London Borough of Southwark: local authority assessment
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Overall summary
Local authority rating and score
Quality statement scores
Summary of people's experiences
People were assessed and supported by committed and compassionate staff. Strength-based assessments and practice were well embedded. People’s right to choose was respected. Their aspirations and abilities were recognised. People were supported with the least restrictive options to promote their independence.
Most people were assessed in good time with limited waits for most services, although there were some longer waits, particularly for occupational therapy assessment. There was good multidisciplinary and multi-agency working to ensure people’s needs were met in assessment and care planning. People had good access to advocacy and translation.
Most people and their carers told us their assessments were positive interactions, although survey data and feedback indicated this was not universal. Most people said they were listened to, could express their wishes, and had choice over their care and support, with good involvement by different teams.
Most people gave positive feedback about preventative support they received, which helped them to be more independent and in control of their health and care needs, although survey data and feedback indicated some people were not sufficiently supported to autonomously manage their care.
Most people told us the local authority supported them to stay well by. For example, they were signposted to local community organisations for assistance. However, few people were supported to access direct payments to independently manage their care needs.
Many people were placed out of area in other local authorities, mostly in nearby London boroughs. The number of new out-of-area placements was decreasing.
The local authority had a targeted approach to drive awareness of carer support and data showed the local authority’s improved outreach and uptake of support for carers. Although some unpaid carers were not aware of what support was available to them or how to access it and some reported mixed experiences about understanding carer assessments and accessing support such as respite, direct payments and short breaks.
Summary of strengths, areas for development and next steps
The local authority’s assessment and care planning approach was person-centred and strength based. Assessments were carried out in different ways to meet people’s needs and staff signposted people to non-statutory services for their non-eligible care and support needs. Most of the local authority’s national data indicators were in line with the England average, for example the proportion of people satisfied with their care and support. Assessments and care planning arrangements were mostly completed in a timely way. Some progress was being made to reduce the backlog of people waiting and there was a reduction in the number of people waiting for assessments and reviews in the 6 months up to our assessment.
The local authority provided many prevention-based activities and early support interventions to improve the health and wellbeing of residents. The local authority used demographic data to inform decision making and target specific needs. However, some of the local authority’s national data indicators for prevention were worse than England averages, including uptake of direct payments and people’s and carers’ sense of wellbeing. The local authority had mixed performance in carer support indicators.
The local authority worked with NHS partners to deliver intermediate care and reablement services to support people to return to their optimal level of independence. There was very good performance in short-term reablement. The local authority managed community hubs across the borough to deliver prevention services and support people to access care, including peer support and self-management groups.
People could access equipment and minor home adaptations to maintain their independence. Occupational therapists were integrated into the local authority’s front door contact team for equipment, minor adaptations and preventative support early in people’s contact with ASC. However, there were long waits for Occupational Therapy (OT) assessments.
The local authority had a comprehensive understanding of local inequalities and clear equality objectives to improve people’s experiences and outcomes. The local authority understood the local population profile and different inequalities faced by residents. There were specific joint strategic needs assessments to tackle inequalities in target populations. The adult social care (ASC) workforce was reflective of the diverse local community. The local authority invested to become an anti-racist organisation and had a zero-tolerance approach to discrimination. The local authority worked with people with lived experience to understand and address the impact of structural barriers to accessing care. The local authority’s inclusion and accessibility arrangements considered people’s diverse communication needs and supported them to engage in ways that worked for them.
Commissioning priorities followed a life course approach with integrated health and social care goals and joint commissioning. The local authority engaged local people in commissioning decision making. However, there was a relatively small care market in Southwark and a high proportion of people were placed out of area, mostly in neighbouring boroughs but some further away. The local authority was taking action to grow and develop additional care capacity.
There were robust, established provider quality assurance processes and these worked well. Providers told us the local authority had a proactive and supportive approach. The local authority supported a sustainable care market, including the Southwark Council Ethical Care Charter and Residential Care Charter to support staff recruitment and retention. Local workforce data demonstrated a relatively stable, experienced provider workforce. Although there were some challenges in recruitment and retention of local authority staff. The local authority worked with providers and stakeholders to understand current trading conditions and how providers were coping with them.
The integration agenda was developing well in Southwark and the local authority worked collaboratively with system partners to align strategic priorities. Partners reported good relations with the local authority. There were some integrated services which resulted in very good outcomes, for example in reablement and preventing readmission. The local authority worked with some partner organisations to pool budgets and jointly fund services where this meant it would achieve better outcomes. Frontline staff reported good MDT working and provided examples of collaborative working. There were examples of effective internal partnerships with other local authority services which supported a ‘whole lifetime approach’ to people’s care and support needs and aligned priorities. Most VCSE groups reported improved relationships and involvement in strategic boards and decision making, but some local groups were under-resourced, which impacted on their sustainability.
Systems were in place to support staff to keep people safe with timely interventions, and the local authority prioritised people’s care based on risk, and these mostly worked well. There was a good multi-disciplinary approach to sharing and managing risk between internal teams and external partners. However, we received mixed feedback from people and unpaid carers about the quality and consistency of their care.
There was a structured preparing for adulthood process to support young people’s transition from children to adult social care services. However, some families told us transitions from children’s to adult services was not seamless and some had experienced delayed assessments. In some instances, this created anxiety and frustration for young people and their families about what support they could expect.
Most feedback from people discharged from hospital highlighted good coordination of care and consistency of support, although managing pressures around hospital discharge was an identified area for improvement. Some staff reported delays accessing and sharing information.
Safeguarding systems were in place to support people at risk of abuse or neglect. We heard examples of making safeguarding personal and involving people in their support and protection plans following referrals. The local authority’s safeguarding indicators were in line with England averages, but there were several areas for improvement to make safeguarding more effective, including uptake of safeguarding training. Providers gave mixed feedback on safeguarding investigation responsiveness. The local safeguarding adults board had insufficient oversight of day-to-day safeguarding performance and was disconnected from frontline practice. There was a need to improve the coherence and dissemination of Safeguarding Adult Review (SAR) learning. There was a backlog of Deprivation of Liberty Safeguards (DoLS) cases, and many people were waiting too long for an assessment.
The local authority had governance, management and accountability arrangements which provided visibility and assurance on delivery of its Care Act duties. There was a well-established, focused and capable leadership team that understood community needs. Local authority leaders engaged partners in difficult discussions about challenges. Staff were committed to the local authority and felt motivated to do their jobs to the best of their abilities. We met many well-established staff with many combined years of experience and in-depth understanding of the needs of Southwark residents.
There were established scrutiny and oversight processes, with clear lines of reporting and escalation. Local political relationships were mature and scrutiny of adult social care was effective, both internally and with key partners within Partnership Southwark. Political and executive leaders were very well engaged and informed about adult social care performance and risk. Leaders worked together for meaningful outcomes for local people.
The local authority used information about performance, inequalities and outcomes to inform adult social care strategy and allocate resources. Leaders used data to review service performance monitor and identify risks. The local authority had robust financial governance arrangements.
Most frontline staff spoke positively about the learning and training offer and opportunities for development. There was a clear learning and reflective culture. Staff reported good relationships between teams. Change was managed well and staff were supported to be innovative. There were opportunities for staff to learn and progress. There were some discrete examples of good, meaningful co-production, for example recommissioning of the carers support service and development of mental health pledges. However, some people told us the service needed to do more to seek and listen to people’s views, involve them in early decision making, and ensure feedback is used to make improvements.