Sunderland City Council: local authority assessment

The local authority’s Adult Social Care Strategy had identified a priority to define and agree a new model of social work utilising a strength-based approach. The local authority had implemented a new front door provision in May 2024 which was central to their prevention strategy. The front door brought together a multi-disciplinary team which included social workers and occupational therapists and due to phased implementation was embedded in practice at the time of this assessment. As part of the development of the front door, the local authority had integrated the role of the single point of contact and the support offer from partners in the voluntary sector to develop a joined-up approach. The front door used a three-conversation approach which encouraged putting people at the centre of their assessment and care planning. It focused on a first conversation focused on listening and connecting with the person, a second person led conversation that support risk assessment and crisis contingencies, and a third conversation based around building a good life.

The restructure was modelled on a vision to ensure people’s journey through the assessment system within the local authority was smooth. The adult social care operational guidance, published in May 2024, provided a detailed guide for staff on how to deliver strengths-based adult social care. It set out the local authority’s core values, aspirations, and the importance of quality assurance. The document covered all areas including guidance on the front door, safeguarding, and Deprivation of Liberty Safeguards (DoLS). The front door provided a single point of access for referrals, with a focus on early intervention and prevention, where people could be quickly assessed and referred to appropriate services. The local authority had consulted widely within the sector to develop this model, which also included a carers centre and voluntary sector staff. Staff gave examples where people needed both a social worker and an occupational therapist assessment, which previously would have involved 2 visits. Now this was 1 joint visit, and the person only needed to have the 1 conversation.

There were effective systems for identifying and addressing urgent cases. Staff told us how the systems had supported people in crisis to be prioritised and receive immediate support. Further integrated working between the front door and safeguarding teams was being discussed with strategic managers to streamline processes, so quicker responses to support better outcomes could be obtained.

Assessments and care planning could be accessed via telephone, online or face to face. The local authority had strengthened this process through the implementation of portals which supported self-assessment and trusted assessments, completed by providers for both care act assessments and therapy assessments. This was in response to people’s feedback that they could not always easily access the local authority’s care and support services. Adult social care operated 24/7 with duty and out of hours able to respond quickly to address presenting needs.

Data from the Adult Social Care Survey 23/24 for Sunderland showed that 67.9% of people were satisfied with their care and support and and 80.42% of people felt they had control over their daily lives. This was in line with the England average.

Staff consistently worked creatively and were encouraged to use innovation and technology to support people to utilise and build upon their own strengths. This strengths-based approach was evidenced in records which used positive language. There were examples of care and support for people with complex needs where personalised care and housing provision was created to enable and support independence. Staff gave examples of strengths based and person-centred practice such as the provision of a direct payment to a person with mental health issues that supported them to access the community in a more creative way. This resulted in a growth of confidence enabling them to subsequently learn to drive, go to college and then find employment, promoting independence and preventing the need for long term services. Staff told us they had tools which supported them to have a strengths-based conversation whilst ensuring that the strengths-based assessment was captured in records.

People told us about their journey through adult social care was focused on their wishes and they felt listened to. Pathways and processes ensured people’s support was planned and co-ordinated across different agencies and services. The local authority had assessment teams who were competent to carry out assessments, including specialist assessments. Social workers and assessment officers worked with a variety of partners to ensure people’s needs were assessed quickly and any opportunities to prevent, reduce and delay need were identified. Staff told us an example of their person-centred approach with a person who frequent hospital admissions. Staff worked closely with the person and supported them to move accommodation and reduce their care and support by 98%. Due to the positive outcome and interventions from staff, they were shortlisted for team of the year award for Social Worker of the Year Awards. Leaders and staff described how integrated records benefitted the care planning and assessment process, which was helpful to understand the holistic picture for each person. Staff had access to health records which improved awareness of and transferring of information. For example, they could see how many times a person had attended hospital. The safeguarding team also shared their electronic recording record system which ensured promotion of safety within the assessment processes.

The local authority commissioned a service to complete their specialist and sensory assessments. Staff told us the there were good relationships which ensured people received the assessment, support they needed, and information was shared accordingly.

Sunderland’s adult social care teams were focused on every person being supported in a way that worked for them. In 2023/2024 the local authority received 14,832 contacts for social care support. Eighty-eight percent of social care assessments were completed within 28 days. Also in 2023-2024, 95% of reassessments were completed within 28 days and 86.7% of people received their annual review compared to 72.9% in 2022/2023. Most providers told us the local authority engaged with them well and completed reviews around 6 weeks and after a year. Sometimes there was a wait for a social worker to be allocated which could be challenging if people’s needs had changed. However, social workers communicated well when people had been allocated to them. Providers were able to send information to social workers through a portal about any changes to a person's needs, which was then used to inform the statutory review. Some providers carried out their own quarterly reviews. There was some anxiety from providers about getting provider staff trained to enable them to ask the right strengths-based questions. However, providers told us the portal was a positive change and an opportunity to reduce duplication and allow everyone to work together to achieve the best outcomes for people.

Staff told us about an app which had been designed to carry out reviews of care and support plans and equipment in non-complex cases. If the person consented, they received a call from the app. There were mitigations to ensure a member of staff called the person if the app was not successful at making contact. People gave positive feedback of their experiences using the app.

The local authority was acting to address waiting times for assessment, care planning and reviews. This included actions to reduce any risks to people's wellbeing, while they were waiting for an assessment. Staff risk assessed allocations using a risk assessment tool. Any delayed allocations were reviewed weekly. However, staff did not know how big the delayed allocations list was, but managers had good oversight and systems to monitor.

The local authority had a system to monitor assessments and reviews and whether these had been completed within their own target timescales. There were regular reviews, updates, and supervision to ensure quality and accountability. Monitoring systems ensured people could receive consistent support and protection through regular case reviews. The mean, median and maximum waiting times were also calculated. Data was shared by the local authority for waiting times for Care Act assessments and financial assessments. This showed, 53 of 113 new care assessments were overdue and had missed the 28-day timeframe and 672 of 4002 pending care review tasks were also overdue. Although there was work needed to improve this journey for people, it was an improving picture and performance over the last twelve months was showing reductions in maximum wait times. For example, the maximum wait time for new Care Act assessments had reduced from 100 days in July 2024 to 85 days in November 2024.

Leaders were cited on the waiting times for care assessments and reviews and had created action plans to address this including employing additional staff and ensuring they had completed onboarding training before they began their role.

The needs of unpaid carers were recognised as distinct from the person with care needs; assessments, support plans and reviews for unpaid carers were undertaken separately. The local authority commissioned a carers service to deliver the statutory carers assessments and held the budget for carer support payments. The benefit of this partnership arrangement was holistic support could be provided to unpaid carers, their families, and young carers. The data provided by the local authority showed that there was 1 new open carers assessment since July 2024. There were no carers assessments overdue and there was a mean, median and maximum wait time of 7 days.

National data for Sunderland National data for Sunderland from the Survey of Adult Carers in England 2023 - 2024 showed 2.9% of carers accessed training for unpaid carers (England average 4.30%). This was corroborated by unpaid carers who felt they could not always access training. The data also showed a positive variation, 44% of unpaid carers were satisfied with social services compared with the England average 36.83%. This said, 11% stated they were dissatisfied with social services and as such work was still needed by Sunderland.

There was also positive variation with 74.9% of unpaid carers that feel involved or consulted as much as they wanted to be in discussions (England average 66.56%) and 87.9% of unpaid carers with enough time to care for other people they are responsible for (England average 87.23%). There was ongoing work in Sunderland to support unpaid carers in the community. The local authority had taken action in response to the aforementioned national data and introduced bespoke training and celebration events for carers. There was acknowledgment that further improvements were needed to improve the whole journey and experience of carers.

People were given help, advice, and information about how to access services, facilities, and other agencies for help with non-eligible care and support needs. We heard examples such as support people had received to make plans in the event of an emergency. This included a carers card which they carried to let people know in an emergency that they have a dependent family member reliant on them.

There was an online resource for people and unpaid carers to search for services, activities and organisations and contact the council, enabling online self-referral. There was also a platform which incorporated social prescribing by linking people to services and self-help resources. Both websites had accessibility and language options which were clear to see and use, they allowed people to change font, backgrounds, language and had a recite function.

The front door service offered a single point of access for older people offering low-level tailored support such as support groups, information, advice, and advocacy. It aimed to connect people with their communities and address social isolation.

The local authority’s framework for eligibility for care and support was transparent, clear, and consistently applied. Decisions and outcomes were timely, and evidence based. The local authority had a process in place for handling reconsideration and appeals against Care Act provisions. There had been no formal appeals made against Care Act assessments since May 2023.

Leaders advised there were no themes of concern relating to eligibility for care and support. Staff explained how they used funding creatively when applying eligibility. For example, staff were encouraged to use small amounts of money for one-off work which could make significant changes. Disabled Facilities Grant funding had increased, and staff made use of the discretionary element to make the changes. Staff worked with people with progressive conditions to make sure decisions showed why they had eligible needs. This meant that people could get the right support at the right time as decisions were defensible.

The local authority’s framework for assessing and charging adults for care and support was clear, transparent, and consistently applied. There were transparent and supportive processes for financial assessment including clear policies, flexibility, and involvement of social workers in the assessment process. People could complete financial assessments through the local authority’s online portal and staff could complete referrals through the local authority’s electronic recording system. Although referrals were processed in date order the team demonstrated a flexible response to risk, giving an example where they were able to provide a financial assessment to relieve stress to an unpaid carer and enable them to continue with their caring role.

Leaders were cited on waits for completing financial assessments. They told us they had taken action to mitigate risks and were capturing improvements in production and compliance. For example, they told us the number of overdue financial assessments was reducing. Additional staff had been employed to address the waiting list and staff told us care could start before financial assessment had taken place to ensure people’s needs were met, wellbeing was prioritised, and risks mitigated.

Data shared by the local authority corroborated this. From July to November 2024 there was a 16.9% increase in new financial assessments that had not been completed within the local authority’s 28-day target timescale. However, improvements were seen in the mean wait time for new financial assessment reducing from 29.43 days in July 2024 to 25 days in November 2024, and the median wait time for new financial assessments had reduced from 23 days in July 2024 to 17 days in November 2024. The number of financial assessment reviews overdue also saw an improvement reducing from 1572 in July 24 to 221 in November 24.

For financial assessment reviews the data shared by the local authority showed that of the 221 assessment reviews which were overdue, 117 were overdue by more than the target timeframe of 28 days. This did not equate to a percentage improvement since July 2024, but the mean days had reduced from 154 in July 2024 to 129 in November 2024 and median days had reduced from 132 in July 2024 to 83 days in November 2024.

Additional staff had been employed to address the waiting list and staff told us care could start before financial assessment had taken place to ensure people’s needs were met, wellbeing was prioritised, and risks mitigated.

There had been appeals against financial assessments, between June 2023 - June 2024 a total of 28 reconsideration requests were made. Of the 28, 3 were upheld, 16 not upheld, 8 partially upheld and 1 withdrawn. Between June 2023 and June 2024, there were 4 appeals, 3 were not upheld and 1 was partially upheld. The main reason for the reconsiderations and appeals was said to be disability related expenditure. Staff told us they had worked very closely with the financial assessment team and carried out joint visits when needed. People and staff told us they benefitted from using the local authority financial calculator which had been quick and easy to use.

The local authority had a contributions policy which covers disability related expenditure and was kept under review, taking account of the cost-of-living impact for customers.

Timely, independent advocacy support was available to help people participate fully in care assessments and care planning processes. The local authority’s commissioned advocacy service were commissioned to provide all statutory advocacy. There was no general advocacy in the contract, but they had been approached for spot purchase for complex cases such as financial issues. The service they knew the local authority well and people told us it was helpful to have that independent support to generate something that was bespoke for the person.

Staff told us the advocacy service was responsive, particularly when the need for an Independent Mental Capacity Advocate was required during hospital assessments. We spoke with people who had been supported by advocates who told us this was a supportive service which was available quickly. The service also gathered feedback from people they supported about their experience of advocacy and measured various outcomes such as goals, rights, quality of life and the client’s voice. People’s feedback was, positive and said that their voice had been listened to.