Sandwell Metropolitan Borough Council: local authority assessment

The local authority worked with local people and stakeholders and used available data (for example the Joint Strategic Needs Assessment) to understand the care and support needs of people and communities. This included people who were most likely to experience poor care and outcomes.

Areas with high levels of need were documented in the Adult Social Care Strategy 2024 to 2028. This highlighted wards in the north of the borough particularly and data showed that Sandwell had significantly more requests for support than the national and regional averages. For example, there had been an increase in the number of people receiving home care from 1,553 in October 2023 to 1,737 in September 2024. Most people currently receiving care and support were aged over 65. Memory and cognition issues were the primary reason for support for 15% of people who accessed adult social care in Sandwell and was more likely once a person was over the age of 75. Most people who received support did so in their own homes through home care or other community-based services. Around 30% of people receiving long-term care were supported in care homes.

Senior staff told us about the work of the local authority to assess needs for care and support and ensure an equitable spread of services and review dementia pathways, which had resulted in Sandwell becoming a dementia friendly borough. This included use of a dementia planning toolkit for staff, dementia champions and ambassadors programmes, use of technology and community-based approaches, and access to a dementia bus to give people an experience of living with dementia. Local authority feedback was the dementia offer in Sandwell was held up nationally as good practice. Partners gave an example of housing developments matched to growing needs in a council owned extra care facility where individual flats and communal areas were upgraded to incorporate dementia friendly care practices and support people further. The facility was now at capacity with further developments planned to meet growing needs of the community.

People had a range of local support options to meet their care and support needs. There were no significant delays in arranging care for people. Local authority commissioning arrangements and strong provider relationships ensured services were available when required.

National data from the Adult Social Care Survey for 2023/24 showed 70.56% of people who use services felt they had choice over services. This was similar to the England average (70.28%). However, national data from the Survey of Adult Carers in England for 2023/24 showed 7.41% of carers accessed support or services that allowed them to take a break from caring at short notice or in an emergency. This was considered somewhat worse than the England average (12.08%) and reflected in some of the feedback we received in Sandwell.

Feedback from people through the Sandwell Adult Social Care User Survey, 2023 to 2024 in relation to their experience of assessment and care provision was 65.9% of people were very or extremely satisfied with the care and support they received; however, this was a decrease from 71.6% in the previous year. The percentage of people who were very or extremely dissatisfied with the care and support they received increased to 3.5% in 2023 to 2024 from 2.4% in 2022 to 2023 indicating that people were less happy with care and support offered now than a year ago.

People had mixed views about their experiences of care in Sandwell. One person told us they were happy with their flat at a local authority extra care facility, their independent living skills had increased, and their needs had decreased, following support from care staff. Another family member told us the quality of care delivered by the care staff was good and once the package of care was right, it had been working well. Other people struggled to find information about care for their family members or felt there were a lack of options available to them.

Feedback from the local authority was that social workers began discussions about available options during the assessment process, ensuring that people were aware of direct payments, community-based options, and commissioned services. This enabled care and support plans to be tailored to individual needs and preferences. Where a residential or nursing placement was identified as the preferred outcome, social workers provided lists of approved providers so that the person, their family, unpaid carers, or advocates can make an informed choice.

Unpaid carers had been involved in the design of a new carers service and had been able to give feedback about the development of this. Experiences of the care support received by unpaid carers were positive, for example, good feedback was received about a sitting service which supported unpaid carers in their caring role. Other examples included support through a wellbeing call each week, which the person appreciated and enjoyment in taking part in a recent carers event. Several unpaid carers attended a carers support group and valued this for the opportunity to socialise with others, although not everyone felt equally supported there. Some unpaid carers told us they had benefitted from services previously, such as grants and respite care, however trying to speak with someone about accessing them again had proved more difficult.

Commissioning staff supported new approaches to care provision, leading to better outcomes for people in Sandwell. The local authority flagship 80 bedded service was developed from the identified needs of people who did not need long term care and this support enabled them to maximise their independence before hopefully returning home.

The local authority provided funding for a new safe place support group where members of the LGBTQ+ community could meet, socialise, get advice and access mental health support as needed. Although the funding provided some support to people it was felt to be insufficient for the level of support required. Other commissioned services included a mental health charity which supported people and provided safe spaces to talk and get support, counselling and advice.

Commissioning strategies considered the provision of suitable accommodation options for adults with care and support needs. The local authority was expanding their Shared Lives Scheme to support more alternative independent living options for people with learning disabilities. The scheme supported young people moving from foster placements as well as day respite for unpaid carers. Shared lives offers people with additional needs the opportunity to live in a family home with people who are trained to support them.

Some partners felt the local authority was stewarding the market well and their approach was strong in comparison to some neighbouring areas. There was no culture of people waiting for services in Sandwell, and very little ‘spot’ purchasing of care to fill gaps. Local authority commissioners were described as having the right spread of provision and good oversight of quality. Feedback from other partners was that changes to commissioning arrangements and personnel had been very positive in terms of relationships, and they had a better understanding of and interest in the work the partner was doing.

The local authority was committed to developing the market to ensure sufficiency and suitability for the needs of the community. Work was undertaken to ensure a fair cost of care in the provider market and there were plans to develop a new dynamic Market Position Statement. The local authority Market Position Statement, February 2024, was available on their website, aimed at current and potential providers of care and support services so that they could understand present and future demands and how services could plan personalised responses to people’s changing needs. The local authority understood commissioning the same forms of care, in the same places and in the same way, would not be feasible in the future so the local authority recognised they needed to be open to a radical change in how they provided future services. This involved changing current methods of commissioning, procurement, and service delivery. The local authority wanted Sandwell care providers to work with them to address this challenge.

There was sufficient care and support available overall to meet demands, and people could access it when needed. As of July 2025, no one was waiting for a home care service, with individuals supported through the local authority Promoting Independence Service whilst long-term packages of care were arranged. No one was waiting for residential and nursing care and no one was waiting for supported living accommodation, and delays only occurred in exceptional cases. Feedback from the local authority was there were some challenges with sourcing more personalised support for people with more complex needs. This may take longer than the average package but there was provision available in the market to respond. Partners shared moving people into 24 hour care settings could be more difficult due to some providers not available to accept admissions at weekends, however there was capacity in the market.

There was not always sufficient capacity for unpaid carers to access replacement care for the person they cared for, in planned or unplanned situations. People told us of issues securing respite care in Sandwell and fed back there was a gap in respite care provision. The local authority recognised there were capacity issues for respite care locally and nationally and were working on developing a replacement care model that looked at multiple options for respite for both the unpaid carer and the cared for person. This may include short breaks, day opportunities or more traditional forms of residential respite. Their shared lives model was also being developed to support respite options further and there were negotiations with individual care providers to resolve any challenges experienced with resourcing.

Some people used services or support in places outside of their local area. As of July 2025, there were 285 out of borough placements out of a total of 1,261 long term care home placements. Most placements were just over the local authority border and the reasons for placements outside of the West Midlands were for 6 people to access a specialist provision and another 6 people to be close to their family members.

Staff told us the majority of out of area placements were in neighbouring authorities, and most people usually stayed in the Black Country. Placements were also a personal choice as there were no issues with capacity.

From 2024 to 2025 there were 33 people aged 18 to 64 placed into care homes with 3 of these placed out of borough. In 2025 to 2026 (for the first quarter) there were 12 people aged 18 to 64 newly placed into care homes with 2 of these placed out of borough indicating an increase compared to the previous year.

From 2024 to 2025 there were 422 people aged 65 plus placed into care homes with 72 of these placed out of borough. In 2025 to 2026 (for the first quarter) for people aged 65 plus there were 146 people aged 65 plus newly placed into care homes, with 20 of these placed out of borough, again indicating an increase compared to the previous year.

Staff told us about work completed in relation to out of area placements to ensure quality. A service rating would be considered and if this was a good rating a remote review process was completed. If the rating was lower than good, staff would aim to complete an in-person visit to check the service directly.

There were some gaps in services in some areas. For example, people with personality disorders, however, mental health commissioners were aware of this and staff told us they provided them with good advice and support. Although there was a range of good support available in a crisis there was a lack of mental health beds for people who were eligible to be sectioned under the Mental Health Act 1983, with Sandwell having no place of safety. However, there were 3 places of safety in other local authority areas which Sandwell had access to. Staff told us this was having a particularly detrimental effect on people and families affected as well as the police. A new scheme had been developed to support people with lower-level mental health needs as this had been identified as gap in the market. Partners fed back gaps in other areas, for example support for people with complex needs when leaving hospital and gaps in services and support for people from the LGBTQ+ community.

Some services were commissioned jointly with other agencies. For example, a dementia support service was funded by the local authority in conjunction with 8 partner organisations to provide care from pre-diagnosis through to end-of-life care. However, one family fed back that when discussing care options for people with dementia social workers appeared to be limited in what they offered to support the person staying in their own home, which led to tense discussions about care homes, despite this not being wanted by the person or their family.

‘Better Together’ events were launched in Sandwell in January 2025 to bring together a range of stakeholders in adult social care. Events were held focusing on a number of different themes. The third such event was planned for September 2025 and would focus on the workforce. Staff told us these events were a good source of information from care providers and voluntary sector services about gaps in support or services. Feedback from care providers was positive with platforms given for feedback on market shaping and quality improvement directly to local authority staff alongside other partners. Providers also found forums useful for networking and discussing collective challenges.

The local authority had clear arrangements to monitor the quality and impact of the care and support services commissioned for people and supported improvements where needed. A Quality and Safety Team providing oversight of the provider market. The team were originally formed through the Better Care Fund (BCF) secured to create an integrated team within the Council in response to market pressures and commissioning arrangements across Sandwell. The team included a pharmacist for medicines management, a Quality & Safety Nurse, Infection Prevention Nurses and a Health and Safety Officer recruited via secondment arrangements with NHS partners. The positive evaluation of this pilot had led to an agreement for substantive BCF funding to extend the team beyond the initial pilot phase to now be a permanent team.

Staff told us Sandwell's style of commissioning was changing and there was more of a collaborative and partnership approach being taken. Staff had positive relationships with providers and there was a balance of proactive and reactive work undertaken. In the borough 30% of services were not commissioned, however care providers were also able to access support from local authority staff if needed.

Sandwell had a high proportion of ‘good’ Care Quality Commission (CQC) rated services with no care provider currently rated as inadequate. The local authority's provider support team were clear in its remit to drive quality and improve outcomes for people and felt care providers were committed to the local authority's expectations for quality and performance.

Information provided in July 2025 was that minimal contracts were handed back by the local authority from providers. There were 12 suspensions of care services from March 2024 to May 2025, 7 due to quality issues, 1 due to safeguarding,1 due to health and safety issues and 3 for fire risk assessment concerns. 6 suspensions had been lifted since and 1 contract terminated. Staff confirmed that if issues with a provider were raised, they were encouraged to conduct a voluntary pause of admissions, offering support to improve, rather than a suspension or embargo taking place.

There was a range of ways the local authority engaged with providers including auditing, surveys and meetings as well as via newsletters and events. The local authority evidenced quality monitoring via various methods including reviewing and supporting with care plans, quality standards, one to one interventions and training and development. Although a current challenge was to be able to offer in-depth and comprehensive training to provider staff.

Annual provider quality monitoring took place in person or remotely with an appropriate approach to quality or safeguarding issues. This ensured providers were meeting assessed and commissioned care plans and provision, ensuring both people using services and staffs safety was maintained and mitigating any issues before they developed. The team reported back to the Safeguarding Board as part of the adult social care safeguarding governance structure. In 2024, 181 monitoring visits were completed with a further 379 provider support interventions.

Meetings were held with relevant partner organisations to share intelligence and to ensure effective oversight. In one example a concern was raised in a neighbouring local authority area placement and so the teams jointly worked together to offer support even though only one person in the placement was funded by Sandwell.

People gave mixed feedback of care packages, with some positive experiences but others questioning if care staff always had the appropriate training. Feedback from partners on quality monitoring was generally good. For example, positive experiences of work with the quality team to identify and address service provision issues, share information and having a shared focus. Staff were described as incredibly supportive and always available to help with advice and guidance.

The local authority had a good understanding of the needs of the local market and responded to changes when needed, for example, they regularly suspended services they felt were failing and took steps to support improvement where they believed it was required. In one example, they had been instrumental in turning a provider service around during a difficult period. Staff listened to concerns in a non-judgmental way with a proactive attitude to finding solutions.

Contract monitoring was described as a supportive process, driven by quality of outcomes and quarterly meetings enabled challenges to be discussed in an open and transparent way, with forthcoming support and advice during times of pressure. Provider forums took place regularly and worked well. Representatives came to the forums to give talks about subjects or on particular organisations.

National data for Sandwell was considered either similar to, or somewhat better, than the England average. For example, data from the Adult Social Care Workforce Estimates for 2023/24 showed 7.96% of adult social care job vacancies, which were similar to the England average (8.06%). Data from the same source showed a staff sickness absence rate of 5.26 which was again similar to the England average (5.33).

However, data from the Adult Social Care Workforce Estimates for 2023/24 showed 64.94% of adult social care staff had a Care Certificate in progress, partially completed or completed, which was considered somewhat better than the England average (55.53%). Data from the same source similarly showed a 0.19 adult social care staff turnover rate, which was also considered somewhat better than the England average (0.25).

Local authority managers used service activity data to assess how they were meeting people’s local needs, evidence how resources were allocated and identify pressures in the system. A ‘sustainability of care’ prompt sheet was sent out to providers to consider the longevity of services with risk management meetings held if required.

In the local authority’s People Strategy 2024 to 2027, workforce resilience was documented as a priority with actions set out to build capacity and respond to future service demand. The workforce planning approach aimed to ensure sustainable care delivery through targeted interventions in hard-to-fill roles. As part of the transformation programme the local authority were working with providers to find joint solutions to market sustainability through launching their 'Better Together' approach.

Partners fed back some concerns regarding sustainability. Some told us business continuity planning, staff recruitment, and access to training remained limited for them due to financial pressures. Care costs made it challenging to find quality members of staff and ensure sustainability moving forward. Feedback was as there were a lot of providers, meaning that sometimes provider staff they were not able to secure as many hours work as they would like. Other partners told us the local authority had created a challenge of having almost too many options, which could be overwhelming for people to navigate. However, they felt the local authority understood the need to ensure each service was delivering outcomes and would review services effectively and scale back where needed. Another partner told us their experience of longer-term contract arrangements provided financial stability which allowed them to plan ahead. Another partner described the support they received from commissioners as proactive and refreshing, within a positive and open relationship.

Feedback from the local authority was that they recognised the significant financial and workforce pressures affecting the care market nationally. In response, the local authority implemented a Market Sustainability Plan in 2022 to support providers across all sectors to ensure they provided equity across the sector and sustainability. For example, the Fair Cost of Care focused specifically on residential, nursing and domiciliary care. The direct payment amount was also uplifted to increase choice and control for people. This plan included uplifts across all care markets to help providers meet rising costs and maintain quality Standards. Following consultation with care providers, structural changes were made to the domiciliary care contract, improving the allocation and continuity of work.

Some care providers received support from the local authority with recruitment and retention of staff, through job fairs and adverts and the careers team offering support for the employment of care staff.