London Borough of Richmond upon Thames: local authority assessment

The local authority worked with people, partners and the local community to promote independence, and to prevent, delay or reduce the need for care and support. Leaders told us they promoted prevention across the whole local authority with a focus on access to reablement, community health support, and digital tools. National data reflected this approach. Data from the Adult Social Care Outcomes Framework for 2023/24 showed 94.49% of people who received short-term support no longer required ongoing support, significantly above the England average of 79.39%.

Staff spoke passionately about the importance of prevention, such as using care technology to minimise the risk of falls. Staff worked creatively with people to provide practical support to prevent needs from escalating, for example, supporting a person with their communication needs during a housing appointment. An unpaid carer for an autistic person described how funding for a personal assistant aimed to promote their family member’s skills and independence, reducing reliance on care services in the future.

The Making Every Contact Count (MECC) initiative aimed to ensure people did not have to keep repeating their story or being referred on multiple times. Staff were required to attend MECC training to aid their conversations with people. This initiative was central to the prevention agenda, and the staff gave us examples of the practical advice provided, for example a person receiving advice on benefits could be given additional support around keeping warm in winter.

Access to appropriate and affordable housing and homelessness were central challenges in Richmond which impacted on peoples’ wellbeing and led to the escalation of care and support needs. The local authority worked well across the organisation and with partners, such as housing providers, to address these challenges and reduce the need for care homes. A specialist housing Occupational Therapist championed inclusive and flexible design for disabled and older people, advising on the build and design of supported and general housing. For example, recommending contrasting colours in flooring and kitchens to support people with visual impairments. They had published a design guide developed to inform the design of new builds. Staff highlighted an innovative homeless hub, due to open imminently, which would bring together services under one roof and support those people who potentially had care and support needs. This service aimed to target people who did not actively approach the local authority, and preventing their needs from escalating.

Care technology supported prevention, promoting people’s independence to enable them to continue living at home. Staff provided examples, including one in which they had arranged for automated blind tilts to be fitted, increasing a person’s autonomy and wellbeing and reducing the need for paid carers.

The local authority had developed a framework which was central to embedding prevention across the organisation and wider community. Public Health sat within the same directorate as Adult Social Care, which helped promote a shared vision and commitment to implementing preventative public health initiatives. For instance, care homes received targeted guidance around risk management in hot and cold weather.

The local authority told us their prevention agenda focused on people at greatest risk of a decline in their independence and wellbeing. Specific consideration was given to supporting unpaid carers preventatively. The local authority worked with unpaid carers around contingency planning, aimed at preventing people’s needs from escalating in an emergency. Staff told us contingency planning was written into carer’s assessments, such as respite options in an emergency.

However, a carer told us they had not received support when their family member was diagnosed with dementia. A gradual escalation of needs led to a crisis and emergency care interventions. A partner confirmed current provision tended to cater to those with more advanced needs. The local authority had recognised there was a gap in this area and were collaborating with key partners to develop a dementia awareness and prevention programme. This included the remodelling of dementia day services to target people in a more preventative manner.

The local authority collaborated with partners to target support to people who did not have identified care needs but were at risk of a decline in their independence and wellbeing, such as door sensors for a person experiencing domestic violence. There was a focus on reducing pressure on acute health services, including monitoring the health of people with learning disabilities who were more likely to be admitted to hospital and enabling the voluntary sector to identify and target support to frequent attendees at Accident & Emergency.

People with mental health needs faced challenges, such as waiting times for support which increased the likelihood of their needs escalating. The Local Authority was actively addressing this with partners through several initiatives, such as the South West London Integrated Care System strategy, which included a preventative service to support people who presented in a mental health crisis.

The local authority had taken steps to identify people with needs for care and support that were not being met. They had worked with Kingston Hospital to reach unpaid carers who did not recognise themselves as carers. Joint work with partners in mental health also aimed to increase representation of ethnic minority communities in early intervention services, targeting people whose needs were not currently being met.

The local authority had arrangements to monitor and evaluate the impact of its prevention strategy and the outcomes for people and the community. Data had been used to measure the outcomes for people who had been supported to remain at home through a ‘Home First’ approach.

The local authority worked with partners to deliver intermediate care and reablement services to enable people to return to their optimal independence. In 2024–25, discharge timeliness improved significantly, with average discharge times reduced by 3.08 days compared to the previous year. National data also reflected this positive picture, with the Adult Social Care Outcomes Framework showing 96.88% of people aged 65 and over remained at home 91 days after discharge into reablement/rehab, well above the England average of 83.70%.

Staff told us intermediate care beds were available, which people might use if they were ready for hospital discharge but needed more support to enable them to return home. Staff said the success of reablement within people’s homes meant intermediate beds were used less frequently. They were still used to support a return to optimal independence and prevent long-term admission to residential care, such as an older person who stayed in an intermediate care while their home was being adapted. A partner confirmed there were good quality intermediate care services in Richmond.

Reablement in Richmond was provided through the Richmond Response and Rehabilitation team (RRRT) and a separate Mental Health Reablement team. Reablement provided integrated personalised support to people to prevent deterioration in their well-being. It helped avoid unnecessary admission to hospital and supported people being discharged from hospital to regain their independence. The reablement teams included professionals from different disciplines who worked together effectively, with clearly defined responsibilities focused on supporting people to meet achievable objectives and improved outcomes. A person described how reablement had supported them on discharge from hospital, enabling care visits to reduce as they regained their independence.

There were three contracted providers who delivered reablement support funded by the local authority. Local authority staff worked in partnership with providers, meeting weekly to provide guidance, help set achievable aims and monitor people’s outcomes. Voluntary services also had a key role in supporting people’s reablement. Local organisations worked in partnership with RRRT, for example supporting people with decluttering or shopping to enable them to be discharged from hospital.

The local authority told us access to equipment and home adaptations was central to supporting independence and delaying or preventing the need for an increase in care packages or development of care needs. Staff said they encouraged people to consider installing equipment before opting to set up care packages. An unpaid carer described how their relative had benefited from equipment to minimise the risk of falls, which provided reassurance and enabled them to continue living at home. Staff had provided equipment to another person to enable them to be discharged home promptly from hospital.

The local authority had a specialist occupational therapy team who worked closely with other frontline teams, including carrying out joint visits, to ensure people’s needs for aids and equipment were met. Staff in other teams and organisations, including in voluntary services, had been trained to become trusted assessors, providing minor aids and equipment to people they were already in contact with. This helped avoid unnecessary referrals and supported the principle of Make Every Contact Count where people only had to tell their story once.

The occupational therapy team also worked in partnership with the Home Improvement Agency in the assessment and delivery of the Disabled Facility's Grant. Through engagement with housing providers, a specialist occupational therapist promoted more accessible housing design, which helped protect the Disabled Facility’s Grant for people at greatest need, by delaying people’s needs from escalating.

As part of their transformation programme, the local authority had invested significantly in developing smart care technology to help people remain healthy, independent and to reduce the need for care services. Staff were passionate when describing the way technology could promote people’s wellbeing and improve outcomes. Support was tailored and personalised. Technology assisted unpaid carers in their role, as well as the person being cared for, such as installing a smart bulb which a person could turn on remotely from their bed, reducing dependence on their unpaid carer.

The local authority acknowledged that there was a lack of responder service in the borough which may impact on the support available to some people living alone without family or friends to support them and could potentially lead to increased admissions to hospital.

The local authority had joined other councils to commission an external agency to provide equipment. The agency went into receivership immediately prior to our assessment. The local authority had responded effectively to source equipment from a new local provider and managed the transition safely. They had applied learning from the previous contract, setting up arrangements to enable people to receive equipment promptly. Staff told us leaders had communicated effectively with them during the changes. Interim arrangements ensured those most at risk had been prioritised during the transition and to ensure information and support was provided to people while they waited for equipment. It was too early for data to evidence the new arrangements had been embedded fully but the local authority had demonstrated it had put safe and effective arrangements in place to manage the provision of aid and adaptations.

People could access information and advice on their rights under the Care Act and ways to meet their care and support needs. Most people contacting the local authority for the first time spoke with the First Contact team, which had a key role in ensuring people accessed good quality information and advice. Detailed information was also available on the local authority’s website. National data indicated the local authority was slightly better than the national average in this area. Data from the Adult Social Care Outcomes Framework showed 70.00% of people who used services found it easy to find information about support in 2023/24, compared to England the average 67.12%. Similarly, national data from Survey of Adult Carers in England (SACE) 2023/24 showed 69.39% of carers who find it easy to access information and advice, significantly better than the England average of 59.06%.

Some people and partners told us access to information was challenging for people who did not have a named contact in the local authority or did not use the internet. The local authority had recognised this and had a programme to support people who were digitally excluded, for example by providing tablets to people to help them access the internet. They also funded a wide range of community and voluntary organisations to reach into the community and provide information to people, such as in local coffee mornings. This included charities who could provide specialist advice on medical conditions. As part of this funding, an information navigation service had been set up by the Community Independent Living Service (CILS). Staff described working well with the information service and individual organisations, signposting people who needed more support to access information.

Some people and unpaid carers said it could be confusing to access information across so many different systems and organisations. They told us the local authority had taken steps to support people’s access to information about the local authority and partner organisations. The local authority published a weekly online newsletter and held a popular annual ‘Full of Life’ fair, attended by older people, which gave access to multiple partners, such as the police and trading standards. People told us the fair was a great way to find information on a wide range of topics.

Due to the number of self-funders in Richmond, some people who required advice did not have services arranged for them by the local authority. People and unpaid carers told us this could make finding information more of a challenge. The local authority was committed to improving self-funders access information and staff across the local authority reflected this commitment. For example, staff described sharing information on how to commission services and financial advice on how to pay for care.

The local authority was committed to increasing the use of direct payments to improve people’s choice and control about how their care and support needs were met. Direct payments were promoted through a named commissioner, specialist team and a champions network. National data from the Adult Social Care Outcomes Framework for 2023/24 demonstrated the local authority was performing well in relation to direct payments, with 35.30% of total service users receiving direct payments, somewhat better than the England average of 25.48%. Data provided by the local authority also showed support for unpaid carers through direct payments had increased significantly over recent years. In 2022/23, 109 unpaid carers received a direct payment, and by 2024/25 this had increased to 267. Data from the Adult Social Care Outcomes Framework highlighted that 100% of carers receive a direct payment in Richmond.

People and their unpaid carers gave us examples where direct payments had improved outcomes and wellbeing. A young person with autism who was at risk of refusing care had used direct payments to employ a younger personal assistant who they felt comfortable with in the local community. Unpaid carers told us direct payments supported them with their physical and mental health, such as purchasing a massage session.

Staff ensured direct payments were linked to clear outcomes, such as increase in confidence or skills. Staff spoke positively about how direct payments supported choice and personalised care, such as funding training for a person with mental health needs so they could move into paid employment. Staff supporting people being discharged from hospital described practical arrangements to ensure equal access to direct payments, which did not delay discharge.

There was wide-ranging support for people around direct payments. Social work staff described how finance staff could join them on visits to people to provide advice around completing forms. The local authority funded a local organisation to ensure people had ongoing access to information about direct payments. Feedback from people and unpaid carers was mixed in relation to this support. One unpaid carer told us they had found the support helpful, however other unpaid carers said they did not have enough support with the system, and remained confused, around the flexibility and restrictions when using a direct payment.

Partners told us there was scope for using direct payments to facilitate more creative support options for people with dementia. The local authority reviewed the uptake of direct payments on an ongoing basis, looking at data and trying to understand why people might chose or refuse direct payments. They demonstrated a recognition of the challenges people might face and were taking action, for example improving systems and developing support for people who might not be able to manage direct payments themselves.