Cumberland Council: local authority assessment

The local authority was developing its approach to working with people, local stakeholders and using data to understand local care and support needs.

The local authority had recently launched its first Market Position Statement (2025-2029) which gave a clear overview of trends in the local population which might impact on local need. For example, Cumberland’s ‘super-ageing’ population was highlighted, with an expectation of a 35-40% increase in people over 65 unable to manage at least 1 activity on their own or admitted into hospital due to a fall, by 2040. The statement also gave market strengths, challenges and gaps, broken down by local areas, which supported a localised view of the market. This localised view was also reflected in feedback from staff and leaders, with a staff team telling us rurality drove the local authority’s approach to commissioning, which was locally based to respond to the issues of specific communities. This focused approach was beneficial for understanding the market due to the size of Cumberland and market differences across areas.

The local authority was developing its use of data to support understanding of local need. For example, a senior leader told us the Joint Strategic Needs Analysis (JSNA), which supported with data oversight of local need, was out of date but was being developed to better focus its scope for adult social care. In an example of data gathering to map future need, a staff team told us of a planned project to forecast residential care demand. They told us they currently used historical data, however, the local authority now wanted to enhance their approach, by using data such as from health partners to support a strong forecasting model. Strengthening data use presented an opportunity for enhanced understanding of local need.

Stakeholder and people’s input was also supporting market oversight, but this was still embedding. For example, the local authority had introduced a quarterly regional care managers forum (CRCMF), alongside Skills for Care, to gather provider voice around the local market. There was some mixed feedback on the effectiveness of provider forums from providers, but they were said to be improving. Providers also gave mixed views around whether they were consulted around the needs of local people, with some feeling they were and others not. A partner also told us they had been asked by the local authority to support information gathering from people about gaps in local services and what they felt was needed before services were set up. This aligned clearly to the local authority’s direction in including stakeholder and people’s voice to support local understanding.

There was use of external resources to help understand current and future local need. For example, the local authority commissioned the Housing Learning and Improvement Network (LIN) to undertake an assessment of the future need, over the next 10-15 years, for specialist and supported housing and accommodation. This supported the planning of future strategies, such as the housing strategy and the supported housing strategy. The local authority was using resources to support understanding and to plan appropriately for future needs.

The local authority was developing its approach to commissioning to meet local needs. With the recognised challenges of the Local Government Reorganisation (LGR) in 2023, the local geography and demographics of Cumberland, such as the ‘super-ageing’ population, a commissioning strategy had been drafted to help outline the local authority’s strategic commissioning priorities. The strategy was due to be imminently published at the time of the assessment and outlined the local authority’s intentions.

Despite local challenges, national data showed people had access to choice. The Adult Social Care Survey for 2023/24 showed that 89.58% of people who used services felt they had choice over their services. This was significantly better than the England average (70.28%).

The local authority was early in its strategic journey with key strategies still under development. Despite this, there was an aligned strategic focus evident across strategies. The new commissioning strategy had been developed in line with the Market Position Statement, the Housing Strategy, the draft Extra-Care Housing Strategy, the draft LIN Supported Housing Study and the draft Unpaid Carers Strategy. From the draft strategies reviewed, there was a focus on commissioning to promote independence and keeping people in their own homes, which was also in line with the wider Council Plan which included a focus on prevention and early intervention. Staff feedback also reflected a consistency in this approach, with a team telling us for example, planned new homes would include ‘future-proofing’ elements so they could be suitable for older people with mobility needs. This showed a consistent approach to shaping both care provision and housing for population need.

The new commissioning strategy set out the local authority’s priorities, which included market shaping activity such as increasing supply of housing with care options, such as extra-care, expanding ‘complex’ care access and choices including dementia care; transforming and streamlining equipment services, and transforming day opportunities to support choice and independence. There was also a focus on using outcome-based commissioning by ensuring service specification and tendering included strength-based approaches. This was recognised by the local authority as a continued area of development. Priorities were reflective of local need and showed the direction of the local authority, with action plans due to be developed within 6 months of the strategy being launched.

There was a strategic focus of the need to increase housing with care options to meet local needs. This was being supported by findings of the LIN Supported Housing Needs Study and the draft Supported Housing Strategy which was due to be completed in December 2025. Some the findings, which were due to form the basis for strategic priorities, included: the need for further extra care housing development; the need for supported housing for people with learning disabilities, autistic people and people with mental health needs; the need for fully adapted homes for those with physical disabilities, and supported housing for younger people. These were all potential long-term developments but mapped out the direction of the local authority in shaping housing with care.

The local authority used both independent sector services and inhouse local authority services (Cumberland Care) to support people. Inhouse services included residential services including respite and interim care beds, homecare services, shared lives and day opportunities. The homecare service included both a reablement team and a domiciliary care team.

Cumberland Care was undergoing a review to better meet strategic priorities. A senior leader told us there was a vision to specialise inhouse services to help fill gaps in the market. For example, inhouse residential services were reviewed to see if they could meet local need such as dementia care, intermediate care and respite care. This involved the closure of a residential service which was not suitable for these priorities, which allowed for the reprioritisation of funding. As a result of the first phase of the review, local authority data showed respite placements in Cumberland Care services increased by 25%, dementia service placements increased by 20% (compared to April 2023) and discharge to assess (D2A) placements increased by 20% during 2024/2025. There was also increased reablement and intermediate care bed capacity. The review was supporting the local authority to shape services to local need and to support people’s independence.

There were inefficiencies to Cumberland Care. For example, following a period of reablement, people awaiting an assessment and/or required ongoing homecare would be placed on an ‘interim’ chargeable homecare service provided by Cumberland Care. They would remain on this service until homecare was found. This involved a change from reablement care workers to interim care workers, who were not the same care team. A staff team told us moving people to an interim service gave the local authority more time to source an independent sector provider, but people were sometimes unhappy to be leaving the reablement service. This also meant some people would be supported by 3 different care teams across their care journey, increasing handovers between services, which risked impact on personalisation and quality of the services provided.

A senior leader told us the directive for staff was to limit the use of interim care as much as possible and this was also reflected in the feedback of a staff team. However, a staff team told us interim care could be a ‘bottleneck’ for people waiting for services and delays could be caused by lack of capacity, rurality of the person’s location, assessment delays and seasonal pressures. Data provided by the local authority on 10 July 2025 showed 39 people receiving interim care, with 14 of these people assessed for a new service and 25 awaiting assessment. The median time on interim care for these people was 60 days. There remained a need to better shape inhouse homecare services for people at the time of this assessment.

There were positive examples of market shaping since the formation of Cumberland Council. For example, the local authority used frameworks to support access and choice of local services. The homecare framework, for example, supported people to have a choice of care providers who had offered to take on their care package. Since its opening in April 2023, the local authority had supported the growth of the homecare market, enabling people to access more commissioned services. This promoted people’s independence and wellbeing.

Access to services to promote independence in more rural areas had also been supported by market shaping approach. For example, the local authority had worked with Community Catalysts to support ‘micro-enterprises’. Micro-enterprises, which were spread across Cumberland, helped to provide activities and support to people in hard-to-reach areas where the standard homecare market may have struggled to meet need. A staff team told us this was a good system, and micro-enterprises were listed for people on a website. These were self-employed personal assistants, some of which could also provide personal care. Data provided by the local authority stated there were over 40 micro-enterprises in local communities, which had provided support to 252 people, where it had been challenging to deliver services previously. This demonstrated a creative approach to overcoming geographical obstacles to service provision.

Staff were supported by the brokerage service to source services for people, such as residential care and homecare. However, some staff told us they sometimes would have to source specialist or out of area services themselves. Staff teams told us this could create pressure on them as they were not always clear on prices to agree with providers, and it increased their workload. A team told us this was not a regular part of their work, but sourcing an appropriate service, checking quality and agreeing prices could be a challenge.

People could not always access local care provision as capacity varied depending on their location within Cumberland. The local authority’s Market Position Statement demonstrated an understanding of where there were gaps and strengths in service capacity.

The rural nature of Cumberland created challenges for some people to access timely homecare. This was dependent on where people lived, with more urban areas generally having better access to provision. Partners told us there could be waits for homecare, but a staff team told us there were homecare services which specialised in supporting people in rural locations. They told us the homecare framework also ensured new providers were aware of the rurality of Cumberland and were asked for assurances about being able to provide services. Data provided by the local authority for February 2025 stated the average wait time for homecare to commence was 7.6 days, which showed a more limited impact on people waiting.

Older adult residential services across Cumberland met demand, but specialist residential service access was more of a challenge for people. A person’s assessment, for example, showed a person was able to access a local residential service, where their family could visit, which the person was happy with. However, the Market Position Statement outlined learning disability placements, mental health placements and dementia nursing placements were limited in areas of Cumberland. This could impact on people’s choice of service, with a relative of a person telling us their loved one was placed a distance away as there was no local provision and they wanted them closer to them. Staff teams also told us there could be challenges in sourcing these types of placements for people, including when people were being discharged from hospital, such as from mental health inpatient settings. They told us, however, they worked with partners to minimise delays in discharges. People could therefore not always access specialist local provision easily.

Local authority data showed most residential and nursing placements were made within 14 days, but some people could face longer delays. Between October to December 2024, 161 placements were made from a hospital setting to residential and nursing care homes. Of those 161 placements; 69 were made within 7 days, 53 within 8-14 days, 33 within 15-28 days and 6 over 28 days. In the three months from October to December 2024, there were 46 placements made from the community to residential and nursing homes. Of those 46 placements; 24 were made within 7 days, 7 within 8-14 days, 11 within 15-28 days and 4 over 28 days.

The local authority had provision of day opportunities, with both in-house and independent sector services, but there were gaps in this area. Staff teams and partners highlighted people with more complex needs, young people and autistic people, did not always have access to appropriate day opportunity provision. A staff team told us people sometimes had to go into residential respite instead if they could not access day opportunities. The distance some people had to travel to access day opportunities was also highlighted as challenging. A staff team also told us there was recognition of a high spend on transport to support people to access opportunities as there was not always local availability, and there were plans to better stimulate provision in areas where it was needed.

The local authority acknowledged there had been some challenges for people newly accessing services in the West of Cumberland. Providers had ongoing recruitment processes to support increased demand for requests for support. The new commissioning strategy also outlined a new day opportunities framework with improved access to employability and skills programmes and opportunities for providers to arrange their own transport. The framework had recently gone live and extended the day opportunities offer to also include a 24/7 model, with day opportunities now available during early mornings, evenings, weekends, and bank holidays. This sought to address challenges and better personalise support for people.

Housing with care options, such as extra care and supported living, were recognised by the local authority as gaps but there was ongoing work to increase this provision. A senior leader told us there was ongoing work to increase extra care provision, but a staff team told us people could be waiting prolonged periods to access this and could end up in residential care. Commissioning of new supported living properties was a particular challenge as there was a lack of appropriate local housing stock to meet specifications. Staff teams told us supported living properties for younger people trying to build their independence, including those with mental health and substance use needs, were difficult to access locally. The upcoming Extra Care Housing Strategy sought to address a lack of housing with care options, but current provision could be a barrier to strategic objectives of reducing the need of residential care home services and promoting independence.

Unpaid carers did not always have readily available access to breaks. Some partners told us there was a shortage of respite provision. They also told us people who self-funded their provision were more likely to be able to access regular services than those who accessed respite through the local authority. This was in line with some carer feedback. A staff team told us they encouraged people and their carers to book respite provision well in advance as services were often booked up. A staff team also told us there was a set offer for respite of 4 weeks which could be used flexibly by carers, who were said to be reassured the offer was there and they could book respite flexibly directly with providers or through the brokerage service. Staff teams were also creative to find solutions when there were difficulties accessing respite. For example, a staff team told us how a direct payment was used to support a person to go on holiday with their family with support in place as they could not access respite initially. Shared lives, personal assistant support or out of area respite were all also used if appropriate.

National data reflected some of the challenges for carers accessing respite or breaks. The Survey of Adult Carers in England for 2023/24 showed 5.12% of carers accessed support or services allowing them to take a break from caring at short notice or in an emergency. This was worse than the England average (12.08%). The survey also showed that 9.44% of carers accessed support or services allowing them to take a break from caring for more than 24 hours. This was somewhat worse than the England average (16.14%). This showed most carers were not accessing services to take short term breaks from their caring roles.

In response to concerns raised about respite, the local authority outlined respite provision had been increased by 25% and provision was spread across Cumberland. Data provided by the local authority showed 30% of respite capacity was used between 01 April 2025 and 31 August 2025, which left 70% available for people. BCF funding for 2025/2026 for respite had also doubled internal Cumberland Care respite capacity to 8 beds compared to 2024/2025. BCF funding also supported beds to be ringfenced for pre-planned respite, as well as emergency respite if available.

The local authority followed Northeast Association of Directors of Adult Social Services (NE ADASS) protocols for placement decisions out of area. Staff teams told us people were placed out of area as a last resort and when people were placed out of area, where it was not their choice, they supported people to move closer to home when possible. As of February 2025, 118 people were placed out of area, with 16 made in the 12-month period from January 2024 to January 2025. Of the 118 out of area placements; 42 were due to the persons choice, 44 specialist needs, 7 lack of capacity in the sector and 25 were made out of area as a result of LGR in 2023.

The local authority had clear arrangements to monitor the quality and impact of the care and support services being commissioned for people and it supported improvements where needed. This included dedicated resource for both independent sector and inhouse service provision.

The local authority was responsive to risk in services and worked with care providers to make improvements. For example, where there were quality concerns about a provider, a provider could enter the Quality Improvement Process (QIP) where the local authority would work with the provider and partners to address concerns and support improvements. This helped the local authority to maintain oversight of provider performance and improvement. The local authority also worked closely with providers and could place embargoes on placements where required, but they tended to work with providers and agree voluntary embargoes with them instead. Where embargos were in place, all new care packages were suspended, rather than just local authority commissioned placements. This was a robust approach to protecting people from potential risks while improvements were made.

While there was a dedicated quality assurance and governance team, the team was currently more reactive to concerns and was limited in making proactive visits to care providers. There was an aspiration to visit all care providers at least once every 2 years, but a staff team told us this was more of a ‘desktop’ exercise as an interim measure due to, in part, staffing pressures. Some providers also told us they had not had recent quality visits, but a provider who had received a recent visit told us this was a positive experience and felt like a partnership. The local authority remained responsive to risk, however, with targeted visits where there were concerns.

The local authority collected information from partners and people to support oversight of the quality of services. For example, a staff team told us there was a form for partners to share information where there were concerns about services. A regular 'RADAR' meeting also supported the local authority and partners to flag if there were concerns about a provider and supported joint decisions on which agency would take action to help improve the service. A staff team also told us frontline workers were encouraged to collect information where there was a change of provider request in case there were concerns about the services provided. The local authority also used people’s voice to support quality assurance of providers. A staff team told us Healthwatch had gathered people’s opinions on services on behalf of the local authority to support their processes. This supported oversight and quality of services as the local authority could respond to concerns.

As of January 2025, 2 homecare providers had agreed to voluntary embargos in the previous 12 months. The reasons for the suspension were concerns about quality, management and leadership, staffing, and concerns raised by stakeholders. Between January 2024 and August 2024, 5 residential providers agreed to voluntary suspension of placements. The reasons mainly related to concerns about the quality of care provided, safeguarding, staffing and management and leadership issues. Embargos were used to support improvements to care quality and to help people stay safe.

Quality monitoring of out-of-area services continued to develop. As there was a large backlog of annual reviews, there was a risk of a reduced oversight of the quality of services provided for people placed out of area, unless the local authority were informed by the host authority. The local authority, however, had recently signed off on using a ‘Host Protocol’ which was an agreed monitoring system for out-of-area placements across multiple local authorities within the region. A senior leader told us this was still being operationally established but would support the monitoring of safety and quality of people within services outside of Cumberland.

The local authority was due to refresh their Market Sustainability Plan (2023), so it aligned with their recent Market Position Statement. The most recent plan was also before LGR changes, although it did include information specific to Cumberland.

The local authority used funding from the Department of Health and Social Care (DHSC) Market Sustainability and Improvement Fund (MSIF) to increase the fees paid to providers. The Commissioning and Procurement Risk Register outlined there had been engagement with the local market around their uplift for 2025 to support the sustainability of the sector.

There were financial pressures on the local market which put sustainability at risk. This included inflationary pressures, higher wages and increases to national insurance. Some care providers told us provider fees from the local authority were not supportive of their sustainability, as although they had received a recent uplift, this did not cover the increase in their costs. They also told us there could be delays in the uplifts, which risked their ability to fund their services.

The local authority took steps to support providers financially, such as through an in-year uplift for residential services and uplifts in response to inflationary and national insurance pressures. There were also price bandings based on level of need in residential care. The local authority highlighted rates for homecare providers were designed to enable providers to pay the real living wage to help attract and retain a skilled workforce. The local authority also used price bandings for homecare based on how rural the area was. The local authority continued to support providers with their sustainability, but there remained challenges in a difficult financial climate.

Similarly, the local authority’s inhouse services, Cumberland Care, were also facing financial pressures. As part of their ongoing review of Cumberland Care, the local authority was completing their asset reconfiguration, rationalisation and investment to support the sustainability of these services. There were projected savings over and above estimates which would support long-term sustainability of these services.

Recruitment was a key challenge for local providers. Most providers told us it was difficult to recruit enough staff. A partner told us some more specialist services, such as those for mental health or learning disability needs in the West of Cumberland, were particularly fragile because of issues with staff recruitment. Most providers felt the local authority was not supporting them with their recruitment. Providers were using overseas workers to fill gaps in their recruitment and a staff team told us there was engagement and monitoring from the local authority as there needed to be enough work for providers to sustain this model of recruitment.

The local authority recognised the recruitment challenges of providers, and this was reflected in senior leader feedback and within the Market Position Statement. In response to these challenges, the local authority was promoting dialogue about recruitment challenges within provider forums, promoting ethical overseas recruitment, promoting the use of technology to streamline tasks, promoting the providers using the real living wage, supporting the development of an adult social care workforce strategy and partnership working with Skills for Care to provide training and support. There were also specific schemes to support workers to access employment. For example, a displaced care worker scheme, which supported workers who had lost their sponsorship to connect with potential care provider employers who had Home Office sponsorship status.

The local authority adopted commissioning frameworks to help support stability and sustainability of the local market. For example, frameworks supported agreed pricing structures with providers; market stability through longer term contacts and demand planning; streamlined procurement and encouraging improvements and innovation through mini competition between providers. There was some feedback from care providers, however, frameworks did not always support sustainability. Some providers felt there were too many services on the homecare framework making it more difficult to acquire care packages and there had been an increase in non-local providers which made competition a challenge for smaller providers. This was also reflected in a staff team’s feedback, who told us some providers would contact them asking for more care packages, but the local authority were required to follow their framework process. The local authority had recognised the number of providers on the homecare framework and had closed it to new providers to support market sustainability.

There was some provider feedback that commissioned services could be better planned for providers. For example, they told us homecare was not always commissioned so providers could support people in similar areas to reduce the need for carer travel. This led to spread out care packages and there was a need for more oversight of this. A staff team, however, told us the local authority did have oversight of data around care packages being grouped more closely together. They told us they recognised it was unsustainable for care providers to only have spread out care and sought to support the providers with this.

Information provided by the local authority stated between January 2024 and January 2025, 47 homecare contracts were handed back totalling 548.25 hours. The reasons why packages were handed back were: the provider being unable to sustain care packages due to rurality; providers not accepting new home care rates; providers exiting the area and staff leaving their employment. No supported living contracts were handed back to the local authority in the same period.

For the same period, for residential and nursing home services, there had been a single residential provider home closure which resulted in 15 people needing to be moved elsewhere. The reason for the closure arose from concerns about the quality of care and the resultant actions taken by CQC to remove their registration. In addition, a total of 4 placements were handed back by a specialist care provider due to longer term sustainability issues because of staffing and location of the service.

The local authority, alongside Skills for Care was supporting providers to access training opportunities and best practice through their provider forums. In a positive example, a care provider told us there had been support for overseas workers to access training because of this being raised as an issue at a provider forum. There was also some provider feedback there was a continued need for more training for when supporting people with more complex care needs, which was increasing more recently. The local authority was continuing to embed support for local workforce development.