Sunderland City Council: local authority assessment

The local authority worked with people, partners and the local community to make available a range of services, facilities, resources and other measures to promote independence, and to prevent, delay or reduce the need for care and support.

There was a digital platform to connect people to local services and support, and social prescribing systems to connect people to community resources and activities. The Health and Wellbeing Board had a focus on a system wide approach to health and wellbeing including introduction of community spaces for social interaction and support.

Specific consideration was given to unpaid carers and people at greatest risk of a decline in their independence and wellbeing. The Survey of Adult Carers in England 2023-24 showed that 19.11% of carers were able to spend time doing things they value or enjoy and 88.3% of carers who found information and advice helpful which was also showing better outcomes than the England average.

Preventative services were having a positive impact on well-being outcomes for people. National Adult Social Care Survey data showed 95.1% of people who used services in Sunderland felt clean and presentable, and 93.9% of people who used services got adequate food and drink. Both of which showed better outcomes than the England average.

In Sunderland, 63.1% of people said help and support helped them think and feel better about themselves. Which was reinforced by 73.11% of people who reported that they spend their time doing things they value or enjoy. The local authority had identified it was not always easy for unpaid carers to visit the drop-in sessions available or attend the activities available. As a result, they had created an app as an alternative way of reaching unpaid carers who needed support, improve awareness of services available, connect carers with each other and increase identification of unpaid carers.

Drawing on the benefits of having this multidisciplinary team, the local authority created a role to focus on falls prevention. This was a response to high numbers of falls in the older population, and in a further effort to prevent, reduce and delay care and support needs, and hospital admissions. The falls lead had progressed the vision of the council and the preventative duty through creation and delivery of a fall’s prevention programme. This was an overwhelming success and significantly reduced hospital admission related to falls. This further evidenced positive outcomes, promotion of dignity and independence and promotion of integration with health services. The role was mentioned in staff meetings to ensure all staff could direct people to the provision wherever appropriate.

The local authority worked with partners to deliver intermediate care and reablement services that enabled people to return to their optimal independence.The transfer of care hub was a team based in the local hospital who focused on hospital discharge. The team provided the assessment and reablement services to support people to return home and rebuild their skills and independence. The care hub improved communication and integration between partners and reduced length of hospital stays by approximately 2/3 days. People also told us the care hub had helped them to return to their own homes and regain confidence in their own abilities. However, staff, people and partners told us there was often not enough capacity to provide reablement for everyone who needed it. Senior leaders had plans to further develop this provision.

There was also a hospital social work team who were based in Sunderland hospital. They took referrals from any hospital and completed assessments for people whose needs were not suited to a discharge to assessment process. This was a 7-day service.

National Adult Social Care Outcomes Framework Data (ASCOF) data for Sunderland showed 2.3% of people 65+ received reablement/ rehabilitation services after discharge from hospital in 2023/24. This was lower than the England average of 2.91%, as was the data showing 79.1% of people 65+ were still at home 91 days after discharge from hospital into reablement/rehab, which compared to 83.8% nationally.

Staff told us they had no assessment waiting lists for people who were ready to leave hospitalWhere the need for reablement care had been identified the team assessed within 4 hours which supported towards a smooth transition home. A home-first approach supported the least restrictive and proportionate approach to a safe hospital transitional journey. Staff explained where people were identified as requiring long term support, they considered bed-based rehabilitation first as opposed to residential care. Staff told us the bed-based rehabilitation was highly effective in promoting people's independence and safety though at times capacity impacted their ability to meet the demand. Where appropriate, people were discharged home with a reablement care package.

Assessments were carried out with people prior to hospital discharge to ensure the process was led by their preferences. Staff were proud of their person centred and holistic approach to supporting people. Examples included supporting people with major adaptations through the disabled facilities grant, such as level access shower facilities. Staff also gave examples of how they used a whole family approach when planning safe and person-centred discharge home.

The local authority had a commissioning intentions database which enabled commissioners to work with people early to identify and create bespoke solutions to meet their needs. Young people were added to the database when they turned 16 so that commissioners could work with them, their family and the social worker to start planning how best to meet any accommodation needs. Plans then considered the wishes and aspirations of the young person alongside their assessed support need. Where appropriate, internal, and external partners were involved, and we were told examples of existing services and properties being repurposed or and new services being developed. Staff told us that this relationship and collaboration with commissioners was highly beneficial in planning ahead.

Staff gave examples of how commissioners worked with housing, a social worker and occupational therapist to identify an existing empty property that would be suitable for renovation for a person moving back to Sunderland.

The local authority provided occupational therapy and physiotherapy support to adults living in registered care homes within the boundaries of Sunderland or living in care homes over the Sunderland boundary but registered with a Sunderland GP. The service offer included to prevent deconditioning, falls, physical and cognitive decline, and the delivery of rehabilitation to promote the development of independence.

The local authority had a Section 75 arrangement in place to use the Better Care Fund to provide both bed-based and home based reablement services. The local authority performance indicators show that most discharges from reablement services were to home and with outcomes met. The local authority told us they used better care funds to provide the right care in the right place at the right time. Examples of this included increased capacity within discharge to assess teams (D2A), implementation of therapy team to support people in residential and nursing homes, increased use of personal assistants to support non-complex discharges and improved use of automated telephony post discharge.

Telephone reviews were conducted for people who had recently been discharged from reablement. The reviews would take place the day after the service finished, then again at 2 weeks and day 91 after the service had finished. This was to identify people who may need further intervention as early as possible and to prevent further hospital admissions. People told us the review process helped them to regain independence and reach goals.

People could access equipment and minor home adaptations to maintain their independence and continue living in their own homes. The local authority had created digital health hubs within the community, designed to provide support to people who had limited skills with technology. These were supported and promoted through digital inclusion events. As the use of technology was a focus for the local authority to enhance and promote people’s independence, a tech team provided people with support, for example people transitioning from landlines to alternative solutions.

The local authority had a smart house which highlighted the digital technology they had available, and it enabled people and professionals to see what could be done using technology to promote and enable independence. The local authority provided a range of smart home technology and voice enabled devices, such as smart speakers, tablets, smart plugs, and sensors. The smart house was an example of evidence-based work which was reinforced by testing the technology by ageing well ambassadors. Further technologies were being explored, improved care records and transfer of information to front line workers. Artificial intelligence was being explored to support development of personalised routines and reminders, medication management, and reducing social isolation.

The local authority was piloting a service using artificial intelligence via a screen. The aim was to reduce the need for face-to-face care and was available via a reablement service which was monitored by therapists. The service offered prompts/reminders and contacted family and friends. Equipment was given free of charge for the pilot however the plan was this would be chargeable if the pilot was successful. There was also a device used to identify changes in behaviour or recognise concerning behaviours, enabling families to care for family members themselves and reduce the need for formal services through the local authority enable social workers and therapists to develop personalised care plans. The device could monitor temperature, door usage, movement, and power use - key items associated with eating and drinking. There were measures to monitor the new technology and protect people’s rights to privacy. Staff told us they used innovative assistive technology to promote independence and enhance safety. An example provided was a person who was at elevated risk of falls due to physical needs was provided with an interactive device that closed the curtains. This was the least restrictive measure and provided the person with choice and control. 

Staff told us about the strength of the assistive technology offer. Staff explained that all assistive technology was free to residents, with equipment being provided on loan for as long as was beneficial. There were sometimes delays with the equipment getting to people as quickly as staff would like, for example when bespoke equipment was required. Not everyone that could benefit from assistive technology could do so, due to digital poverty. Work was undertaken to overcome digital poverty, by giving a person a tablet they were able to do their own finances, shopping, maintain social contacts by video calls and see who was at the front door. People who funded their own care and support could access telecare free of charge for up to 6 weeks if on a reablement pathway or privately if they wished to do so. These services could also be funded through a Direct payment.

The Home Improvement Agency and tech team received referrals from trusts and professionals, equipment referrals came from staff with prescribing rights. Staff were able to arrange for equipment to be delivered to people within a day. Staff gave an example of equipment being provided on Christmas Eve to a person who was at end of life.

The local authority had measures to monitor the use of equipment, which enabled staff to identify where people required additional support, contact, or whether equipment provided by the local authority was still being used and was still appropriate. There was a multi-disciplinary approach to monitoring the needs of people with complex needs who were supported by technology. This ensured people whose needs had increased were identified and supported promptly.

The local authority had systems and process to manage waiting times for community occupational therapy or care home occupational therapy. On 1 March 2023, 287 people were waiting more than 28 days for a wheelchair assessment. Providers told us the occupational therapy service was supportive when there were manual handling issues for example, they visited the service to demonstrate a different move to staff, or to assess equipment for suitability. There were 38099 deliveries completed by the equipment service for 2023/24. This included 759 same day orders for health and 268 for community. From January to March 2024 there were 193 referrals for Disabled Facilities Grants (DFG). A total of 563 minor alterations were completed and the average waiting time was 11 days.

Data provided by the local authority showed the number of people awaiting an occupational therapy assessment was 898 of which 344 were overdue. The median wait was 28 days the maximum wait was 317 days. Once equipment was ordered the median wait time was 3 days and the maximum waiting time is 272 days. Telecare median waiting time were 6 days, and the maximum waiting time was 37 days.

As part of the adult social care digital strategy the local authority commissioned housing services to incorporate assisted living technology, such as lifelines, with new build properties. As part of this strategy staff completed a survey which concluded staff were confident to use digital technology to support people using the service and their carers.

People could easily access information and advice on their rights under the Care Act and ways to meet their care and support needs. This included unpaid carers and people who funded or arranged their own care and support. National data for Sunderland in the national Adult Social Care Survey 2023-2024 showed 68.9% of people who use services found it easy to find information about support which was higher than the England average of 67.9%. This was complemented by data showing 65.6% of carers found it easy to access information and advice, also higher than the England average 59.06%.

The local authority had reviewed their performance from national data from the Adult Social Care Survey for 2023-2024. The biggest percentage decrease was the proportion of people who use services who find it easy to find information about services. The local authority was updating their website information in relation to adult social care and assessing opportunities to improve or replace their online advice, information, and guidance provision. 

Staff told us about a relatively new online platform providing a directory of services and other prevention information. They explained they signposted people to the platform and used it themselves to provide information. This said, staff told us people who were not confident online could find it challenging to use. They explained this was mostly overcome by staff finding information on the platform and then emailing or posting it out to people. Social prescribers also supported people to access information online.

Staff said that where people had limited skills with technology, voluntary sector staff, who were part of the front door team, could go out and give the information. There were 20 digital health hubs in city to help people with no technological skills to complete forms, and digital inclusion events were held. Staff were working with commissioned agencies on information pamphlets and written information was given to people and placed in GP surgeries. People could access information in easy read formats and in different languages as requested. Staff had access to translation and communication services to support them to provide information and advice in ways that met people’s needs.

The local Authority used message boards to provide information to people. The tech team were collaborating with people and telecommunications providers to move away from land lines and use alternative approaches which would enable them to have greater access to innovative digital solutions. The tech team held tech forums with partners, for example a care home group was created to provide updates to providers on new tech.

The Carers Strategy had been produced using feedback from unpaid carers and what was important to them. A main point from the strategy included improving the way the local authority identified unpaid carers. To achieve this the local authority held a range of face-to-face sessions, unpaid carers week events, online and postal surveys. Unpaid carers told us after a carers assessment they received a lot of information and leaflet and could access the carers centre which was a key source of information.

Feedback from surveys had identified mental health was a key concern for young people, and they were unaware of where to get help. As a result, volunteers created a suite of videos. They approached key mental health support organisations, who were involved, and videos were made in partnership with them and made available through the local authority or partner organisations.

There were guides for people accessing adult social care which outlined different housing options such as supported living, extra care, residential care and nursing care, day centres, short breaks, and shared lives and how people could access these services. There was also a guide which outlined some of the different services that were available to support people to regain independence such as 'home first, discharge to assess' and the support of reablement.

Sunderland Adult Social Care Outcomes Framework (ASCOF) data 2023-24 showed that 13.1% of service users received direct payments which was significantly less than the England average. The data also showed 23.6% of service users aged 18-64 received direct payments which was significantly less that the England average of 38.06%; and 4.4% of service users aged 65 and over received direct payments, also significantly less that the England average 14.80%.

The local authority recognised the reduced uptake and had a Direct payment Strategy which evidenced a new model for direct payments with a specific team for direct payments whose aims were to promote direct payments and increase the uptake. Data shared by the local authority showed the local authority had increased the number of people receiving a direct payment from 261 in 2023-23 year to 294 in 2023-2024. There was a programme of work aimed at increasing the overall direct payment uptake to 20%. Performance was measured through data and use of reports, which were discussed at monitoring meetings, where they looked at trends and impact on people’s outcomes.

Staff were encouraged to support creative use of direct payments. For example, supporting the provision of equipment via a direct payment. This gave people using the service choice and freedom to buy equipment independently. For example, we heard of hospital discharge grants which were used to purchase a microwave and table and chairs to enable a person to remain independent and leave hospital in a timely way. There were direct payment champions, who had produced a promotional video and provided training courses and showed how to be creative in meeting needs. Social workers said the direct payment team were accessible and provided monthly drop-in sessions.

The local authority had identified a theme coming from case file audits about inconsistency in how direct payments were discussed with people. After further investigation they discovered there was a lack of confidence from some staff in the direct payment processes. The direct payments team continued to promote direct payments through staff drop ins, staff events linked to Personal assistants and reviewing the direct payments guidance to improve staff confidence and understanding.

People had ongoing access to information, advice, and support to use direct payments. For example, we saw leaflets that explained how to access direct payments, what a direct payment was and the support available to set direct payment up. The local authority had commissioned a service to complete a piece of work around people’s knowledge and understanding of adult social care. It was aimed at understanding if people knew how and where to access information they required.

Although direct payment uptake was improving, the uptake of direct payments was low. Leaders told us the local authority were committed to integrating direct payments further into the adult social care practice but were focussing on ensuring the wider community understanding was there first. For example, there was ongoing work with the community to communicate what care provision was looking like for the future and how traditional models of care, such as residential care were no longer seen as the best options for most people.

People told us their main concern with direct payments was the provision of personal assistants. They said it was challenging to find age appropriate, young, and skilled staff. This was corroborated by unpaid carers who said that social workers offered direct payments, however it was difficult to recruit personal assistants. The finance team had responded to feedback by arranging presentations for unpaid carers. Unpaid carers who had managed to source personal assistants and used direct payment gave positive feedback about the support provided. Initiatives were being tried to boost the personal assistant pool, for example by working with the Skills for Care agency.