someone who was ill or disabled with long-term complex health needs. They qualified for free social care, which was arranged and funded by the NHS.

Senior leaders told us there were positive relationships with the local Mental Health Trust enabling open discussion on improving the mental health offer in the Borough. Partners told us they were working closely with the local authority to deliver community mental health transformation along with other partners. Funding for social prescribers from the voluntary and community sector had been obtained to support people in hospital wards before transitioning into the community.

St Helens had clear arrangements for governance, accountability, monitoring, quality assurance and information sharing when working with partner organisations. The Place Leadership Team (PLT), Executive Management Board (EMB), and the People’s Board (Health and Wellbeing Board) all supported effective partnership working, with strategic decisions made collectively through weekly meetings of the integrated senior leadership team.

As part of St Helens 'Our Borough Strategy’ (2021-2030) the local authority set out a key priority to promote good health, independence, and care across communities. This joint-funded strategy aimed to improve people’s physical and mental wellbeing, independence, and experience of health and social care through partnership working. The St Helens People’s Plan (2024-2027) identified an all-age vision for integrated health and social care provision across the Borough, led by the Integrated People’s Services Leadership Team and delivered through the Contact Cares services.

Senior leaders said they were committed to listening to people receiving support and providers to ensure the services were safe and of good quality. This was achieved through a number of provider forums and partnership boards. The forums were designed to be a platform for providers to share feedback on how services were delivered and partnership boards designed to provide a platform for services users, unpaid carers and their families to actively have a say in how the services were developed and to provide feedback on any issues impacting them.

The DASS chaired the Northwest Regional Safeguarding Group working with a number of Local Authorities across the Northwest to collectively look at Safeguarding processes learning from Safeguarding Adult Reviews (SARs), as well as data analysis to continue to improve and standardise good practice across the region. St Helens was also nominated by the Northwest Association of Directors of Adult Social Services (ADASS) to chair the Older People’ s Network across the region. This group worked to ensure better outcomes for older people, promote the implementation of prevention and Home First approaches, and reduce the reliance on long-term care.

Staff and leaders told us they worked in partnership with Merseyside and West Lancashire Teaching Hospital NHS Trust (MWL) to actively manage and support system escalation issues on a weekly basis. Adult social care played an active role in managing system pressures. Weekly system escalation meetings were attended by leaders from the St Helen’s Hospital Discharge team, St Helens Place, and MWL to support workflow including capacity and demand management. Commissioners were linked into these meetings to support conversations and actions around market management and service development.

Partners told us NHS Cheshire and Merseyside ICB had arranged for some of its functions to be delivered and decisions about NHS funding to be made at a Place level. This was done through Placed Based Partnerships. The St Helens Cares model used a range of partners working together to design and deliver services locally. St Helens People’s Board used the Better Health Care Fund to enhance schemes supporting the integration of local services.

St Helens Our Better Care Fund plan (2023-2025) was a collaborative approach to delivering a range of services to support both community and hospital discharge services through a partnership approach including key stake holders from across adult social care, St Helens Place, Public Health, strategic housing, and the voluntary and community sector. The plan primarily focused on integrating services to support the Home First model, including out of hospital support and the discharge transfer of care hub.

Staff and leaders told us the BCF delivery board was a multi-organisational board which oversaw the delivery of the key priorities of reducing hospital length of stay and supporting more people to remain at home. Senior leaders told us they had recently agreed to increase mental health reablement funding to provide intensive support for people following discharge from acute mental health wards.

The local authority monitored and evaluated the impact of its partnership working on the costs of adult social care and the outcomes for people. This informed ongoing development and continuous improvement.

Senior leaders told us the local authority’s integration journey, with the BCF used to deliver a number of key place and system changes since 2022 including the establishment of virtual hospital wards, 2-hour urgent community response services, and the establishment of a self-harm pathway. Locality and care community working continued to be the focus of community integration, with Care Connect used as the link between hospital discharge and adult social care assessment.

Partners told us the move to localities and Care Communities had been led by the ICB and were expected to focus on homelessness and to improve communication and joint working around mental health. The care community model had people with complex needs at the centre, supported by wrap-around services including key professionals from health, adult social care, community services, specialist services and the voluntary and community sector led by care coordinators and forming strong local multi-disciplinary teams. There were 4 Care Communities aligned to 7 localities across St Helens.

Partners told us the aim of Care Communities was to build on existing local teams to provide health and care services in response to increasing demand for services through the use of all health and social support services available in the Borough, including the voluntary sector. The focus was on early intervention and prevention through empowering, enabling and supporting people to ‘self-care first’, whilst embedding processes to support people with more complex health needs.

Staff and leaders told us about a key approach for the local authority’s preventative support which was to provide the ‘right care, at the right time, in the right place.’ The local authority told us it aimed to work collaboratively with people in their community so skilled staff ensured people’s needs were responded to in a timely way, and preventative care and support was suitable and available in communities. For example, there was a whole partnership approach to suicide prevention as this was major concern in St Helens.

Partners told us the local authority was taking an evaluating approach to health and social care themes & trends. Senior leaders told us they were working with John Moores University, with weekly meetings including police, health partners, and other organisations. This approach included tackling the stigma of mental health needs. For example, people with lived experience of mental health needs had produced a video on tackling stigma. There was also a drugs and alcohol project using funding to tackle addiction.

Partners told us the quality assurance process included a nurse from health partners as part of the team carrying out joint visits to nursing and residential homes. This allowed support with provider improvements relating to falls, medicines errors, continence promotion, hydration, and skin integrity.

People and partners also shared their experiences of Brookfield Support Centre, a 30-bedded residential intermediate care unit operated by St Helens Council in partnership with the ICB. Brookfield provided an integrated team with therapy and clinical staff from Mersey West Lancashire Trust providing rehabilitation for people who no longer needed to remain in hospital but were not yet well enough to return home. This enhanced patient flow both in the Whiston Hospital site and as step-down from the sub-acute intermediate care units. The service also supported step-up admission from the community via Urgent Community Response referrals to avoid hospital admissions.

St Helens worked collaboratively with voluntary and community organisations to understand and meet local adult social care needs. The local authority provided funding and other support opportunities to encourage growth and innovation. Senior leaders told us the voluntary and community sector were integral in tackling the health and social care inequalities in the Borough to support the prevention strategies through community engagement, coproduction and intervention.

St Helens State of the Sector Report (2023) identified a total of 1120 voluntary and community sector organisations working in St Helens, including 261 registered charities. The most common source of funding for organisations was from local authority grants (23%) and 92% used volunteers to support their activities.

Senior leaders told us their place-based plan and priorities had been informed by what local people said was important to them about their health and care needs. The voluntary and community sector supported the 3 key priorities of mental wellbeing, healthy weights, and resilient communities by providing support, advice and services to people at risk of self-harm (including alcohol dependency), supporting active lifestyles and healthy eating across the Borough, and reducing social isolation and loneliness.

Staff and leaders said they had recently re-commissioned the unpaid carers support, jointly commissioned between adult social care, children and young people’s services and the ICB. The Carers Centre was seen as pivotal in delivering the All-Age Carers Strategy (2024-27) and was held to account by the Carers Partnership Board.

Staff and leaders told us St Helens also commissioned the voluntary and community sector to provide information and advice services. The organisation sub-contracted the delivery of the service to Citizens Advice St Helens who signposted residents to statutory services, advocacy, benefits advice services, homelessness and housing advice, and health prevention services.

Partners explained one of the main benefits to local communities came from the introduction of the Inequalities Commission, made up of voluntary and community organisations, the NHS, the local authority, and regional experts. Local people identified food poverty as one of the main concerns, leading to the implementation of food pantries across the Borough, run by voluntary and community organisations.

Partners gave another example of good working relationship with the local authority leading to positive outcomes for the local community. Partners shared how the local authority supported and encouraged different voluntary and community organisations to link in with each other. For example, carers organisations supporting older people to live independently were signposted to organisations offering lived experience of specialist dementia care.

People told us the voluntary and community sector had a strong working relationship with council. The St Helens Come Together hub provided a safe space for people who looking to improve their lives through positive community activities, outreach programmes, and support. Activities included yoga therapy, sports therapy, wellbeing support groups and a community outreach programme. The hub also supported other voluntary and community organisations through a star standards award. This was a checklist to make sure charities had everything in place such as liability insurance and polices. They also made people aware of tenders they could apply for.