Sandwell Metropolitan Borough Council: local authority assessment

National data for Sandwell from the Adult Social Care Survey for 2023/24 was similar to the England average. For example, 65.85% of people were satisfied with the care and support they received (65.39%) and 79.40% of people felt they had control over their daily life (77.62%). However, from the same data source, 54.20% of people reported having as much social contact as they wanted with people they like. This was better than the England average (45.56%).

People’s experiences of care and support was primarily positive in that they were involved throughout in decisions which were incorporated into care planning. Some relatives (where this was appropriate) were involved in decisions about their family members care, with people’s choices being respected. People told us they could contact the local authority, speak with someone within an appropriate timeframe and were allocated social workers quickly. Some staff were described as genuine and wanting to make positive changes to people’s lives. However, some people had less positive experiences, for example, having to tell their story again with each change of social worker, another person struggled to get a call back from the local authority and someone else felt their assessment was completed with a lack of empathy. Another person had not discussed any long-term plans as part of their assessment so was unaware of what these might be.  

People could access the local authority’s care and support services and the front door to adult social care was through an Enquiry Service. Here, 75% of contacts were either resolved or triaged on the same or following day, with one third of contacts resolved through advice, information and signposting from over 11,000 contacts each month.

From 1 January 2024 to 31 December 2024, 55% of requests progressed to an assessment or review, with 45% resulting in no further action being taken following advice or information being given. The local authority told us the number of referrals received had resulted in a substantial demand and had been identified by them as an area for improvement. Consequently, they were transforming this service and implementing a new digital call handling system. Plans were to introduce social workers and occupational therapy to the front door in the coming months.

The Enquiry Service team had been trained in relation to ‘trusted triage’, which meant as well as being able to order small pieces of equipment themselves to support people, they could also refer to other teams such as prevention officers or occupational therapy for support. Staff reported feeling confident in their approach with people, ensuring their interactions were person-centred. Further feedback from the local authority was the introduction of trusted triage was designed to reduce unnecessary referrals to therapy teams and avoid delays in meeting people’s needs. This meant staff were empowered to be able to resolve issues immediately, while also identifying and referring more complex cases to the appropriate team, ensuring people received timely, proportionate support and that professional capacity was focused where it was most needed.

Staffs approach to assessment and care planning was person-centred and strength-based. Staff told us they considered what the person could do for themselves rather than what they may need support with and co-produced their care plan. Where appropriate, staff worked as appointees for people living in Sandwell, communicating with them and completing practical tasks to support them. Staff gave examples of ensuring they had a good understanding of the person and what was important to them when taking an actions on their behalf.

The local authority had teams who were competent to carry out assessments, including specialist assessments for physical disability, learning disability and autism, and mental health.  The community social work teams were split into north and south areas, aligned with the 6 towns within Sandwell. Sensory teams carried out specialist assessments with rehabilitation officers. Staff felt they were given autonomy in this area of work and felt their offer to the people of Sandwell was particularly good.

Partners’ feedback to us was that improvements were needed. With a turnover of staff at Sandwell, unplanned reviews could be carried out by staff who did not always know the services available or the person’s background. Feedback from the local authority was that staff turnover for 2024/25 was 7.96%, which was significantly below the West Midlands local authority median of 15.1%, evidencing a stable and well-retained workforce. Unplanned reviews were allocated within the team that completed the most recent assessment and, wherever possible, to the same worker to ensure continuity. Robust processes ensured assessments and reviews were timely, person-centred, and informed by accurate and up-to-date information.

Partners told us some people did not receive copies of their assessments or reviews, or in some cases these had been taken from partners assessments, so were not always personalised. They shared they felt there was some reluctance from staff to provide interim support if people were awaiting a diagnosis, such as for dementia or autism.

Other feedback from partners more positively was about a consistency in social workers which provided stability and allowed for relationships to be built, reducing duplication. Also, some staff went out of their way to get the voices of others involved in care services for people’s reviews, to ensure they had gathered a full picture of the situation.

National data from the Short and Long Term Support for 2023/24 showed 41.54% of long-term support clients received a review (planned or unplanned). This was somewhat worse than the England average (England: 58.77%).

The local authority was acting to manage and reduce waiting times for assessment, care planning and reviews. Data provided by the local authority in July 2025, showed 92 people were waiting for a Care Act Assessment, with a median wait time of 30 days and a maximum wait time of 115 days. This was a reduction from 129 people in March 2025.

In terms of reviews, 787 people were waiting for a review in July 2025, with a median wait time of 169 days and a maximum wait time of 1,028 days (which was the wait time since the previous assessment). Figures for time since the review was actually due, showed a median wait time of 83 days and longest wait time of 663 days. This was a reduction from 995 days in March 2025.

People’s experiences of assessments were mixed. One relative told us about the delays for assessment for one person which had caused them stress and anxiety and led to them having to contact the local authority several times to chase this up. Other people had also experienced similar long waits for assessments. However, other people had better experiences where they had been assessed, then visited again after this by staff to review their care and support.

Staff confirmed there were waiting lists for assessment and reviews, a contact assessment team contacted and supported those who are on the waiting list, focusing first on the people who had been waiting the longest. Data was actively used to manage flow, risk and quality whilst also considering data was about ‘people’ and not just about numbers. The analysis of call volume and contact types was used to inform staffing levels within the contact centre and this intelligence supported effective triage to ensure enquiries were responded to promptly and appropriately.

Partners told us about people’s experiences of long waits following referrals for assessments and reviews. Although timeliness had improved significantly over the last 2 years, there could still be a wait for an assessment and these delays were not specific to certain teams. Also, people in short term placements did not always receive a full Care Act assessment before the end of the placement which hindered post placement planning.

Feedback from the local authority was data reports on longest waits were reviewed by senior staff, providing oversight of pressures and the reallocation of resources where required. Monthly performance meetings were held to maintain focus on timeliness and quality. If a delay in assessment was unavoidable, interim arrangements were extended to ensure that no person is placed at risk.

The local authority told us the number of people waiting for a Care Act Assessment had reduced significantly in the past year due to additional resources targeting waiting lists and improved risk management and they were confident this could be sustained in the longer term. Further improvements were being made such as developing a Practice Framework with tools aimed at improving workflow in teams. The local authority had several other measures in place, as well as longer-term plans to prevent waiting lists from escalating. For example, utilising some further digital and prevention initiatives. The local authority waiting list tool included a risk rating system of High, Medium and Low with subsequent actions aligned to manage the risk. Feedback from the local authority following our site visit to Sandwell was, with the exception of 1 person who was in hospital who was considered high risk, the waiting list comprised of people living with either medium or low risks.

National data from the Survey of Adult Carers in England for 2023/24 showed 28.33% of unpaid carers were satisfied with social services. This was somewhat worse than the England average (36.83%). Some other national data relating to support for unpaid carers was more positive. For example, the Survey of Adult Carers in England for 2023/24 showed 30.12% of carers felt they received encouragement and support which was similar to the England average (32.44%) and data from the same source showed 32.53% of carers reported having as much social contact as they desired which was also similar to the England average (30.02%).

According to data provided by the local authority documented in March 2025, 83 people were waiting for carer assessments, the median waiting time was 31 days, and the maximum waiting time was 304 days. By July 2025, this had reduced to 78 people waiting for a carer assessment, with the median waiting time of 24 days and maximum waiting time of 93 days. Feedback from the local authority was that a backlog of waits for carers assessments was created during the time of the Covid-19 pandemic, with staff prioritising those who were assessed as being most at risk. The local authority had employed temporary staff to address the backlog of people waiting from over 600 to the current figures.

Feedback from unpaid carers in Sandwell was mixed. For example, in some cases people were not offered a carers assessment, said they felt forgotten about, and one person had felt their mental health was at risk due to their caring role so they had made a complaint but had no response. Other people had to wait long periods of time for assessments and reviews. Others had a better experience, feeling supported and listened to during assessments, and more positive about the timeliness of these. Feedback about the support of occupational therapy was positive, however the front door to access the local authority was felt to be difficult to navigate by some.

The local authority told us unpaid carers were routinely identified and considered as part of every assessment and review. All formal complaints were logged and tracked, with response standards and any delays escalated to senior staff. Unpaid carers waiting for assessment were contacted regularly to check for any changes in risk or need, and other mechanisms to support them were also available.

Unpaid carers had fed back to the local authority they wanted a service which addressed the issue of long waits for assessments, support and reviews of care. Carers identified the need for support to be more responsive at key points of crisis, including around hospital discharge and during transitions. Unpaid carers were confused over the next steps, in some cases in contacting services and getting support so wanted clearer guidance. They fed back they were tired, especially from chasing up the local authority and there was a need for quick, effective support for the cared for person and solutions to presenting issues.

The local authority told us data from surveys they carried out from 2021 to 2024 showed unpaid carers did not experience good support services in Sandwell and therefore support for unpaid carers was a key area of development for them. Their strategy for unpaid carers had been refreshed with input from unpaid carers and they were commissioning a new community support service to commence in August 2025 which hoped to offer unpaid carers more choice and control. The new service would initially assess and signpost people to align with services including financial support where relevant. Care Act assessments would be passed to community social work teams and a proposed carers support team then manage oversight of the assessment process, completing urgent assessments when required.

The local authority Joint Carers Strategy Action plan 2024 brought together plans for improvements to support for unpaid carers with quarterly updates. These included early identification of carers through local hubs and other routes, a review of respite care, development of an app for unpaid carers to monitor wellbeing, and development of initiatives to encourage registering with GPs to access the support offered there. Also, use of an emergency unpaid carers card, to alert others to a carer’s status. There was a plan for targeted support in each of the 6 towns in the borough and to identify areas of the community where support was required to target the greatest need.

Senior staff told us support for unpaid carers was part of their broader improvement plans. Audits of staff practice had shown the need for a broader offer involving community organisations which the new carers service would facilitate. Staff told us they understood identifying and supporting unpaid carers was a key part of their role and that the most helpful work was to support the cared for person as quickly as possible.

Partners told us they felt there had been a lack of ongoing support for unpaid carers, giving an example where an unpaid carer needed practical support after a bereavement but had not received this. This had been highlighted to the local authority who felt this would be addressed by the new Carers Strategy.

The local authority fed back how they provided support to unpaid carers and the action they had taken to strengthen this work based on direct feedback, which included funding to 2 VCSE organisations. Some grant funding had been used to increase support for bereaved unpaid carers and those caring for people at the end of life with a range of support provided through the new Carers Support Service.

Targeted work was planned for young unpaid carers, to ensure they received educational, mental health, and social support to prevent caregiving responsibilities from negatively impacting their personal development. A young unpaid carers advocacy project had been set up and included awareness and outreach work focusing on issues which mattered to young carers, for example navigating challenges at school and removing barriers which may prevent school attendance.

People were given help, advice and information about accessing services, facilities and other agencies for help with non-eligible care and support needs. However, feedback from people around this was mixed. Some people fed back positively about the support they received to access a work placement and travel training which had increased their independence. However, a person who was supported in moving accommodation felt they would have benefitted from more help in this process.

Staff provided support to people to access suitable information. The local authority Welfare Rights Team helped people access benefits they were entitled to with several referral routes open to them from adult social care, voluntary sector organisations, and care provider networks. Staff working with young people told us people with non-eligible needs required careful explanation of the support available, as often young people and families were not aware of possible financial contributions. As a result, staff delivered Care Act and Mental Capacity Act 2005 training to children's staff to enhance their understanding of the role of transitions staff.

The local authority's practice guidance for staff included a section on people self-funding their care which set out clearly the circumstances when the local authority must arrange and provide services. Feedback from the local authority was they had commissioned improved services for people, funded through the Better Care Fund, to support those with non-eligible needs, to reduce social isolation and supplement more formal care packages.

A partner told us about services being commissioned by the local authority to provide crisis prevention support to communities. This addressed people’s non-eligible needs and a wider cohort of people whose needs were high, but not high enough to be eligible for statutory support. The service worked to prevent low and medium needs from escalating into high-level needs and then health and social care crises. Other partners felt the local authority’s wider strategies did not always encompass people with non-eligible needs, whereas smaller Voluntary, Community and Social Enterprise (VCSE) organisations did this. A lack of accessible information about the range of community support and services available could be another barrier, particularly for people facing social isolation. The local authority highlighted there were a number of public health initiatives available in Sandwell aimed at reducing loneliness and social isolation which included activity based and wellbeing initiatives.

Feedback from the local authority was they invested in preventative and community-based support, which was specifically designed to meet the needs of people who fell below Care Act eligibility thresholds. For example, through the VCSE grant programme and Better Care Fund. A Community Offer Plus service, provided tailored, short-term, person-centred support to adults who did not meet eligibility for formal services, but required help to maintain their independence and wellbeing. Community Navigators provided up to 12 weeks of personalised, practical support, helping people connect to community networks, manage daily tasks, and access emotional and social support. This is delivered through a borough-wide network of trusted local VCSE organisations.

The local authority told us a Corporate VCSE Grant Review in 2024 evidenced their commitment to maintaining and modernising funding for the sector, ensuring that resources were distributed equitably, duplication was minimised, and outcomes were clearly defined. This demonstrated their continued commitment to prevention, early help, and in supporting people with non-eligible needs through partnerships with the voluntary and community sector.

National data from the Adult Social Care Survey for 2023/24 showed 64.77% of people did not buy additional care or support privately or pay more to top up their care and support. This was considered similar to the England average (64.39%).

Local authority Statutory Care and Support Guidance provided the basis for determining eligibility under the Care Act. This criterion was embedded in assessment documentation and formed part of the assessment conversation. There was no specific appeals process for eligibility decisions as any person not satisfied with the outcome of their assessment was able to challenge the decision through direct discussions with the social work teams or through the local authority's complaints procedure.

The local authority told us all assessments, reviews, and care plans were subject to management approval to ensure decisions were lawful, consistent, and evidence based. Social work case progression was monitored through supervision and data performance dashboards, allowing managers to review decisions and ensure they remained proportionate and person-centred. Monthly case file audits were supported by follow-up telephone calls from senior staff to confirm people’s experiences and outcomes. This approach provided early, informal resolution opportunities reducing the need for formal appeals. If a person wished to challenge an eligibility decision, the complaints process ensured cases were reviewed transparently and independently.

A review of information was undertaken to ensure there was consistency in eligibility decisions taken by staff. Local authority data was analysed during 2024 to 2025 for unpaid carers and assessment outcomes for people by age, gender and ethnicity showed the proportion of assessments that were eligible or non-eligible decisions were broadly similar. Case file audits were completed monthly by senior staff which supported consistency of the application of the Care Act eligibility criteria.

The local authority and Integrated Care Board (ICB) partners reviewed the way in which Continuing Health Care (CHC) was aligned to the national framework to ensure people received the appropriate level of CHC funding entitlement. Dispute resolution protocols and procedures aimed to ensure the ICB and local authority had clear guidance to ensure consistency in the event of a dispute between them and, in these situations, the prime consideration was to ensure the interests of people were protected and care was provided first.

The framework for assessing and charging adults for care and support was clear, transparent and consistently applied. An adult social care contributions policy could be accessed by people on the local authority website. For financial assessments a person could challenge the decision through a review and appeals procedure.

According to the Sandwell Adults Board Annual Report 2023 to 2024, people had fed back to the local authority they wanted timely reassessment of funding when their needs changed. In similar feedback from engagement with unpaid carers, they felt the design for the new carers service needed to explain the social care financial assessment to manage people’s expectations. One person told us they had been waiting for an update about a request for additional funding but had not heard back and time scales were not clear.

On 11 March 2025 there were 355 people waiting for a financial assessment. In an update given by the local authority in July 2025, 243 of these people had a meeting booked, had received a visit or were scheduled to receive a visit in July 2025. Feedback from the local authority was the waiting list for financial assessments had built up due to a mix of staffing changes and proactive service improvements. Visiting officers conducted financial assessments via both telephone and face to face visits and the team were fully staffed. Advocacy was offered at the point of initial contact.

The local authority's practice guidance for staff was detailed and included information on financial assessments and contributions including consideration of mental capacity and managing and preventing debt. Staff told us named officers coordinated all work relating to people who were deceased, supporting families through the various processes required. There was a current backlog of this work, which was described as significant. Services of specialists such as heir hunters were procured if there was no family involved, which had resulted in more cases being closed. Staff referred to specialist support, for example, legal services, to ensure the best outcomes for people whose cases were complex.

Timely, independent advocacy support was available to help people participate fully in care assessments and care planning processes. Feedback from unpaid carers as part of a local authority engagement activity reinforced the importance of being able to access advocacy to support them when dealing with professionals, for example, one person had been provided with an advocate to support them successfully with care planning to move from living with their family to managing a tenancy themselves.

Where people struggled to engage with the assessment process staff referred them for advocacy support with the commissioned advocacy partner. Staff told us when initially contacting someone lacking capacity with no family present, an advocate was always used and there were no issues in being able to get an advocate. The commissioned advocacy service was described as good with no waiting lists and a range of advocates to meet people’s needs. Some examples were given where advocacy was used in relation to hoarding and self-neglect, resulting in positive outcomes for people.

Information sessions were delivered to staff to enable better understanding of the different types of advocacy. Senior staff told us this had made a tangible difference and data showed a 19% increase in the Care Act advocacy following training dates.

Partners fed back there was a good understanding about the use of advocacy to support Care Act processes across teams, and referrals from staff were made appropriately, contained relevant information and were timely. There was less assurance about the use of advocacy in relation to community Deprivation of Liberty (DoLS) cases as it was felt staff could lack some confidence and understanding in these situations. Local authority feedback was that in May, June and July 2025 staff received further training in relation to Community DoLS via an external provider to improve their knowledge and confidence. Weekly risk surgeries also supported practice discussions with guidance given to staff when a Community DoLS required progression.