London Borough of Richmond upon Thames: local authority assessment

People could easily access the local authority’s care and support services through multiple channels, including online and self-assessment options. People accessed support through a clear front door process that included phone, email and walk-in options. Staff described how the front door team triaged referrals to ensure people met Care Act criteria or safeguarding thresholds and passed information to locality teams to avoid people repeating their story. For example, staff said the front door communicated well with locality teams and handed over information effectively. This meant people experienced smoother transitions and less frustration when seeking help.

First Contact staff managed a high volumes of calls, including safeguarding and police reports, and signposted people to appropriate services. We heard that one staff member handled 35 calls in a single morning, showing the demand and pressure on the system. Despite this, people were listened to and their needs recorded, which helped ensure timely responses.

The approach to assessment and care planning was person-centred and strengths-based. The approach reflected people's right to choice, built on their strengths and assets and reflected what they want to achieve and how they wish to live their lives. Assessments were described as person-centred and strengths-based, focusing on what mattered most to people. For example, care records showed assessments included prompts such as “What strengths does the person have and what support do they need?” This helped ensure plans promoted independence and choice.

We saw evidence of trauma-informed practice, where social workers gave time and breaks during assessments and considered triggers. This approach enabled people to feel supported and respected. Similarly, we observed reviews showed how tasks were broken down to highlight what the person could do, such as placing clothes in the washing machine, which promoted independence.

Staff confirmed this approach was embedded in practice. Leaders said they were proud of work on personalisation and direct payments, and staff surveys showed 86% of practitioners had sufficient training in strengths-based practice. This meant people’s assessments were more empowering and aligned with their preferences.

Performance in key adult social care indicators highlighted good outcomes compared to national averages with the Adult Social Care Survey (ASCS) showing 65.43% of people were satisfied with care and support, similar to the England average of 65.39% and 79.01% of people felt they had control over their daily life, similar to the England average of 77.62%. In addition, 42.59% of people reported they had as much social contact as desired, similar to the England average of 45.56%. These figures suggested most people experienced positive outcomes, especially around satisfaction and control although social contact remained a challenge.

People’s experiences of care and support ensured their human rights were respected and protected; they were involved throughout in decisions and their protected characteristics under the Equality Act 2010 were understood and were incorporated into care planning. People described feeling listened to and involved in decisions. Unpaid carers said they felt heard during assessments, even though they noted paperwork was extensive. Care records showed assessments considered communication needs and wellbeing, and examples from records demonstrated sensitivity to autism and mental health challenges. The social worker apologised for terminology that could have caused distress, which set a positive tone for engagement.

Staff also worked to ensure equality and inclusion. For example, assessments for people with complex needs included input from families and professionals, and reviews considered cultural and communication requirements such as Makaton and British Sign Language (BSL). This helped ensure plans respected rights and supported participation.

Pathways and processes ensured people’s support was planned and co-ordinated across different agencies and services. Processes supported joined-up working. For example, quarterly reports showed teams collaborated when family members were open to multiple services, ensuring documentation, for example Lasting Power of Attorney (LPA) documentation and advanced decisions were recorded. This improved continuity and reduced duplication.

Staff described strong relationships with health partners and voluntary sector agencies, though some partners raised concerns about inappropriate referrals and gaps in understanding complex neurological needs. These issues were being addressed through open dialogue and training, which aimed to improve co-ordination and safety.

Digital solutions also supported co-ordination. For instance, care technology was used to tailor packages, such as installing devices to maintain contact and reduce additional care calls. This promoted choice and improved outcomes for people while supporting efficiency.

The local authority had assessment teams who were competent to carry out assessments, including specialist assessments. Staff surveys indicated high engagement and confidence, with 91% of staff feeling part of a supportive team and 80% able to access learning when needed. This prepared practitioners to deliver accurate and timely assessments.

Specialist teams managed complex cases, including mental health, substance use and neurodiversity. For example, the mental health team undertook safeguarding, transitions and section 117 reviews with health partners. The local authority also commissioned deep dives to understand rising safeguarding concerns in substance misuse, showing proactive risk management.

Policies and procedures were up to date and comprehensive, covering assessment, care planning and review. They emphasised prevention, proportionality and person-centred practice, ensuring compliance with Care Act duties. This framework supported staff competence and consistency in delivering high-quality assessments.

Assessment and care planning arrangements were timely and up to date. The local authority had acted to ensure assessments and care planning were timely and up to date.

Performance data showed that from March to July 2025, waiting times and completion rates for care assessments, financial assessments, and reviews improved. For example, the local authority reported 75.7% of Care Act assessments were completed within 30 days, and 83.9% of people were reviewed in 2024/25. This exceeded their target of 70% for annual reviews, with 78% achieved in 2023/24. These improvements meant people accessed support earlier and experienced fewer delays in having their needs met.

Partners told us they had no concerns about timeliness of Care Act assessments for people and unpaid carers. Providers said changes in need were addressed promptly, and the process for self-funders worked well, with reviews set up seamlessly. This responsiveness ensured people remained in stable care arrangements and avoided unnecessary disruption.

Performance data from the local authority showed that in July 2025 there were 8 people waiting for an assessment, with a median wait time of 1 day and a maximum wait time of 246 days. The local authority had set a target timescale for assessment completion of 30 days.

The local authority also confirmed that in July 2025 there were 187 people were waiting for a review, with a median wait time of 22 days and a maximum wait time of 600 days. The local authority had set a target of achieving 75% completion of reviews annually.

According to the Adult Social Care Activity Report (ASCAR) 2024/25, 76.54% of long-term support clients received a review, significantly better than the England average of 59.13%. The local authority was acting to manage and reduce waiting times for assessment, care planning and reviews. This included actions to reduce any risks to people's wellbeing, while they are waiting for an assessment. For example, in March 2025, 49 people were waiting for occupational therapy assessment, which reduced to 34 by July 2025. The occupational therapy team worked hard to lower the waiting list, using a risk rating system and prioritising high-risk referrals within 2 weeks. They contacted people on the waiting list to check their needs and asked them to update the team if circumstances changed. This approach meant people waiting for support were monitored and connected to community resources, reducing risks to wellbeing.

For instance, the preparing for adulthood team held weekly meetings to review referrals and used a red, amber, green rating system. People waiting six months were rated amber, and those approaching transition at 17 were rated red. This prioritisation ensured urgent referrals were addressed promptly, reducing anxiety and safeguarding continuity of care.

The local authority also reminded front door teams to explore immediate support options while full Care Act assessments were pending and increased staff capacity to enable timely allocation. These actions improved responsiveness and reduced delays, meaning people accessed interim support earlier and avoided crises.

Partners confirmed these efforts were effective. For example, voluntary sector organisations said they had no concerns about timeliness, and providers reported that urgent changes were picked up responsively. This meant people experienced continuity of care and avoided gaps in support.

Data showed consistent improvement. In March 2025, there were 11 people waiting for assessment, and by July 2025, only 8 people were waiting. Median waiting time for assessments was 1 day, and the maximum waiting time reduced from 236 days to 75 days. These reductions meant people accessed assessments faster, improving their experience and reducing risks of harm.

The needs of unpaid carers were recognised as distinct from the person with care needs; assessments, support plans and reviews for unpaid carers were undertaken separately. For example, unpaid carers described having a dedicated assessment alongside the Care Act assessment, which captured their own needs and included contingency planning. Staff confirmed unpaid carers’ assessments were scheduled independently and could be completed in person or by phone. These assessments often led to signposting or one-off support rather than a package of care, but they were recognised as an important step in acknowledging unpaid carers’ roles.

Evidence from multiple sources indicated contingency planning was a priority. Unpaid carers spoke positively about receiving Carers Emergency Cards, which reassured them that plans were in place should an emergency occur. Staff explained these cards were incorporated into assessments and reviews, and the local authority had updated its processes to include a contingency section in assessments following feedback. This change aimed to ensure unpaid carers’ relationships were flagged promptly in emergencies.

National data supported the view that unpaid carers were generally satisfied with the support they received, though there were areas for improvement. Survey of Adult Carers in England (SACE) 2023/24 metrics showed 41.07% of carers were satisfied with social services, better than the England average of 36.83%. Unpaid carers reported feeling encouraged and supported was 36.36%, compared to the England average of 32.44%. However, only 21.21% felt they had control over their daily life, similar to the England average of 21.53%.and 48.48% of unpaid carers experienced financial difficulties because of caring responsibilities, similar to the England average of 46.55%. These figures highlighted that while satisfaction was relatively strong, challenges around autonomy and financial strain were present.

Local authority data demonstrated progress in reducing delays for carers’ assessments. In July 2025, 7 unpaid carers were waiting for an assessment, with a median wait time of 28.4 days and a maximum of 159 days. This was a significant improvement from February 2025, when the maximum wait time was 236 days. Staff attributed this reduction to increased flexibility in scheduling and the introduction of online assessments, which allowed unpaid carers to request reviews when their circumstances changed.

Examples such as unpaid carers receiving direct payments for gym memberships, theatre tickets, or equipment repairs illustrated how assessments translated into practical support. These measures helped unpaid carers maintain their wellbeing and continue their caring role effectively. For instance, one carer struggling to afford travel costs received a direct payment for petrol, enabling them to visit the person they cared for. Staff also described funding short-term respite through voluntary sector partners, which provided unpaid carers with essential breaks.

Feedback from unpaid carers reinforced the impact of these changes. Unpaid carers said they felt listened to during assessments, even though paperwork was burdensome. They valued support from local organisations, which offered counselling, training, and social activities. For example, unpaid carers reported counselling sessions and training days helped them cope better and feel less isolated.

These experiences aligned with findings from the Survey of Adult Carers in England (SACE) 2023/24, which showed that 38.46% of carers accessed a support group or someone to talk to in confidence, somewhat better than the England average of 32.98%.

Overall, the recognition of unpaid carers’ distinct needs and the improvements in assessment processes had a positive impact on people’s experiences. Unpaid carers felt more informed, supported, and able to plan ahead, which reduced stress and improved their ability to care. However, ongoing challenges around financial hardship, social isolation, and control over daily life indicated further work was needed to strengthen outcomes for unpaid carers.

People were given help, advice and information about how to access services, facilities and other agencies for help with non-eligible care and support needs. People had access to advice and information through various channels, and this often helped them understand what support was available and how to plan ahead. People were given help, advice and information through various channels about how to access services, facilities and other agencies for non-eligible care and support needs, which often helped them understand available support and plan.

For example, unpaid carers said they had received guidance and signposting from local organisations, which included information about coffee mornings, training sessions, and counselling opportunities. This support helped unpaid carers feel less isolated and more confident in their caring role. Feedback from unpaid carers showed they valued being able to return for help when circumstances changed, which gave them reassurance and reduced stress.

Staff described how they worked to ensure unpaid carers were informed about options for support. Staff explained they provided contingency planning advice and issued carers’ emergency cards to help people prepare for unexpected situations. These cards were incorporated into assessments and gave unpaid carers peace of mind, knowing that emergency contacts were clear. The local authority also introduced flexibility in reviews, allowing unpaid carers to request earlier reviews when their circumstances changed. This meant unpaid carers could access timely advice and avoid crises.

Partners confirmed that the local authority expected voluntary sector organisations to identify unpaid carers and make sure they were told about available support, including assessments. Examples such as the Carers Hub and Carers Centre showed how unpaid carers were supported with information and advice, including help to prepare for assessments. This collaborative approach ensured unpaid carers were not left without guidance and could access services that maintained their wellbeing.

National data from the Survey of Adult Carers in England (SACE) 2023/24 supported these findings, showing that 74% of carers felt involved or consulted as much as they wanted in discussions, and 36.36% felt they had encouragement and support. These figures were above the England averages, indicating people generally felt informed and supported. The impact of this was significant and unpaid carers reported feeling less alone, more able to cope with caring demands, and better able to maintain their own health and wellbeing. For example, feedback from the Carers Centre Impact Report highlighted that 85% of unpaid carers felt their caring needs had been understood and 73% felt more confident in their role. This improved people’s experience by reducing isolation and helping them manage responsibilities effectively.

The local authority’s framework for eligibility for care and support was transparent, clear and consistently applied. Decisions and outcomes were timely and transparent. The local authority had a clear framework for determining eligibility for care and support. It provided staff with structured guidance documents were comprehensive, easy to read, and included clear ownership and review dates. These documents were on standard templates, included contents lists, and outlined processes in a logical way. This ensured staff had access to consistent information when making decisions.

The local authority also introduced an appeals process that allowed people to challenge decisions. The process had two stages and gave people the option to escalate to a formal complaint if they disagreed with the outcome. For example, the guidance stated appeals must be reviewed by a Head of Service within 15 days, and outcomes communicated in writing. If people remained dissatisfied, they could approach the Ombudsman. This provided a clear route for people to raise concerns and seek resolution.

However, despite these processes, the local authority reported that it had not received any formal appeals in the previous 12 months. It acknowledged that some people had challenged assessment outcomes through the complaint's procedure, but it did not provide data on the number or themes of these challenges. It was unclear why the appeals process was not used in these cases but the existence of a two-stage appeals process with an option to escalate to a formal complaint gave people a clear route to challenge decisions. This helped ensure fairness and accountability.

Quarterly reports showed social workers were reminded to explain the rationale behind decisions and outline team roles during assessments. This improved transparency and supported person-centred practice. For example, guidance encouraged staff to provide clear explanations, which helped people understand why decisions were made and what options were available.

People’s experiences reflected both positive and negative aspects of decision-making. For example, some people described delays and unclear communication about eligibility for adaptations. Occupational therapists visited properties and discussed adaptations, but some people told us that months later they were told they did not meet criteria for adaptations without a clear explanation as to why. Some people said they would have paid for work earlier if they had known, which caused frustration and limited independence, such as being unable to leave their homes without a carer. We heard one example regarding the rejection was for an automated door, which would have allowed the person to leave their home independently rather than waiting for a carer. This showed inconsistent communication about eligibility decisions could negatively affect people’s independence and wellbeing.

In contrast, partners gave positive feedback about how staff applied eligibility decisions in practice. For example, an occupational therapist managed a dispute about ineligibility for equipment provision in a professional and sensitive way. They explained the rationale for the decision clearly, which helped the person understand the outcome. This demonstrated that staff communicated decisions in a respectful and transparent manner.

The local authority had reminded social workers to explain the rationale behind decisions and outline the roles of different teams during assessments. This aimed to improve transparency and make assessments more person-centred. For example, quarterly reports highlighted this as an area of focus, which indicated that the local authority was taking steps to address gaps in communication.

National data from the Adult Social Care Survey (ASCS) 2024/25 showed 71.60% of people did not buy additional care or support privately or pay more to ‘top up’ their care and support, this was better than the England average of 63.73%.

The local authority’s framework for assessing and charging adults for care and support was clear, transparent and consistently applied. Decisions and outcomes were timely and transparent. The local authority had a structured framework for assessing and charging adults for care and support. Guidance documents for determining eligibility and appeals were comprehensive, well-structured, and easy to read. For example, the Guide to Delegated Financial Decision-making outlines how managers will make delegated financial decisions in an effective and proportionate way, which is compliant with the duties under the Care Act 2014 and was last updated in May 2024 and scheduled for review in April 2025. The appeals policy launched in November 2024 had clear timelines and escalation routes. These processes showed a commitment to transparency and consistency.

Data from the local authority indicated that in July 2025, 5 people were waiting for a financial assessment. The median wait time was 2 days, and the maximum wait time was 43 days. The local authority had a target to complete 90% of assessments within five days, which demonstrated an ambition to provide timely decisions. This was important because delays in financial assessments could affect when people accessed care and support.

Timely, independent advocacy support was available to help people participate fully in care assessments and care planning processes.

The local authority had commissioned advocacy services to support people and unpaid carers. The advocacy provider had established their own local operating procedures which sets a 5-day allocation of referrals including a prioritisation system meaning referrals to safeguarding or support for those people deemed to lack capacity to make decisions were assigned as high priority.

The local authority closely monitored data relating to referrals and allocation times. For example, in quarter 4 of the Advocacy Update dated November 2024, out of 77 referrals only 30 fell outside of the 5-day allocation target. The local authority explained that during this period a system change may have impacted on the recording of allocations.

Data collated by the provider was regularly analysed and where issues were identified the provider would implement remedial actions. For example, the 2023/24 data demonstrated block hours commissioned had not been utilised, and this led to the provider attending adult social care team meetings to raise awareness of the service and referral routes.

A partner told us the local authority’s understanding of advocacy has improved. They expressed that there previously had been a misunderstanding of advocacy's remit. However, the local authority acted prompting in facilitating advocacy visits to team meetings to raise a better understanding of advocacy as the support it could provide to people. Partners told us commissioners arranged bi-monthly drop-in sessions for staff to attend to improve their understand of advocacy and to clarify any queries they had with the commissioned advocacy service.

Staff told us they routinely considered advocacy support for people who required it. They said the commissioned advocacy service for Care Act advocacy, safeguarding, and Independent Mental Capacity Advocates (IMCAs) was available. For out-of-area placements, staff explained it sometimes took longer to secure an advocate because they had to use a different provider, but they always managed to achieve this.

Staff provided examples of the positive impact of advocacy. One example involved a person with fluctuating capacity who wanted to return home from hospital, while professionals preferred a care home placement. Advocacy involvement had supported the person to return home, and additional measures were put in place to facilitate discharge, such as arranging extra introductions with the care agency to help the person accept care.

We heard from one partner that the local authority had a good person-centred approach to advocacy. For example, when advocates felt they needed more time to build rapport with people this was appropriately provided to ensure best outcomes were reached for people when assessing their needs. Feedback they received from some people using services was that they did not always feel heard but they expressed that when advocacy was involved, they had felt listened to.

Another partner told us a review was planned to look at the high numbers of families advocating for their family member, especially during safeguarding matters, to ensure this was appropriate and that everyone had access to independent advocacy.

The Commissioning Team told us they had worked with other London boroughs in respect of Independent Mental Capacity Act advocates (IMCAs) in hospitals. They now had a single provider to cover all acute mental health hospitals, with a single point of access.