Stockton-on-Tees Borough Council: local authority assessment

Staff and leaders worked with local people and stakeholders to understand the care and support needs of residents. This was done through use of the local data, for example the Joint Strategic Needs Assessment (JSNA). At the time of our assessment, the JSNA was out of date, as it covered the period up to 2019, however, this was being refreshed with partners at the time of our assessment. Priorities outlined in the local authority’s Adult Social Care strategy, Council Plan 2023-2026, and Better Care Fund indicated a high-level understanding of some of the communities in Stockton-on-Tees’ long-standing care and support needs.

Other tools and data used by the local authority to understand peoples’ current and future needs were under development. The local authority’s performance reporting and analytic functions were brought together in 2023 so performance data could be triangulated with statutory reporting data and financial intelligence. This was starting to be used to understand the population’s care and support needs to strategically plan for services, although this process was still being developed at the time of our assessment.

The local authority also heard directly from local people through surveys, partnerships and consultations, and the Powering Our Futures work. People with lived experience of using care services were being included on some commissioning panels. This helped the local authority to co-produce service decisions and to have a clear focus on people rather as well as process.

The local authority’s Fair Cost of Care work identified more work was needed to understand the self-funding and non-commissioned care market. The local authority was working to establish reliable and regular flows of information to manage the wider market in Stockton-on-Tees and ensure a consistent level of quality information to support self-funders and social workers in their decision making.

The local authority was aware people did not always have access to support options that met their care and support needs in the borough. Leaders told us they worked with neighbouring local authorities to ensure people with specialist needs could receive support. A recent retendering process for domiciliary care services had been undertaken to increase responsiveness of provision and to allow greater flexibility in service delivery for providers. The specification and terms of the contract were informed through engagement and feedback with people using home care services and from care providers. The new arrangement required providers to sub-contract to other providers if they were unable to meet demand for care within their contracted ‘zone’. Providers retained responsibility for assuring the quality of the service provided by any sub-contracted provider. The new contract had been implemented in the weeks prior to on-site assessment work, but it was showing an initial positive impact, in that there were no people waiting for their home care service to start after the first three weeks. Monitoring over the longer term was needed to determine the sustainability of the new arrangements on this initial improvement trajectory.

The Adult Social Care Commissioning Service Delivery Plan 2024/25 was aligned with the strategic objectives of other partners, for example public health. Work was also in train with other local authorities in the region where there were shared priorities, for example around developing suitable housing with care options and remodelling existing housing stock for people with care needs. Providing suitable housing options for vulnerable groups was a known priority, as there were gaps in provision for people with complex support needs, older people requiring extra care, and young people moving into adulthood. Plans were in the early stages of development, with options being explored for the re-provision of some existing underutilised care services, and for capital investment to fund new services, for example a new service for people with a learning disability.

The local authority told us they were working with partners and neighbouring authorities to develop a regional approach to meeting the needs of those with complex or specialist needs, including those placed out of area and people living in geographically diverse areas of the borough.

Some market-shaping interventions identified in the Market Position Statement had been recently implemented, such as the Wellbeing Hub (providing walk-in, multi-agency mental health support) and a Housing with Care model (an initiative combining accommodation with care and support services) which had begun in 2024. Other interventions included a new complex mental health residential support service specification which was brought to market in March 2024. There was evidence of how the local authority had engaged with other agencies such as voluntary and community sector (VCS) partners on this work through events in April 2024.

The carer’s service was provided in-house. Approximately 73 new carers per month were being identified at the time of the assessment. There was regard for the provision of services to meet the needs of unpaid carers. However, only 25.19% of carers said they were accessing a support group or someone to talk to in confidence, which was worse than the England average of 32.98% (SACE, June 2024). Some carers said they received no support from the local authority despite assurances from staff that they would receive help. The local authority was aware of the need to improve the offer for carers and work was ongoing working towards maximising support available to them. This included entering into a 2024 partnership with an online carer-led platform that offered carers advice, tools, and community networks to support them in their caring roles. In July 2024, the platform had provided 165 carers with support that included emails, a peer support community, and a financial toolkit to help them manage their carers’ allowance.

Commissioning strategies emphasised the importance of co-production and partnership working with care providers to meet local needs and to improve the quality of care. We were told of some actions to support this, for example, people with lived experience were involved in some commissioning panels, and people’s feedback was used to inform the new home care contract specification. However, leaders acknowledged that the approach to coproduction in commissioning required further work to fully embed it.

There was an ambitious programme of commissioning activity planned for the short and medium term to address current gaps and to plan ahead to meet future needs. The aim was to move away from traditional commissioning activity which focused mainly on market management to a more strategic approach where commissioning was a transformative process with a stronger focus on promoting independence and early intervention. Leaders were seeking to develop the local authority’s strategic commissioning capability to lead this programme of work. There had been good progress in developing performance and information management capability so that future commissioning decisions would be based on a robust evidence base. Development work was ongoing.

There was a diverse range of services available in the community. Leaders were aware of gaps in some areas of provision which led to insufficient capacity to meet demand for some people, for example, those with mental health needs and young people transitioning to adulthood. However, arrangements were in place with neighbouring local authorities to provide speciality care to people that was not available in the borough.

Capacity in local service provision was usually adequate to meet demand. In June 2024, out of 26 people admitted to residential or nursing care, one person waited 76 days for residential support, and another person waited for 47 days for nursing home support. At this time, out of 153 commencing a new homecare package, three people waited an average of 11 days for home care.

Staff and leaders told us work to improve provision for people with complex moving and handling needs to support them to return home from hospital was showing positive outcomes. For example, occupational therapy staff were utlising analytical, functional assessments to ensure proportionate levels of care and support were provided, which reduced peoples’ required care levels and increased their independence. Additionally, training was being provided to care partners to enable them to support people requiring complex moving and handling support.

We received information describing arrangements the local authority used to manage risks to people waiting for services, which included a process to contact people to monitor their well-being weekly, fortnightly, or monthly, based on a prioritised risk rating. We were not made aware of anyone being left at risk of harm whilst waiting for a service to start and we were assured that leaders were taking steps to understand the demand and supply picture and manage risk to those waiting for services more effectively. This included making better use of performance data to monitor and track timeliness of provision and to enable them to be more responsive to fluctuations in demand.

While there was a diverse range of services available in the community, some people were using services and support from outside the local authority area. Leaders told us people receiving care and support outside the borough were often placed close to the borough’s borders and within the Tees Valley. The main reasons for this were personal choice (for example, the person wanting to be closer to their home residence) or lack of suitable provision in the borough. 23 of the 47 Stockton-on-Tees residents placed out-of-area were receiving care outside the borough because of lack of available provision in-borough. 14 of these people had increased needs for which no borough provision was available, and 9 people required specialist provision that was only available outside the borough, for example, head injury services. Out of area market-shaping work had helped the local authority identify key themes associated with those placed out of area, and work was ongoing to increase service provision in these areas. Staff told us about a lack of mental health and learning disability provision in the borough and we were told about plans to develop capacity with care providers in these areas, such as through commissioning mental health support in residential settings.

There was consideration for the provision of services to meet the needs of unpaid carers. Significant investment into carers’ services had been made by the local authority, and more carers in Stockton-on-Tees were satisfied with support they received than the England average (47.83% compared to 36.83%, Survey of Adult Carers in England (SACE), June 2024).

National data showed that 10.77% of carers said they were accessing support or services that enabled them to take a break from caring at short notice or in an emergency, which was in line with the England average of 12.08% (SACE, June 2024). Numbers of carers able to access support enabling them to take a break from caring for up to 24 hours were higher at 19.08%, but still low overall and below the England average of 21.73%. The local authority had plans to review capacity for contingency planning in its carers’ support offering.

The local authority had clear arrangements to monitor the quality and impact of the adult care and support services being commissioned in Stockton-on-Tees, including alignment with the Public Sector Equality Duty (PSED). Concerns raised about care providers were monitored for trends and raised with individual providers when improvements were needed. There was senior oversight of trends and formal quarterly review meetings.

Within the local authority, 80.65% of residential care homes, 66.67% of nursing homes, and 64.10% of homecare providers were rated as Good by CQC, with a small proportion rated Outstanding (6.45% for Residential Care, 4.76% for Nursing Care and 2.56% for Homecare). Within Nursing Care, a higher proportion of providers were rated as Requires Improvement (23.81%) than were providers of Residential Care (9.68%) or Homecare (7.69%).

A review of care provision undertaken in May 2024 indicated the quality of local services had increased slightly with limited risk identified across the market. In the event of persistent or serious quality concerns, temporary commissioning embargoes were used whilst improvements were made. The local authority worked with the providers to secure improvement as the default position. Seven of ten embargoes placed on adult social care providers between April 2023 and May 2024 had been removed by June 2024.

The local authority had arrangements for engaging routinely with care providers, both individually and collectively on matters relating to the provision of adult social care in the area. Care providers were generally positive about their interactions with the local authority and told us they had regular opportunities for engagement on local trading conditions and that they were supported to be sustainable through support with issues such as workforce recruitment and retention.

Local authority leaders, staff, and care providers said a significant risk to delivering sustainable social care services was budgetary limitations. As such, the local authority was working to understand risks to the sustainability of adult social care services, including its current and future social care workforce needs. The local authority collaborated with the care provider market to ensure the cost of care was transparent and fair, for example, by undertaking a Fair Cost of Care assessment.

The local authority had a robust approach to supporting and upskilling the adult social care workforce in Stockton-on-Tees, increasing the sustainability of local services. An Adult Social Care Workforce Development Plan 2024-26 had been developed with partners. The local authority’s social care workforce had an 8.32% adult social care job vacancy rate, which was similar to the England average of 8.06% (Skills for Care, October 2024). Several initiatives had been introduced to support the workforce, with the offer being extended to the whole social care workforce, and not only direct employees of the local authority. These included a bespoke 12-week workforce development programme and a training and employment Hub. The local authority also had links with universities and other agencies to upskill people and enhance workforce sustainability through a Sector Based Work Academy Programme (SWAP). Providers said the local authority had supported their workforce development capability by providing training tailored to emerging needs such as substance misuse issues. It promoted adult social care recruitment campaigns locally and nationally, as well as having its own apprenticeship programme to support succession planning for the workforce.

The local authority also worked with care providers and stakeholders to understand current trading conditions and how providers were coping with them. For example, an annual review to assess the sustainability of the older persons care home market was carried out. Processes were in place to safeguard residents in the event of care provider failure and other service interruptions and there were some strong relationships with voluntary and community sector (VCS) groups who could provide contingency support.

VCS partners acknowledged the limitations of funding available through the local authority and they expressed concern about sustainability risks inherent in short term funding arrangements. They told us local authority funding was sometimes limited to a year which could have a negative impact on the groups being funded and the communities the groups supported. For example, some partners experienced staff retention challenges as staff knew their jobs were not guaranteed past the end of the local authority funding, which reduced the ability of the groups to support the local community. This led some VCS partners to seek funding elsewhere or self-funding projects. However, some VCS partners told us they had received local authority funding to carry out engagement work on behalf of the local authority, and that this has been extended in some cases where positive outcomes for people could be evidenced. Further consideration of this risk was needed to ensure alignment with the local authority’s strategic intention to build community capacity as part of its prevention and early support transformation programme.