Sandwell Metropolitan Borough Council: local authority assessment

National data from the Adult Social Care Outcomes Framework for 2023/24 showed that 52.66% of people who have received short term support no longer require this support. This was considered significantly worse than the England average (79.39%). However, national data from the Survey of Adult Carers in England for 2023/24 showed 85% of unpaid carers found information and advice helpful. This was considered similar to the England average (85.22%).

Plans were in place in the local authority adult social care strategy for 2024 to 2028 setting out intentions to prevent, reduce and delay people’s needs. The local authority had seen a population increase of 11% in the last 10 years. With the metropolitan borough being the 12th most deprived area out of 317 across England and having higher than average numbers of poorer outcomes and health inequalities, the impact on wellbeing and socio-economic inequalities were evident and impacted on the risk factors for adult social care. Five strategic themes were being implemented which were of early intervention programmes, supporting people to remain as independent as possible, unpaid carers being supported in their caring roles, people being protected from issues impacting on their health and wellbeing, and increasing the health and wellbeing of the most vulnerable groups. Although plans were in place, feedback from some people about their care and support remained more mixed.

The launch of an initiative known as the 'Sandwell Story' provided the narrative of a significantly deprived area where health and social care were the key pillars. People need to be able to navigate access to adult social care and so local authority officers were placed in each of the 6 towns to provide people with links to support and advice to help them live well. This was funded by the Better Care Fund and began in January 2025.

Part of local authority plans related to digital strategy and the better use of technology, with the aim of promoting independence and improving care outcomes for people. However, currently just 20% of people had technology enabled care support in their adult social care provision with the local authority aiming to achieve 70% by 2027 to 2028.

Some measures were taken to prevent, reduce and delay people’s needs, however in some cases, this could be improved further. For example, there was feedback from people where a local authority supported 12-Week Pathway, had helped them in a variety of ways including with work experience, however other people felt they could have been supported to access longer term options which could have improved the outcomes for them.

The local authority worked with people, partners and the local community to make services available, to promote independence, and to prevent, delay or reduce the need for care and support. For example, one service offered lower-level support to prevent the need for adult social care and another provided prevention crisis support to the deaf community. Some partners felt more services could be offered by the local authority to work in more of a preventative way and that they did not always prioritise prevention, being more reactive to crisis.

Other feedback however noted recent investment in this area, with a new community contract focused on prevention in areas such as housing support, mental health care, food and fuel poverty relief, and debt management. Responses to demand had also led to the creation of some peer support groups such as community hubs and food pantries. Other prevention work had taken place with the VCSE, for example, a drug and alcohol partnership and some other partners felt the local authority had a strong focus on prevention.

Staff worked in partnership with others including the public health team and were kept informed of services to support people in relation to prevention. A multi-disciplinary team meeting was held monthly to gain knowledge of service provision and to make staff aware of what was available locally. This included key local charities, organisations and events offering support to people.

Several publications were aimed at preventing people’s needs in Sandwell including a Winter booklet which amongst other areas included information about hoarding and Ageing Well in Sandwell. Sandwell’s Town’s Directory August 2024 documented the available resources, including local authority services, with its statutory and non-statutory support groups, voluntary and community organisations that were available to help and support people in terms of prevention. There was training for staff at the front door enquiry service to promote services and embed the preventative approach. Issues covered included reducing inequalities, promoting wellbeing activities and directing people to support, advice and information on matters such as safeguarding, domestic abuse and homelessness.

National data from the Adult Social Care Outcomes Framework for 2023/24 showed 5.81% of people aged 65+ received reablement or rehabilitation services after discharge from hospital. This was significantly better than the England average (3.00%). However, by contrast, national data from the Short and Long Term Support for 2023/24 showed 67.06% of people aged 65+ were still at home 91 days after discharge from hospital into reablement or rehabilitation and this was significantly worse than the England average (83.70%). Further context provided by the local authority in relation to this data, showed Sandwell delivered approximately 1,220 episodes per 100,000 of the population, compared with the England average of 617. This showed an intentional strategy to promote independence and enabled more people to leave hospital earlier or receive a rapid response in the community, avoiding hospital admission and reducing the need for ongoing long-term care. This model prioritised prevention, ensuring people benefited from reablement wherever there was potential for recovery.

The local authority told us the demand for its services had increased with 5% more people receiving care and support in the last 5 years and 82% of its requests being from people in the community. From July 2024 to June 2025 there were 3,715 reablement episodes of which 73% were people being discharged from hospital, 21% of people did not require further care following this. The local authority was clear in its ‘home first’ ethos. Feedback from people about the reablement care offered and the adaptations provided were very positive. Comments included the Occupational Therapist (OT) that supported them was ‘wonderful’.

The local authority worked with partners to deliver intermediate care and reablement services that enabled people to return to their optimal independence. The local authority STAR (Short Term Assessment and Reablement) service and external promoting independence pathways ensured people received timely short-term support, reducing long term reliance on care services. The STAR service had a current Care Quality Commission (CQC) rating of Good. The demand for these services had increased from 2024 and response times from contact assessments to STAR assessments were quick with a median response of the same day which meant people continued to receive support and risks were reduced while they waited for a full Care Act assessment.

The local authority had a well-developed highly performing reablement service. They had built and co-delivered an integrated reablement centre of which they were the care provider. This 80 bedded flagship health and social care facility was described as the first of its kind in the West Midlands. The service aimed to support people back home from hospital and prevent hospital admissions, supporting 600 people since opening in November 2022. Future developments to this were being explored through the local authority transformation programme.

People could access equipment and minor home adaptations to maintain their independence and continue living in their own homes. People told us in their experience occupational therapy assessments and equipment delivery was swift without any significant waiting time. An unpaid carer told us when unsuitable equipment was being used by their family member to walk, the social worker had acted quickly to ensure more appropriate equipment was provided along with moving and handling training for the unpaid carer.

In 2024 to 2025 there were 259 disabled facilities grant awarded. Over 41,000 items of equipment were delivered in 2024 to 2025, with 95% arriving within 7 days. On 1 August 2025, 312 people had one or more equipment orders pending delivery of which, 81 people were waiting longer than delivery timescales. In most cases, delays occurred either because the person had requested a later delivery date or because the item was a special order. Waits were monitored by senior staff, providing visibility of delivery performance and an escalation route.

A trusted triage pilot was now delivering small equipment adaptation requests and from April to June 2025, 10,000 items were requested with 88% arriving within 7 days. Staff told us this was having a positive effect on the waiting list for OT assessment. The pilot enabled minor equipment requests to be fulfilled and had already reduced the waiting list from 17 weeks to 5 weeks.

Despite more positive feedback from people, the local authority reported 675 people waiting for an OT assessment in July 2025 with a median waiting time of 102 days and maximum of 265 days. The pathway through to OTs was reported by staff as being quick and easy, however people had been on a waiting list from April 2025. The aim of staff was to contact everybody on the list every 6 weeks to review their status and any changes. Staffing had been an issue previously but had been addressed through recruitment and a redesign of the service. At the time of our visit there was 1 vacant OT post covered by an agency staff member.

Challenges in recruitment of occupational therapists and waiting lists had created a back log in terms of Disabled Facilities Grant funding awards and delays for contractors, however, recent extra capacity had resulted in cases coming through more quickly than the previous year. Feedback from the local authority was that while there were periods of vacancy, agency occupational therapists were used to maintain capacity. This meant complex cases and disabled facilities grant assessments continued to be prioritised.

Staff gave positive feedback about recent changes to improve OT services. A clinic had been introduced where people could come and see what equipment was on offer. Staff felt the local authority were good at providing equipment options compared to other areas with offers included community alarms, key safes, fall detectors, flood detectors and movement sensors. In-house community alarms offered a 24/7 service, 365 days a year for assessment, installation and mobile response, including an emergency response to people who had fallen.

A separate sensory and therapy team delivered statutory services and supported people with visual or hearing impairments in addition to those who had dual sensory loss, seeking to maximise their independence, via equipment, training and annual planned reviews. Prevention Assessors picked up urgent work, for example, if someone had fallen, providing further support and advice.

The local authority had begun to integrate technology into its care offer through piloting an online self-help guide. Further development was planned to provide a digital platform to assess the need for equipment and respond to requests in a more timely way, which would contribute to reducing waiting times.

National data from the Adult Social Care Survey for 2023/24 showed 69.65% of people who use services found it easy to find information about support. This was similar to the England average (67.12%). However national data from the Survey of Adult Carers in England for 2023/24 showed 52.00% of carers found it easy to access information and advice. This was somewhat worse than the England average (59.06%).

Information from the Sandwell Adult user Survey 2023 to 2024 found for people that had tried to find information or advice, 69.9% found it very easy or easy to find. This was an increase from 67.3% in 2022 to 2023.

People using services fed back there had been inconsistent information provided to them at times, for example, in one case about dementia care, which had left people feeling unclear about their options. Other people felt like they had not been provided with all the information they needed and had to chase staff to get the correct care in place. Other feedback was the website for Sandwell had improved and that a list of available activities were published, but these could be out of date at times. People wanted correct, clear and timely information and advice in a variety of formats, as some people did not access IT.

A range of leaflets and information about adult social care services had been developed. These were accessible in a variety of ways including Braille, video or audio messages if this was preferred and some staff were trained in using sign language.​ Key updates and service information was distributed 4 times a year to all residents via a local newspaper delivered free of charge. ​

Staff told us there was a high proportion of people without English as their first language, so a language network had been developed to help people alongside translation, interpretation and training. This offered community-based English language learning, aiding vulnerable people in connecting with the community and accessing services. This meant people were now better able to tell professionals how they were feeling in English and the success of this had meant some people now volunteered to work with others as a result of improving confidence.

The biggest challenge for people in Sandwell was knowing which services were available to them. Staff told us there had been a focus on improving information over the last 12 months to let people know how to access support and the website had been significantly updated with translation options and easier navigation.

Senior staff told us issues of accessibility of information for people had been raised before and although digital accessibility was comprehensive and new technology utilised, they were aware not all people were able to access information in digital form and that monitoring was needed to prevent people from becoming isolated. They also wanted to keep reviewing the availability of languages on offer and access for those with sensory needs. As a result, ambassadors were being identified in the community and used as conduits to identify and support those with poor access to adult social care information and referral routes.

Staff provided information to people they visited, for example, offering a resource pack for the use of direct payments. Staff commonly made use of the technology already present in people’s homes and had easy read versions of resources and a library of resources specific to people’s needs.

Some partners felt there was a lack of collaboration with the local authority and staff did not always utilise their skills or knowledge to support people effectively. Other partners fed back reliance on some automated services which meant a lack of human contact. Website information was not always easy to access and information sharing felt uneven across language and cultural contexts.

Uptake of direct payments was lower in Sandwell. The majority of national data from the Adult Social Care Outcomes Framework for 2023/24 was considered worse or somewhat worse than the England average. For example, 29.04% of people aged 18 to 64 received direct payments. This was somewhat worse than the England average of 37.12% and for the same data source, 11.09% of people aged 65 and over received direct payments, which was again considered somewhat worse than the England average of 14.32%. From the same data source, 19.16% of people received direct payments, which was considered worse than the England average of 25.48%.

Data from the local authority showed as of 30 July 2025, 12 new people were waiting to attend decision panel for a direct payment with an average wait time of 20 days. Three direct payment processes were being set up at this time with an average time taken of 3.7 weeks to do this. When direct payments ceased it was usually for people who had passed away, moved to commissioned support or had gone into 24-hour care settings.

The local authority was developing their direct payments offer acknowledging lower uptake than the regional and national averages. Direct payment support services had been redesigned and retendered and there was a dedicated service to help people manage their direct payments with support such as employment and retention of personal assistants and further advice and information.

People had ongoing access to information, advice and support to use direct payments. This included a checklist and a number of fact sheets with subject matters such as getting started with direct payments, employing a personal assistant (PA) and using pre-paid cards.

Feedback from people who had used direct payments was mixed. One unpaid carer felt there was more of an emphasis on the financial details in their experience, rather than explaining and discussing direct payment opportunities during the assessment process.

Senior staff confirmed direct payments were part of the transformation programme and had been a key focus over the last 2 years. There had been a decrease in people taking up direct payments so increasing uptake was a key priority. The local authority felt staff had lost confidence and so had been carrying out training sessions for them to help improve this alongside other measures. A panel was set up around 3 months ago to improve direct payment practice by helping staff understand how to get the best out of using direct payments and reduce delays in their set up. Staff fed back this had significantly increased their knowledge of quality, creativity and clarity in direct payments usage.

There were problems recruiting PA’s in Sandwell with most people employing family and friends instead. Staff supported people with employment issues and in other areas practically, however there was a current wait as the support team were small. A recently changed commissioned service who now managed the payments for personal assistants had created some initial challenges too.

Staff were aware of current work to promote flexibility around options for direct payment usage. Staff told us about the creative use of direct payments, for example, by funding additional hours for a person with mobility issues to meet their needs on a holiday.

Partners felt support for people accessing direct payments could perhaps be more accessible for some communities as it could take up a lot of time for voluntary organisations to support people with processes. The system in place was described as inflexible and bureaucratic and not easy to adapt to people’s individual and fluctuating needs. There had also been a lack of understanding within teams about the purpose and potential of direct payments, leading to restrictive practices which could undermine individual choice and control. Innovation in service delivery, such as flexible use of direct payments for creative or therapeutic purposes, had not been supported by the local authority in the past and had been more restrictive.