Stockton-on-Tees Borough Council: local authority assessment

The local authority worked with people, partners, and local communities to provide a range of services, facilities and resources to promote independence. These included community courses to improve skills such as cooking, languages, and financial literacy to help people enhance their skills and stay independent. A befriending service was available from the community-based LiveWell Dementia Hub, and a Wellbeing Hub provided multi-agency mental health support, reducing the need for long-term intervention. People could also access a Home Improvement Agency (HIA) for minor home adaptations and equipment provision for those with additional requirements such as sensory needs. Other commissioned resources focused on preventing longer-term care and included an intermediate care facility, an in-house reablement team, multi-agency support from specialist services such as a Sensory Support team, dementia team, falls service, a community champions network, and a Short Term Enablement Programme Service (STEPS) programme which supported people with autism and learning disabilities across key areas such as employment. The local authority also worked with regional partners to support continuing improvements for social care outcomes for people in prisons. For example, workers delivered training about prisoners’ rights, eligibility, and delivery of duties under the Care Act 2014.

People told us preventative resources and support improved their wellbeing and promoted their independence. For example, one person told us the local authority had provided resources that reduced their reliance on intensive support and helped them progress their educational goals to become employed. Additionally, on release from prison, staff told us a person was supported to obtain a tenancy and given a mobile phone, which helped them integrate into the community and promoted their independence. Evidence of improved outcomes as a result of preventive services was in line with national data: 91.04% of people who received short term support no longer require support (Adult Social Care Outcomes Framework, December 2024) which was much better than the England average of 79.39%. This indicated resources provided by the local authority were helping prevent, delay or reduce the need for care, and promote early intervention and prevention.

The local authority had arrangements to monitor and evaluate the impact of its prevention strategy and outcomes for individuals and communities. For example, activity monitoring equipment, which was used to keep people safe and independent at home, collected data to support evidence based, person centered decision making and best use of resources. A multi-disciplinary team also told us their funding had been extended following evidence showing their work had reduced hospital readmissions. Additionally, leaders said the evidence base for professions such as Occupational Therapy (OT) had strengthened in recent years, and they had used evidence to demonstrate the service’s value and how they supported positive outcomes for people and their families within system.

Identifying people in the area who had needs for care and support that were not wholly or only partially met was a priority for the local authority, however this work was in its infancy. The prevention and early intervention strategy, as well as the Powering Our Futures change programme, outlined plans for targeted, evidence-based approaches to identify and reach groups with unmet needs, such as integrated substance misuse support for those with comorbidities. There was an ambition among leaders to make use of community partnerships to better identify and target vulnerable groups such as unidentified unpaid carers, victims and survivors of domestic abuse, and those with substance misuse issues. This indicated a joined-up approach to prevention across adult social care, the wider organisation, and partners.

Consideration was given to supporting unpaid carers and people at greatest risk of a decline in their independence and wellbeing, but more practical support and resources were required to help carers live as they wanted. For example, there was a timeout service in place which provided free short-term respite for unpaid carers and aimed to delay or reduce further need for carers’ support. Carers who had accessed this service valued it highly and said it supported them in their caring role. However, there were approximately 20 people waiting for the timeout service at the time of the assessment, meaning that not everyone who could benefit from the service was able to do so.

National data from the Survey of Adult Carers in England (SACE, June 2024) showed that 90.7% of carers found information and advice from the local authority helpful. This was better than the England average of 85.22%. However, the same survey also indicated more could be done to improve the respite offer to unpaid carers; only 15.15% of carers in the borough said they were able to spend time doing things they value or enjoy – although this was in line with the England average of 15.97%. In relation to employment, 34% of carers said they could not maintain paid employment because of their caring duties, which was above the England average of 26.7% (SACE, June 2024). Further work was in train to build on the existing support offer for unpaid carers.

The local authority’s adult social care teams worked with community partners to understand peoples’ needs as early as possible, to deliver timely intermediate care and in-house reablement that enabled people to return to their optimal independence. This resource helped prevent deterioration to peoples’ wellbeing and avoid unnecessary hospital admission. Staff had a strong knowledge of community groups, hubs, activities, such as person-centred employment support and a STEPS programme which supported people to build their confidence to access the community. Staff recognised the importance of linking with other preventative reablement measures outside of commissioned services to provide residents with a wider network of support.

The local authority provided information indicating almost 68% of people accessing reablement support following discharge from hospital required no further funded support after six weeks. It also supported people leaving hospital to regain their independence; 86.36% of people aged 65 years or over were still at home 91 days after they were discharged from hospital into reablement or rehabilitation services, which was in line with the England average of 83.70% (Short and Long Term Support (SALT), October 2024). The quality of reablement provision was reflected by staff winning a ‘Great British Care’ award in November 2024, and feedback from people receiving reablement support was positive. However, significantly fewer people aged 65 or over were accessing reablement or rehabilitation support after leaving hospital than the England average (1.46% compared with 3.00%, Adult Social Care Outcomes Framework, December 2024).

Feedback was mainly positive relating to assessment for, and provision of, equipment. OT assessments had a waiting list of 9 people, where the median wait was 17 days (10 days higher than the local authority’s target). In the last 12 months, the maximum wait was 241 days. The local authority said this was due to reduced workforce capacity during a period of high demand in 2023 and had since been resolved. The local authority’s data indicated there were no waits for home adaptations and equipment for those leaving hospital, though arranging access to people’s houses to set up equipment prior to discharge was sometimes delayed beyond the 48-hour target. The waiting time for urgent, minor home adaptions were a median of 4 days with 7 people waiting, and a maximum wait of 8 days over the previous 12 months where the target was 5 days. Waits for non-urgent minor home adaptations were well below the 42-day target, with 31 people waiting for work to be completed. Overall, this indicated the local authority was supporting people to remain independent through timely access to equipment and home adaptations.

Access to equipment was provided through a section 75 agreement. 95% of items ordered in the year prior to December 2024 were delivered within the 7-day target. However, waiting times could be as high as 273 days, related to the procurement of bespoke or specialist equipment. Additionally, staff said low stocks of specialist equipment such as chairs and sleep systems had resulted in waits of seven to eight weeks. However, a 24-hour urgent equipment response target time had always been met, and staff told us they usually had no issues with accessing equipment or delivery.

Similarly, people could access equipment and minor home adaptations in a timely way to maintain their independence and continue living in their own homes. Waits for adjustments by a handyperson to make peoples’ homes safe (such as fitting handrails or key safes) were low, with 12 days being the longest wait recorded in the last 12 months against a 10-day target. A Sensory Support team carried out assessments and provided equipment for a variety of sensory needs without the need for a financial assessment or charge to the person. 15 people were waiting for this service, with a maximum wait over the previous 12 months of 42 days against a target of 7 days. However, staff gave recent examples of high-risk referrals made to the Sensory Support team that were swiftly acted on, indicating people who urgently needed sensory support were able to access it within a reasonable time period.

Staff said there was a strong technology offer available to support people in their homes, including the OneCall home monitoring system and telecare services, which enabled people to stay connected to support networks and befriending services. OneCall supplied sensors to monitor wellbeing in the home through detection of falls, floods, and medication alerts. Around 12,000 calls were received from 5,000 OneCall installations per month for the service’s 24-hour personal care and falls pick-up service, indicating good awareness and use of the service within the area.

People could access information and advice on their rights under the Care Act and ways to meet their care and support needs. For example, people said they were impressed with the range of services provided in Stockton-on-Tees compared to neighbouring boroughs, and 75% of carers engaged with the local authority said they found it easy to access information and advice, which was significantly better than the England average of 59.06% (SACE, June 2024). Additionally, the local authority was aware of feedback from some carers who wanted better access to information and advice, and work was ongoing towards this.

Strategic work was ongoing through change programmes such as ‘A Fairer-Stockton-on Tees’ to improve the accessibility of information and advice about adult social care services to seldom heard and vulnerable groups. For example, some people involved in co-production work said the local authority was working towards empowering people to manage their own wellbeing, for example by supporting a ‘positive living’ forum initiative, where the local authority offered independent living workshops and signposted people to relevant resources and services.

The voluntary and community sector (VCS) and care providers said certain Black Asian and Minority Ethnic (BAME) communities were less able to access information and advice due to cultural and language barriers. Additionally, people who were self-funding their care told us they could have been given more information about available support. Staff and leaders agreed access to information about the preventative offer in Stockton on Tees could be improved for people who were seldom heard, and/or who were not already receiving services or engaged with the local authority in other ways.

The local authority had a clear approach to direct payments, providing a dedicated support function to enable people to access ongoing information and support. Staff said an in-house direct payments brokerage service worked closely with adult social care social work teams to support peoples’ choice and control around how their care needs were met. A social media page had been set up by the direct payments team to establish a peer-support function and promote independence among people accessing support from the local authority.

The effectiveness of arrangements to support people to take up direct payments were reflected in national data. Uptake of direct payments across all age groups was higher than the England average, particularly for those aged between 18 and 64 (49.51% compared to 37.12% for England, Adult Social Care Outcomes Framework (ASCOF), December 2024). Local authority data indicated that 100% of identified carers had also received direct payments in the last year.

The local authority understood some of the barriers for people using direct payments and took steps to remove them. For example, the direct payment team worked closely with the carers’ service to ensure they had a point of contact for support. The local authority also recognised national and local challenges around recruiting and retaining Personal Assistants (PA) and the impact of this on residents in Stockton-on-Tees wishing to employ a PA.

Promotion initiatives for the Personal Assistant role were underway to address recruitment issues in partnership with local carers’ services. To further increase awareness and uptake of direct payments, staff attended job centre fairs and community-based parent/carer groups. This was positive action to increase the equity of their direct payment offer and make use of community assets to reach people. This work was ongoing, and leaders told us it evolved according to demand and available opportunities.