St Helens Borough Council: local authority assessment

The systems and processes in place in St Helens showed the local authority understood the risks to people across their care journeys. Safety was a priority for everyone, and risks were identified and managed proactively. The effectiveness of these processes in keeping people safe was routinely monitored and the views of people who used services, partners and staff were listened to and considered. However, people did not always feel safe in St Helens, particularly during transitions.

Most people told us there were effective safeguarding processes in place to keep vulnerable people safe when concerns were raised, however not everyone who used adult social care services felt safe. National data provided by ASCS (2024) showed 67.27% of people who used adult social care services felt safe. This was tending towards a negative variation to the average for England of 71.06%. Data also showed 78.42% of people who used services said those services had made them feel safe. Again, this was tending towards a negative variation compared to the England average of 87.82%.

Senior leaders told us policies and processes about safety were aligned with other partners involved in a person’s care journey. This enabled shared learning and drove improvement. The corporate risk register held oversight of adult social care concerns. Actions taken to mitigate strategic and operational risks were subject to scrutiny by senior leaders, cabinet members and independent partners. Risks to adult social care service delivery were managed at a departmental level through quality assurance and governance processes, including the recording of mitigating actions and the use of prioritisation tools to analyse and triage concerns.

Staff and leaders explained there were prompts and questions identified for frontline teams to ask people to help them assess the level of risk to individuals, and staff used professional curiosity and professional judgement within their work. The risks identified in the adult social care risk register included the retendering of the Community Falls Service and an increase in the number of people on the daily hospital discharge delay tracking list.

Senior leaders explained the governance arrangements for delivery of the Care Act 2014 were structured around a suite of documents mapped out primarily in the Department’s ‘Assessment, Eligibility, Personal Budget & Support Planning Guidance’. This set out departmental standards for allocation of referrals, and the application of the eligibility criteria, including what factors should inform the assessment considering the St. Helens Practice Model. This document also included an escalation process and a multi-agency care planning protocol.

Senior leaders explained how St Helens was focussed on the development and establishment of 4 Care Communities across North St Helens; Central St Helens; Newton & Haydock; and South St Helens. Care Communities were seen as a way of working together with people and partner organisations in a multi-disciplinary way, to establish and maintain safe systems of care, in which safety was managed, monitored and assured. The local authority and its partners aimed to ensure continuity of care, including when people moved between different services through the provision of a seamless journey through health and social services.

People told us of a lack of engagement with older carers and families supporting people with learning disabilities who were living at home. For example, people felt Contact Cares was set up to support immediate need, and not future contingency planning. Therefore, there were no easy access pathways for older carers to plan for transitions of adults living at home moving into supported services when their unpaid carer or family member were no longer able to support them.

Where people transitioned between different adult services people felt this was managed well by the local authority, with planned handovers identifying areas of risk. However, whilst most people told us their experiences of local authority support during transitions was positive, there were some occasions where people felt there was not enough communication between children and adult services leading to delays in recognising when young people met the criteria for adult social care support.

People told us their experiences of transitioning from children to adult social care services was mixed, with young people feeling this was reliant on the frontline worker assigned to support them rather than through a robust transition process. People also told us high staff turnover and a lack of pre-planning for Care Act 2014 assessment meetings meant transition arrangements were often delayed. For example, people did not always have the correct professionals such as OTs attending meetings or have access to people who could support their understanding of the process.

Senior leaders shared details of a recent learning event held to address concerns raised when a person was detained under the Mental Health Act 1983, but no hospital beds were available. As a result of these concerns being reviewed, further issues were highlighted. It was felt by senior leaders elements of the concerns raised were of a similar nature to those highlighted in the last SAR completed by St Helens, and therefore leaders were not assured that the scenario could not re-occur. Key areas of concern included inconsistent responses from mental health services, with some appearing to work more cohesively than others, access to crisis support lines, and homecare staff who were not trained to support people with complex mental health feeling unsupported. Clarity on the remit of the mental health screening role in Contact Cares was also identified as an area of development.

The St Helens ‘Support you to grow into Adulthood’ transitions procedure set out how young people transitioning into adult services should be supported. The year 9 annual Statutory Education Review began the process of transition when the young person was 14. However, frontline teams told us the transitions process started with a young person at the age of 16 and finished at 25 and there was a lack of understanding of who made the first contact to review transition needs. Senior leaders told us the more structured involvement of the transitions team (Transitions Plan and Care Act assessment) took place between the ages of 16 and 18.

Staff and leaders told us there was a joint transition team with adult and children’s specialist social workers working together from the Children Act 2004 then onto the Care Act 2014 as the young person moved through the age groups. A joint referral portal enabled professionals to refer for transitions support online and ensure a safety plan was in place whilst waiting for the referral to be screened. Partners said the local authority had a clear focus on young people and supporting them through their transitions journey with Care Act 2014 assessments usually completed before the person was 17 and a half to ensure young people did not fall through any system gaps.

Partners told us the integrated hospital discharge process worked well, with Contact Care seen as essential in communicating and coordinating with colleagues at all levels within St Helens Place, and Mersey and West Lancashire Trust. The point of referral was through discharge coordinators on hospital wards. People were then allocated to a social worker for assessment. A person's assessments would be started in the hospital prior to discharge and then reassessed in the community once they returned home. If a person required a 24-hour care placement this would be passed to a hospital nurse who was also trained as a Trusted Assessor.

Data provided by the local authority showed in December 2024 there were 54 people waiting for services to start following the completion of a Care Act 2014 assessment, with a median average waiting time of 5 days for home care services and 18 days for residential services (including hospital discharges). Reasons for delays included, people not being medically fit for hospital discharge and difficulties in identifying a care provider to meet people’s needs or the initial provider found not being an acceptable choice to the person receiving support. Partners told us they would liaise with local care homes and the local authority’s brokerage function to ensure the correct placement for the person being discharged.

Staff and leaders told us follow up support visits took place in care homes once a person was discharged. This enabled them to pick up issues with discharge quickly, for example around medication administration. This had decreased the readmissions back into hospital. The St Helens Practice Model, combined with a Home First approach to hospital discharge and an integrated Urgent Community Response (UCR) and Emergency Duty Team allowed Contact Cares to respond to risk within 2 hours, with complex care referred on to frontline teams following triage.

Staff and leaders told us specific consideration was given to protecting the safety and well-being of people who were using services which were located away from their local area, and when people moved from one local authority area to another. Senior leaders told us the local authority followed Local Government Association best practice guidance to ensure conversations were started with the local authority where the person was moving to, and referrals were made in a timely manner. Decisions were taken in the best interest of the person requiring support, using the MCA 2005, and supported by independent advocates where appropriate.

St Helens undertook contingency planning to ensure preparedness for interruptions in the provision of care and support. The local authority knew how it would respond to different scenarios with plans and information sharing arrangements set up in advance with partner agencies and neighbouring local authorities to minimise the risks to people’s safety and wellbeing. Funding decisions or disputes with other agencies did not lead to delays in the provision of care and support.

Staff and leaders told us about the tendering process for new service providers, which included the submission of policies and procedures including contingency planning, modern slavery, and safe recruitment practices. Tenders also included a robust financial viability plan which was monitored quarterly through the market stability team. Every commissioned service had a specific 2-yearly safe recruitment audit including a review of compliance with working time directives. Senior leaders shared Cheshire and Merseyside care homes were also working together to fund an international recruitment advisor post in 2025.

Partners told us as part of the local authority’s contingency planning adult social care identified and assessed potential risks in St Helens with local partners, working together to determine the services they were willing and able to provide in the case of provider failure. The St Helens Provider Failure Policy (2024) enabled the local authority to facilitate a prompt response and secure continuity of care for people affected in the event of a business failure or service interruption.

Senior leaders told us the local authority met urgent support needs regardless of whether the person was ordinary resident in St Helens and acted quickly if circumstances warranted. As soon as a failure notification was received or real risk of potential provider failure identified, senior leaders were notified, with an Incident Response Group (IRG) meeting to taking place at the earliest practicable opportunity to agree a plan of action.

Staff and leaders shared internal contingency plans were in place to ensure continuity of essential systems, including Contact Cares, UCR and the emergency duty team function, and hospital discharges. The local authority also had a civil contingency plan in place via their emergency operations centre procedure to allow staff, working with partner agencies, to respond effectively to different emergency scenarios such as adverse weather conditions. The local authority’s pre-planning and lines of joint responsibility allowed staff to quickly coordinate placements and reduce the risk to people.