Cumberland Council: local authority assessment

The local authority had worked with partners to strengthen their relationships since becoming a unitary authority. This included working collaboratively to agree and align strategic priorities, plans and responsibilities for people in the area. This work continued to embed at the time of assessment, but aligned priorities were supporting positive outcomes for people.

There was recognition from the local authority of the complexities of partnerships with health. Cumberland spanned across 2 Integrated Care Systems (ICSs), with an ICS covering the majority of Cumberland and another covering a smaller Southern area. The North East and North Cumbria ICS, which covered the biggest area, also spanned across a large area outside of Cumberland. Leaders told us the local health structures increased the complexity of their partnerships but partnerships with health had strengthened over time. For example, a senior leader told us the local authority and health partners were making decisions together with improved processes and governance. They also told us the local authority was an active system partner, in the wider ICS.

There was strategic alignment between the local authority and health partners. The Health and Wellbeing Board (HWB) supported local strategic oversight, with membership from local authority leaders and key partners from health and the VCSE sector. The work of the HWB also supported a more integrated strategic approach with health. For example, the Joint Health and Wellbeing Board (HWB) Strategy (2023) was designed to complement the Integrated Care Board (ICB) Integrated Care Strategy. A priority of the HWB strategy was to develop integrated approaches to health, social care and prevention services. A partner also told us there was strategic alignment and good relationships with the local authority and this was built from years of working together.

A senior leader told us there had been a more recent alignment which was supported by a Health and Care Summit in 2024, which enabled a focus on shared priorities. The summit was attended by the local authority and key partners and the leader told us it represented a significant change in the nature of discussions and strategic direction. There was said to be a renewed focus on health and social care supporting independence and enabling people to remain at home. This was also reflected in a partner’s feedback, who told us there had been a shift in focus to promoting people’s independence when people were being discharged from hospital.

There were systems to support local place-based relationships, with the North Cumbria Integrated Place Board (NCIPB) and associated sub-committee supporting Cumberland-based health and social care partnerships to deliver wider shared strategic aims. A senior leader told us these arrangements supported relationships at the local level. A partner also told us the NCIPB worked well, facilitated relationships and allowed discussion of system issues between key partners. The Lancashire and South Cumbria ICB, which covered the Southern area of Cumberland, was also included in place-based conversations to support oversight and joined up working for people in this area.

The local authority was working with system partners towards shared goals. For example, the local authority had adopted the Housing, Health and Care Programme, which spanned across the North East and North Cumbria ICS, with the programme co-created by a range of partners, including the North-East Association of Directors of Adult Social Services (ADASS), the Integrated Care Board (ICB), the Northern Housing Consortium, and the TEC Services Association (TSA). This involved an improvement initiative focused on delivering better, more integrated housing, care, and support so that people could be healthy, live well, and stay independent in their own home. This included a pledge of better housing for people with ‘complex’ needs and older people. This demonstrated partnerships through a system-wide approach.

The local authority had governance and oversight arrangements to support the use of pooled budgets, such as the Better Care Fund (BCF). The BCF was governed as part of a Section 75 (s75) (NHS Act 2005) agreement between the local authority and ICBs. The Cumberland Joint Commissioning Board (CJCB) reported to the HWB in relation to the BCF. The CJCB was responsible for monitoring finance, performance and risk. A partner told us partnership arrangements and governance around the BCF worked well and supported discussions over any disagreements. These processes supported effective oversight and scrutiny of the use of pooled budgets.

The BCF was being used to support people’s independence through a range of services and functions across Cumberland. For example, this included aspects of carers’ support, home adaptations such as through DFGs, the community equipment services, intermediate care and reablement, discharge facilitation and low-level homecare support.

There was also close working between the local authority and the ICB to commission some services. For example, there had been an enhancement of the local authority’s homecare framework to incorporate the delivery of Low-Level Health Care (LLHC) tasks on behalf of the ICB. This involved short visits to people’s homes to support them with healthcare tasks such as taking their medication. This partnership approach supported people’s independence at home.

The local authority worked with ICBs to support joint and health funding of people’s care. For example, a leader told us local arrangements included a set 50/50 split of funding between the local authority and health for people eligible for Section 117 (s117) Mental Health Act (1983) aftercare. S117 aftercare refers to free aftercare for people who have been detained in hospital under the Mental Health Act and meet certain criteria when they leave. The leader told us the agreed split funding was an informal arrangement, and discussions were ongoing with partners about strengthening funding agreements.

Partners were also generally positive about operational arrangements around joint funding. Staff teams shared there could be delays with Continuing Health Care (CHC) funding conversations, but they had close operational relationships with health colleagues. In an example, a person was supported to access health funding and was able to access an adapted property with care and support to meet their needs. The local authority continued to develop partnership agreements to fund people’s care and support.

The local authority had established partnerships to support service delivery and continued to pursue more integrated approaches with partners. For example, a transfer of care hub supported hospital discharges, which included both local authority and acute-based health staff. A partner told us the hub was established following challenges in discharge performance and these arrangements gave a better overview of discharges and strengthened relationships with the local authority. A senior leader told us the local authority was, in collaboration with partners, also moving towards a more integrated care model with health partners with the timeline for implementation still being established.

There were opportunities to review some working arrangements to support efficiency and reduce overlapping services. For example, hospital services within Cumberland used a ‘Health Care Practitioner’ (HCP) pathway to support discharges. This pathway supported people to return home and receive healthcare services from health staff with the aim of completion within 28 days. This was separate to the reablement pathway, and reablement could be accessed by people following the HCP. A partner told us the HCP had been commissioned during the Covid-19 pandemic, but there was a need to consider merging this with the reablement pathway and reduce hand-offs within the system. The BCF end of year report (2024-2025) also highlighted, on average, 50% of people remained on the HCP pathway on or over the designated 28 days. This was contributed to by delays in transfer to reablement pathways or in allocation and assessment of people by local authority staff. This was recognised as impacting patient flow and BCF resources were being used to support capacity and timely movement between pathways. The HCP and reablement pathways did, however, work closely to share capacity where required. The local authority continued to work with partners to support efficiency in discharge pathways.

The local authority was continuing to strengthen data sharing arrangements with partners. A staff team told us the local authority shared and received data from health, with an aspiration to strengthen this. In a positive example, the local authority had signed up to the Great North Care Record which would support staff to have up-to-date information about people they were supporting. Some partner feedback also reflected conversations about shared data collection systems to support some operational functions, with discussions ongoing.

The local authority monitored and evaluated the impact of its partnership working on the costs of social care and the outcomes for people. This informed ongoing development and continuous improvement.

The local authority used data to support measurement of the impact of the BCF. The end of year BCF report (2024-2025) highlighted mixed performance across BCF metrics. For example, avoidable admissions to hospital and discharges to a normal place of residence showed the local authority on track to meet performance targets. The report highlighted step up in virtual ward capacity and intermediate care bed capacity supported this. However, falls and residential admission rates were not on track to meet relevant targets. The falls prevention activity included both health and local authority initiatives and this was due to be reviewed more closely by the HWB. While the report also acknowledged a higher than target residential admission rate, there was a year-on year-decrease in admissions, and this was seen positively given the local ageing demographic. The local authority continued to work with partners through pooled budgets to support independence and positive impacts on people.

Partnership working and funding was supporting people’s independence. For example, a partner highlighted the shift of people returning home following hospital stays. They told us the use of bedded discharge pathways had reduced by around 60% over the previous 18 months, demonstrating the impact of the strategic alignment between health and social care on supporting independence. A staff team also told us multi-disciplinary working with health colleagues was supporting people to return home, including when people were admitted to hospitals outside of Cumberland. The local authority continued to work with partners to promote people’s independence following hospital stays.

A partner told us there was specific project work with the local authority to support people’s independence. In an example, they told us there had been a pilot between the local authority and ICB to support the discharge of people who had a stroke and support them in the community to prevent readmission. The pilot demonstrated 100 care hours had been saved and had improved people's independence and abilities.

Close operational work between frontline teams and health teams was also supporting people to positive outcomes. For example, a leader gave an example of a staff team working with community nurses to provide ‘wrap-around’ support for a person, which provided ongoing care and support, promoted their independence and supported them towards their goals. Staff teams also told us they worked closely with local health teams to help get people access to emergency interventions and help prevent admissions to hospital.

The local authority worked collaboratively with voluntary and charity organisations to understand and meet local social care needs but there was an opportunity to strengthen this approach.

The VCSE sector was included at a strategic level to support oversight, scrutiny and decision making. For example, the VCSE was represented on the HWB. A senior leader told us the VCSE advocated for individual communities and was listened to at the HWB. Some partners told us they had opportunities to interact strategically with the local authority including through relevant boards. A partner also told us they were heavily involved with the board at a strategic level. A senior leader also told us there was VCSE inclusion at the Health and Care Summit in 2024, to support conversations about health and social care organisations working together. This supported the local authority to understand and meet local social care needs.

VCSE partners gave mixed feedback on relationships with the local authority. For example, some partners told us they did not feel valued and could feel more dictated to than feeling like a partner. Some partners specifically referred to not feeling part of commissioning processes or new tenders with an opportunity to better coproduce services with the VCSE sector. Despite this, some partners felt there were good relationships with the local authority, with a partner telling us they were accepted as an equal and partnerships with senior leaders were strong. Other partners told us they met regularly with the commissioners, including through quarterly meetings with relevant staff and partners present.

There was some feedback from VCSE partners on difficulties around funding for the sector. For example, a partner told us their contribution to local services was not reflected in the low-level funding they received from the local authority. Another partner told us there was a lack of investment in the sector. A senior leader told us they recognised the very important role of the VCSE sector and there was ongoing work to allocate more funding to areas with higher deprivation, allowing VCSE organisations to be more sustainable for the long term instead of receiving annual funding grants. Funding continued to be a challenge for VCSE partners.

There were positive examples of use of the VCSE sector to support people’s independence. For example, a staff team told us there was a link worker from the commissioned carer service who attended a hospital each week to help identify unpaid carers so they could be supported. This arrangement was said to work well. They told us, however, this was not a consistent approach across all hospitals locally, with potential opportunity to expand this approach. The VCSE sector also worked within the discharge hub to support people to return home. For example, they could ensure a person’s home was warm and there was shopping in the house. These arrangements supported people’s safety and independence.