Sandwell Metropolitan Borough Council: local authority assessment

The local authority understood its local population profile and demographics. Sandwell was the 12th most deprived borough in the country and services were shaped around the complexity of people’s needs and differing groups. The 6 towns that made up the borough were very varied with different ethnicities in each area and vibrant communities. The local authority used intelligence to forecast and identify emerging hotspots of need. Resources were spread across the 6 towns aligning with the equity of deprivation and the placing of services considered accessibility and location, for people who were the most in need.

Population and demographic data were used to ensure equality, diversity and inclusion through the routine breakdown of service information by protected characteristics. Analysis had been undertaken to see whether gender or ethnicity influenced access to care and support, by age. This analysis highlighted potential areas of inequality around access to support and helped the local authority to identify areas for further exploration to ensure their practice and commissioning approaches were appropriately focused on challenging these inequalities and enabling an improved equity of access.

Staff understood which ethnic groups accessed care in Sandwell and which did not, for example, Black people showed the highest relative usage of adult social care long term services with Asian people being below the level expected. In term of equipment or adaptations during 2024 to 2025, usage was higher for Black people, slightly higher for Asian people, average for White people with other ethnic groups notably below average. Staff had begun to investigate additional factors, for example, awareness, cultural preferences and referral patterns to understand why these groups had notably lower usage rates.

Equality Impact Assessments (EIA’s) were used when a new contract was considered and where there were proposed changes in service delivery with the focus on who was using the services and the impact of any changes or new initiatives. The EIA’s were reviewed by the Equality and Diversity Lead to ensure they were robust and took account of all protected characteristic groups.

The local authority recognised that there were some groups that were ‘hidden from sight’, for example, some LGBTQ+ older people. Staff told us Sandwell were the first local authority to discuss LGBTQ+ in care home settings and there was a large event held in 2019 for staff and since then support had grown. Staff were involved in developing a LGBTQ+ level 2 qualification and encouraged care providers to have LGBTQ+ champions who could promote this work with confidence.

Other examples included the oversight of the imminent Carers service which would be through a suite of key performance indicators. Part of this would be identifying seldom heard unpaid carers, such as unpaid carers from South Asian and Eastern European communities whose numbers in Sandwell were increasing. Partners fed back around 37% of unpaid carers known to the local authority were from minority groups and there was ongoing need to identify unheard carers. Funding had been given specifically for further work within these communities.

People were supported to have their cultural needs met within care services provided. One local commissioned care service aimed to reduce inequalities by offering staff diversity training and awareness activities. An example given was of a Punjabi-speaking person with complex needs being supported alongside their family member. Support was provided by the service communicating in their language to arrange a financial assessment and support them by referring them to other suitable specialist services. There were other culturally competent care providers, for example for Afro-Caribbean communities. The local authority's cultural competency training offer had increased in response to increased recruitment of overseas care staff. In one example, a member of care staff attending dementia training fed back positively as dementia was not something that was recognised within their culture.

Local authority staff involved in carrying out Care Act duties had good understanding of cultural diversity within the area and how to engage appropriately with people. There was ongoing work with staff to help them to challenge racism and discrimination confidently. Staff recognised language could be a barrier at times, especially out of office hours when interpreters were less available. Gaps were identified where staff would like to have more training, for example, to support increasing numbers of people from neuro-diverse populations. There were other examples given of complex work with people to support cultural differences in areas such as mental capacity assessment. Wider learning, for example, in relation to discrimination some people faced, was shared amongst teams.

The local authority was aware that some areas of their work with minority groups could be improved. In one study undertaken, the local authority identified lack of communication between ethnic minority groups, service commissioners and providers and that understandings, expectations and provision did not align. This was reflected in some feedback we received. Some partners told us that gaps in service provision reflected how different people were accommodated within existing services rather than absent or insufficient services. The local authority had invested heavily in a comprehensive community offer and were now beginning to drill down into how the market was best serving vulnerable groups such as people from LGBTQ+ and neuro-diverse communities. The Better Care Fund was being repurposed for this work, however truly accessible services for all were not yet in place, but there were firm plans to work towards this. Senior staff told us about voluntary sector grants and micro commissioning being used for the groups of people yet unreached.

Partners felt more needed to be done to reduce inequalities. Comments included work could be done with VCSE as it was felt the local authority were missing a potential opportunity to identify, understand and support people from seldom heard groups who needed more support and recognition in commissioning and service design. More positively, other partners told us senior leaders and staff in Sandwell had a good understanding of local areas and people’s needs. The local authority had previously engaged in joint initiatives to support ethnic minority communities. They were described as self-aware of their deficits and committed to making positive changes and improvements to address them.

The local authority took a strategic approach in their work to reduce inequalities. An Adult Social Care Culture Strategy 2025 to 2030 aimed to ensure staff provided people with care and support which focused on cultural awareness, unconscious bias and inclusive communication. The strategy was co-produced with partners, people with lived experience, and unpaid carers with the aim to deepen understanding of peoples’ wider experiences, needs, and barriers to engagement. The local authority was committed to creating a diverse workforce that reflected the local population. Recruitment included outreach to under-represented communities and workforce monitoring to ensure equity. Inclusive recruitment practices and digital inclusion initiatives were planned to reduce barriers and promote equal access to employment opportunities. The strategy documented that people’s cultural identities and experiences were central to how care was shaped and delivered, supporting a more inclusive and equitable approach across adult social care. Cultural champions were introduced to promote understanding across staff, share good practice and ensure ongoing development in how services addressed cultural needs across teams. A staff learning programme was developed incorporating case studies and real-life experiences to help practitioners understand how culture and identity impact care delivery and supported a deeper, person-centred insight.

Employee networks such as LGBTQ+, disability, women’s and ethnic minority groups were used to inform organisational development. Emotional and spiritual support was available through these networks as well as training and awareness sessions for staff. These included culturally sensitive mental health approaches and helping staff to better understand how different backgrounds may influence how people expressed or managed mental distress.

Appropriate inclusion and accessibility arrangements were lacking in areas, so that people could not always engage with the local authority in ways that worked for them. People told us that information did not always feel accessible to them, for example, one person said their family whose first language was not English had struggled to understand the terminology used by staff and a translator had been provided but this person had confused them more with the terms they used. Another person told us their assessment and support plans were not translated into their preferred language, and they were not aware they could ask for this as a legal right as no one had told them.

Most partners’ feedback about inclusion and accessibility arrangements was poor. Examples included difficulties in getting translators or British Sign Language (BSL) services due to these not being arranged by staff, which had led to assessments being cancelled. People from seldom-heard groups felt excluded from engagement processes and faced some barriers to accessing support. Signposting and referral information was not always given in an accessible format. BSL interpreter conversations were not always understood by people as getting to know and understand someone could take time and such time was not always offered. Examples were given in relation to a mental capacity assessment which was felt to be completed without staff having adequate training in the person’s preferred communication needs.

By contrast most staff considered the approach taken by the local authority to support people to be strong with any complaints made about equality, diversity and inclusion taken seriously. Staff were trained to be able to offer greater support to people, for example, understanding that if someone with a learning disability contacted them this may need a longer phone call and they did not feel under any pressure to deal with calls quickly if someone needed longer. Makaton (a sign and symbol system) was used by staff where appropriate.

A social work presence was also in towns, a One Stop Shop in Oldbury, in hospitals and intermediate care settings and an Independent Living Centre. These helped to provide accessible opportunities for local people to drop in or attend timed appointments enabling support closer to home and within local communities’.

Feedback from the local authority was many staff members were multilingual with several trained in BSL, including staff working outside the sensory service. Out of 834 staff working in adult social care at the local authority, 255 identified as from Black, Asian or Minority Ethnic communities which broadly represented the communities served in Sandwell.

A number of internal and commissioned services, projects and initiatives supported people with a sensory impairment including the local authority specialist team. The team worked in partnership with several organisations and signposted people to further specialist support where required. Staff confirmed good support, including out-of-hours, for interpreters including BSL interpreters. Interpreters could be accessed face to face, by telephone, and through video interpreting, also providing American Sign Language interpretation and translation and transcription services in over 250 languages as well as Braille. Teams praised the commissioned interpreter services.

Digital exclusion had been recognised and was being addressed. Senior staff were aware of the possibility of digital exclusion so access had been improved to some digital platforms to make them more user friendly whilst also improving information for people who did not have this digital access. Developments had been made to ensure people could find information online in accessible ways. Over 60 languages were available through website translation functionality. Easy read, braille and large print document formats were available where required. A free newspaper was delivered to households in Sandwell quarterly which included information and support for unpaid carers, safeguarding information and support for people living with dementia. Customisation tools enabled people to adapt content in several ways including using read aloud functionality. Other technology used such as Apps had voice activated settings for those who preferred this. More practically staff felt the provision of individual mobile work phones had added valuable texting options for people who preferred to communicate with them in this way.