Sunderland City Council: local authority assessment

The local authority worked with local people and stakeholders using data to better understand the care and support needs of people and communities. Staff described how there was a focus on individuals, with sharing of information supporting a collaborative approach to meeting people’s needs in a person-centred manner. The needs of unpaid carers were threaded through the work done by the local authority, reflecting a commitment to understanding their specific needs and challenges. Information on unpaid carers needs was gathered in a variety of ways, including face to face meetings. The commissioned carers organisation told us unpaid carers were high on the agenda for the local authority and they worked closely with the local authority to understand unpaid carers needs.

Information about local needs was outlined in the local authority’s Joint Strategic Needs Assessments (JSNA) and market position statements. The publicly available JSNA summary for 2023-24 reflected the overall aims of the local authority, with links to more detailed analysis of need such as the Ageing Well JSNA. The latter demonstrated an understanding of the needs of older people in Sunderland, including themes of dementia, an increase in complex needs and elevated levels of falls which were central to discussions with local people, staff, and partners. The Market Position Statement, 2024 was central to interpreting the JSNA for commissioners and the care market, outlining the local authority’s central priorities for care provision, such as preferred models of care delivery.

The JSNA: Learning Disability (2023) noted the recorded prevalence of people with learning disability in Sunderland was marginally higher at 0.8% compared to a prevalence of 0.5% in England. It highlighted the challenges from the increased complexity of needs, including the growth of people with a learning disability with early onset dementia. This assessment provided commissioners with information about the specific issues for people with learning disabilities, to complement data about the wider increase in dementia. The report had also considered the needs of young people transitioning into adult services to support the planning for future need and included intelligence about black and minority ethnic communities to support a greater understanding of local need.

Staff supporting people with learning disabilities and autism told us they had a strong working relationship with commissioners, meeting with them regularly to discuss the current and future needs of specific people they were working with and any gaps in provision. Staff reflected a positive commitment to ensuring care provision was developed in line with people’s individual needs. The local authority had systems in place to ensure data was analysed on an ongoing basis. Weekly meetings were held to review the commissioning intention data base where themes of need, demographic, location, and bed capacity were summarised. This data was analysed against reports to understand whether care provision was meeting local needs.

Although co-production was not fully embedded within the local authority, there were systems in place to capture people’s views on local needs. The local authority had commissioned a service to gather feedback from people receiving care at home. The survey captured an understanding of what was important to people and unpaid carers to ensure people’s needs were met, such as good communication with care providers.

The local authority had engaged with some stakeholders to understand local needs, working closely with partners, such as health and housing. A health partner told us the diagnostic work that had been commissioned by the local authority and other system partners, had been valuable in increasing understanding of local need, particularly for people waiting in hospital while ready for discharge.

The local authority had contacted a local ethnic minority community group to understand the needs of people in the community to help ensure care provision met the needs of people from this community, including their cultural needs. This was an approach the local authority had recently strengthened, and senior leaders and staff told us they were committed to developing a greater understanding of needs through further links with different communities in Sunderland.

Data for Sunderland showed 73.08% of people who used services felt they had a choice over services, which was higher than the England average of 70.28%. Adult Social Care Survey (ASCS) 2023. Feedback from people and unpaid carers we spoke to was mixed in relation to choice. Some people described working with staff to choose accommodation with support which met their needs, with some being involved in developing new services. People and staff gave us positive feedback about the development of bespoke accommodation with support following targeted commissioning to address gaps in the market.

However, some unpaid carers told us there was lack of choice about respite options as people had been offered only 1 care home and insufficient personal assistants hampered the availability of alternative options. The data for unpaid carers accessing support or services allowing them to take a break from caring for more than 24 hours was 22.3%, was positive compared to the England averages of 16.14%, respectively, Survey of Adult Carers in England (SACE) 2024. Senior leaders and staff told us they were shaping the market away from bed-based respite in care homes and pointed to recent action they had taken to improve the availability of personal assistants to promote choice in respite provision. However, the impact on peoples experience was not yet known.

Senior leaders and staff pointed to ‘Keeping Well,’ the new tender for care at home services, as an example of shared market shaping which supported the shift away from bed-based and task-focussed care. Staff told us there was a gap in availability of reablement services and commissioning staff described how this initiative aimed to address this, through the promotion of reablement as a priority across all care providers accepted through the tender. Commissioning staff described how the tender had been openly published to stimulate the market and encourage innovation and welcome new providers.

Health partners described positive collaboration around people’s health needs with an understanding of the complexity of people’s needs being used in the modelling and shaping of services. They told us there were aligned strategic commissioning objectives, such as the shift towards home-first and the focus on reablement.

Providers and staff told us the local authority worked well with providers to stimulate and shape the direction of the market. There were structures such as market oversight networks to enable ongoing communication and stimulate innovation. They described strategic discussions about transformation and the importance of the preventative approach, working with providers to understand the shift away from bed-based and task-based care. This had led to the ongoing increase in extra care provision.

Funding priorities had reflected the local authority’s focus on developing and maintaining people’s independence with the commissioning of an external service to provide effective preventative services and equipment at the front door, to reduce the need for ongoing services. Some funding arrangements with long-term partners were more fixed and there was limited evidence to indicate funding was used strategically to promote innovation across the whole care provider and voluntary sector.

Resources such as the commissioning intention database and market update reports were used to shape the development of care provision to ensure it met local needs. New supported living accommodation had been co-produced with agencies, considering the needs and preferences of named individuals transitioning from children’s to adult services and adults with complex mental health needs leaving hospital. These collaborative approaches were designed in line with best practice.

Commissioning strategies reflected the vision of the local authority; to ensure people stayed independent for as long as possible, support people to live healthier lives, promote wellbeing, support people to make informed choices and to provide care in the right way at the right time. There was a focus on the cultural change needed from staff to implement the current strategies and how this would be achieved, such as through a review of existing provider contracts.

Unpaid carers' needs were a key focus of market shaping, as demonstrated by the recently updated Carers Strategy (2022-24). The strategy had been coproduced with carer representatives. The strategic direction of the local authority had been shaped by co-production. The objectives reflected an understanding of the priorities which unpaid carers had discussed with us. This included a review of services providing short break and replacement care across the city, development of accessible alternatives ensuring sufficient capacity in local services to meet demand.

The local authority was actively addressing areas where capacity needed to grow to meet demand. This was being done both strategically through planning and in the short term to respond effectively to sudden changes in demand. Better Care Funding and a Market Sustainability Improvement grant had been used to temporarily increase the capacity of domiciliary care provision. There were systems to measure performance and test the effectiveness of any remedial actions. The local authority told us in June 2023 they had 148 people awaiting a community care package and through these initiatives they had reduced the waiting list to 13 people awaiting a care package in February 2024. This demonstrated that the actions they had taken had reduced pressure on the system and had a positive impact on people awaiting care.

There was a heavy reliance on care home provision and occupancy rates were high at over 90%. This posed a risk to the council, such as in event of a care home closing due to financial challenges. Senior leaders described an increased focus away from residential care towards promoting community-based care solutions and this was echoed in our discussions with staff across the council. Staff gave us examples of innovative care arrangements they had developed with people, avoiding unnecessary admittance to residential care. People and unpaid carers we spoke to were positive about alternatives such as supported living. Some unpaid carers spoke enthusiastically about how they had used direct payments to source personal assistants, as an alternative to residential or formal day care.

The local authority’s vision for community-based care provision had meant a reduction in care home respite beds and increased encouragement for unpaid carers to use alternative respite solutions, such as personal assistants. However, as previously mentioned some unpaid carers told us the lack of personal assistants could make this challenging for people with more complex needs. This had impacted on their ability to set up alternative arrangements when planning a break from their caring role. Staff told us they had recognised the market in community-based respite care was still catching up with demand and in response they had commissioned a new sole occupancy respite service to provide increased capacity and choice. Alongside this there was a focus on increasing community-based solutions, such as targeted recruitment and training of personal assistants which had resulted in an increase in supply. This was not yet impacting the carer/people’s experience and needed time to embed or make a difference to the market.

Partners and staff told us there was a lack of capacity in reablement services, so that some people’s reablement needs were picked up by a domiciliary care agency which was not a reablement specialist. Commissioning staff advised they were addressing this through the upcoming tender. The tender had not yet been put in place, so further time was needed to measure the effectiveness of this approach.

The local authority told us that in June 2024 the number of people placed out of area was 143 people, with most of these residing within the northeast region. They told us a lack of specialist resources was a key factor to out of area placements. Staff we spoke with said there was of a lack of provision for people with complex mental health needs. Senior staff discussed measures being taken to support people who wished to return to Sunderland.

We had positive feedback about commissioning initiatives aimed at increasing capacity, such as recent improvements in the supply of supported living accommodation for people with learning disabilities and people with mental health needs. Staff from teams across the local authority described how they had collaborated to design bespoke care arrangements for named individuals, which reflected their individual needs and usually involved them continuing to live in the community, which minimised the impact of any lack of capacity in formal care settings. A partner also told us the local authority had started to work more effectively with the voluntary and community organisations to promote their role in supporting people to access additional care arrangements.

There were processes to manage demand for care provision, with data being analysed geographically to match demand against capacity and local availability. Collaborative discussions between managers, providers and staff enabled resources to be moved around and people’s needs to be met in a timely manner. The system was used to maximise all community and bed-based resources available to support the hospital discharge process.

Some services, such as the provision of community equipment, were commissioned jointly with health, with the local authority being the lead commissioner. In these instances, there were clear roles and accountabilities for monitoring the quality of the services being provided and the outcomes for the people using them. Health partners told us these arrangements worked effectively, with good communication with local authority staff over the provision.

Feedback from people and families was mixed in relation to the quality of local services. All the people we spoke with told us they had been involved in in choosing their accommodation and were positive about the quality of the care provision. We also had positive feedback about the provision of wheelchairs and the local authority’s ‘Smart House’ where people had gone to test out equipment. However, although staff told us they had positive feedback about respite provision, some carers felt the quality was not good. The local authority described the quality checks in place to monitor respite provision and how they were promoting more choice and options for unpaid carers requiring a break.

Stakeholders and staff were positive about the quality of the local authority’s care provision, with any concerns being about lack of availability rather than quality. Feedback was particularly positive about the quality of recently commissioned services, such as new supported living services. This demonstrated the actions being taken by the local authority to address lack of capacity had a focus on quality and a commitment to developing services in line with best practice.

Adult social care services in Sunderland overall were rated by CQC as 5.80% outstanding, 84.78% good, 0.72% requires improvement, with the remaining services unrated. We were told there were no providers under suspension. With no inadequate services these figures reflect a positive picture in relation to the quality of care provision in Sunderland. The local authority had clear arrangements to monitor the quality and impact of the care and support services they commissioned and used this information to support improvements where needed. There was a quality framework in place and as part of this providers regularly returned data about care provision. There were systems to analyse the information gained from monitoring of care provision. Data was evaluated for risk and actions taken in response. This included information from any safeguarding concerns.

The local authority told us they used the same framework to monitor the quality of the care provided by other services they commissioned. Local authority staff completed regular monitoring visits to commissioned providers. A provider told us these meetings and the associated quality monitoring reports were helpful. Staff responded to risk, with ad-hoc contact taking place when concerns were raised. For example, staff described how they had increased monitoring of a provider, including visits, when a neighbouring authority raised concerns. Providers told us communication with the local authority was open and the local authority was challenging but fair and supportive, when necessary.

There was a regular provider forum which provided opportunities to discuss key themes and drive improvements. Providers we spoke to told us the forum helped them share learning and ideas they could implement in their service. A provider told us they had recently discussed good practice around promoting equality and diversity.

There were some arrangements for capturing people’s feedback of the care they received, such as through individual reviews and through other organisations. The local authority also used technology to offer people more opportunities to provide feedback. The local authority had commissioned and implemented an automated telephony app to expand its ongoing communication and feedback with customers. The automated call took place annually and supported the completion of the annual review. It also gathered feedback on the assessment and care planning process. This also enabled the local authority to measure the effectiveness of the care it commissioned, capturing themes and trends about what was working well and where improvements were needed. The local authority told us they were planning to set up a network for people with lived experience to enhance how they captured feedback.

The local authority included information from partners to monitor the quality of services. There were also systems, such as joint meetings for them to share information and escalate any concerns, for example with health partners, and ensure any actions taken were communicated and consistent.

The local authority had a Market Sustainability plan which outlined how it planned to ensure local services were sustainable, such as negotiations with providers about fees. The local authority collaborated with care providers to ensure that the cost of care was transparent and fair. There had been no contracts handed back to the local authority by adult social care providers in the 12 months prior to our assessment. Staff described how they had worked collaboratively with two providers who had contacted them to inform them their services were not financially viable. By reviewing the service model with input from staff across the local authority, a solution was reached, and the services remained open.

The local authority’s contracting arrangements provided stability and allowed them to plan, as evidenced in the new Keeping Well tender for home care services. Staff told us a decision was made to have a fixed contract term to offer stability to providers. Despite the less flexible nature of this approach, staff felt it was necessary to offer existing providers more security at a time when care costs were a factor affecting sustainability of services.

Risk management tools were used to monitor trading conditions and get early warnings of potential service disruption or provider failure. Staff gave an example where they had supported a provider at risk of failure and prevented service disruption, having a positive impact on people who were using the service. They also gave an example where they had worked together effectively with a provider and stakeholders to respond to any temporary and unexpected provider failure. Providers told us about the open relationship with the local authority meant they felt able to contact staff proactively to discuss concerns and seek solutions.

Providers told us workforce retention and recruitment were regularly discussed with local authority staff at provider forums. One provider told us the local authority paid a realistic fee which enabled them to pay the living wage. There were multiple areas where the local authority was acting in response to workforce challenges, such as supporting providers with issues around international recruitment, and signposting to training resources. Data from the national adult social care workforce estimates showed that for Sunderland the % of adult social care staff with care certificate in progress or partially completed, or completed was 58.05% which was higher than the regional figure of 50.45%. Actions to support the local workforce needs also included a recent focus on maintaining and supporting capacity and capability of the personal assistant workforce, recognising this as a priority area.

The local authority used data effectively to ensure the sustainability of local care market. There were systems to support them to understand how, when and where to target the support, diverting resources flexibly to ensure the right services were available when needed. Efficient brokerage systems such as geographical mapping of care request were also in place to support care providers to pick up care packages promptly, supporting their sustainability.