Sunderland City Council: local authority assessment

The local authority was passionate about working with partners to promote a shared commitment to the health and wellbeing of people in Sunderland. There was a particular focus on collaboration to maximise community assets and strengths. A partner told us partnership working with the local authority was positive and breaking down barriers meant a focus on people’s journey. This had helped improve co-ordination of services and pathways for people.

Leaders effectively used multi-agency boards to plan strategically and work together to tackle urgent priorities. The central themes guiding the Health and Wellbeing Board of ‘Starting Well, Living Well and Ageing Well’ were threaded through the work carried out by the local authority with their partners. For example, staff described the positive impact of the ageing well ambassadors, recruited by local partners, who helped ensure the needs of older people were central, both strategically and operationally. Ambassadors championed areas of interest such as the needs of people with dementia. A partner told us the ambassadors influenced leaders thinking.

There were strong city-based partnerships with numerous agencies and more localised projects such as the HALO (Hetton Aspirations Linking Opportunities) which focused on health and housing improvements alongside reducing crime and anti-social behaviour in one locality. Relationships with local health and housing partners were particularly strong, with the local authority, Integrated Care Board (ICB) and the main housing provider spearheading strategic priorities.

Well-developed connections with health partners were being strengthened further through increased health and care integration. The local authority told us they were proud of the strong system-wide governance and shared commissioning arrangements. Health partners confirmed they and the local authority had worked hard to establish the strong relationships and arrangements, working effectively and collaboratively to address priority areas such as hospital discharge.

There was a positive partnership with the main external housing provider, around delivering prevention objectives and developing bespoke accommodation. This strong partnership had improved outcomes for people. People told us they enjoyed living in their new homes, which was an example of the type of bespoke accommodation being developed. Reflecting the theme of ‘Living Well,’ partners worked together to help people sustain their tenancies and reduce the need for formal care services. Staff gave us examples where people had achieved improved accommodation and outcomes because of partnership working with housing providers.

The commitment to strong partnership working was supported by effective systems, with clearly defined roles and responsibilities. The recent developments in the local authority’s front door service reflected best practice in partnership working. Voluntary sector and commissioned services were a central part of the front door, working alongside local authority staff as equal partners. For example, handing out warm home packs to people being supported by social workers in the team. Partners and staff spoke passionately about how this joint team enabled them to work collaboratively to meet people’s needs effectively and promptly. They told us co-location in one building enhanced ongoing communication between agencies and increased efficiencies through reduced duplication. They described examples where different agencies had carried out joint visits, so people were seen more promptly and did not need to tell their story twice.

There were arrangements to promote effective partnership working with the local Integrated Care Board (ICB) and management of the Better Care Fund. The local authority told us these were being strengthened as part of their transformation road map for integration. Health partners told us decisions about care were agreed as a system and there were joint appointments and pooled budgets to support this approach. They described how this had worked well when planning for winter pressures. A systemic approach, rather than individual organisational efforts, was taken to develop winter funding plans which focused on prevention and the patient journey from admission to discharge from hospital.

Health and social care staff were supported by effective systems which enabled them to work closely around complex cases. The local authority role as commissioner on behalf of the ICB supported this joint working. A member of staff described how a person with complex mental health needs required joint funding to return home from hospital. Local authority managers communicated well with health counterparts and there had been no delays to the planned discharge. Providers told us the joint funding arrangement enabled a more seamless experience when they picked up new packages of care.

The sharing of care data was key to partnership arrangements with health and other agencies and leaders told us said they were proud to have been in the forefront of developing the Great North Care Record initiative. The Great North Care Record is a system that allows healthcare providers in the North East and North Cumbria region of England to securely share patient information electronically. This includes information like diagnoses, medications, and hospital admissions. The goal is to improve the quality and efficiency of patient care by giving healthcare providers a more complete picture of a patient's medical history. Staff described proactive measures to promote integration of care records with health. Staff working in hospital discharge described how their role was enhanced by being able to view health records as it helped them understand people’s needs better. Leaders told us developing safe sharing of data with partners, such as providers was key to their vision for partnership working.

The local authority monitored and evaluated the impact of its partnership working. A senior leader described systems which supported this, such as Better Care Fund partnership meetings, and how as part of governance arrangements a working group had been set up to carry out an in-depth review of integrated care. A health partner told us there were mechanisms in place for review by health and social care in the event of financial limits being reached during commissioning activity. Leaders told us shared care records and jointly funded staff supported the monitoring of the impact of partnership working and these were areas they were enhancing. Key partners fed back that meetings to review their contracts were open and they felt able to speak up about any challenges.

Partners told us the local authority responded well to feedback, using it to inform ongoing development and continuous improvement. The local authority had adjusted activity after reviewing a 2-year Better Care Fund Plan against agreed targets. Two providers told us they had gained insight through attendance at different working groups, reflecting the local authority’s openness to scrutiny and feedback.

The local authority told us they recognised the unique contribution of the community and voluntary sector in the provision of care and support. There was evidence of positive involvement with the voluntary and charity sector, however we received mixed views and experiences across the different organisations we spoke to. Organisations with established relationships with the local authority spoke of involvement as equal partners.

The local authority told us the Sunderland Voluntary Sector Alliance (SVSA) was established in 2021 to support the growth and sustainability of the voluntary and community sector (VCS) in Sunderland. Recognising the sector's crucial role in the city, the local authority, along with funding from the European Structural and Investment Funds and other partners, supported the SVSA's initial development. The SVSA operated with a defined strategy and a Board of Trustees, ensuring strong governance and a collaborative approach with statutory and voluntary partners. It had become a key point of contact for commissioners and funders seeking to engage with the VCS in Sunderland. The SVSA played a vital role in supporting the sustainability and growth of the VCS, meeting the needs of residents across the city and fostering effective partnerships and collaboration.

Staff confirmed there were some funding arrangements which had been set up historically with key organisations and were renewed every year, as they continued to meet the local authority’s strategic priorities. However, some organisations told us the local authority was not sufficiently transparent in their allocation of funding, with rolling contracts affecting equitable access to funding. The LA told us the majority of these had now gone through a process of competitive retender by procurement. This was to encourage a broader range of organisations to submit a tender and to enable increased sustainability for the successful organisation due to the award of longer periods of funding

Organisations who had established links with the local authority gave multiple examples demonstrating positive relationships and where the funding they received had improved people’s outcomes and wellbeing. One organisation described how the local authority communicated well with them. Members of the local authority were involved as trustees on their board, and they sent representatives to one of the local authority’s oversight groups, which they had found useful.

Feedback from some organisations we spoke to indicated improvements were needed to ensure engagement was meaningful and strategic. The local authority recognised it needed to engage more with grassroots organisations and gave us an example of how they were applying learning from engagement with one community to improve engagement with others.

The local authority had also spearheaded significant changes in how the voluntary and community sector was coordinated locally. Changes were aimed at driving improvements in this area, including ensuring the sector was more involved at a strategic level. Alongside key partners, they had commissioned an organisation to help ensure funding and support to organisations reflected existing, rather than historical needs. Leaders and staff across the organisation spoke with commitment about this change in approach. There was an emphasis on promoting innovation and creativity to enable bespoke and individualised approaches to meeting people needs.

These changes had not been in place long enough for improvements to be fully implemented and embedded. However, the commitment the local authority had shown demonstrated a pro-active approach to ensuring funding was targeted effectively and voluntary and charity sector groups were strategically involved in the planning and delivery of services to meet the requirements of the Care Act.