Cumberland Council: local authority assessment

The local authority had developed their systems to support the management of escalating risk. They had implemented a Safeguarding Operational Support Group meeting which staff could attend to discuss people they were working with where there were concerns about high risk. There were a range of managers at the meeting and staff who attended told us they received strong support and guidance. Staff also told us they used their manager for support where there was risk. A leader also told us support for staff in this area was more informal. This meeting was for internal staff and was not attended by key partner agencies, but the local authority highlighted this was used as a complementary tool for staff alongside statutory safeguarding processes which included a multi-agency approach.

The local authority understood where there were risks to people’s well-being across their care journeys. In their self-assessment, the local authority highlighted how their Allocation and Waiting Well Procedure had enabled them to develop more robust oversight and management of risk. Staff teams spoke consistently about how this procedure was used effectively in practice. They also told us there were good relationships between teams, which enabled discussions about which team would be the most appropriate to support the person and ensured safe transfer.

The local authority had systems to support people out of hours. There was an urgent care team with dedicated staff who were Approved Mental Health Professionals (AMHPs). This team also covered the AMHP services in work hours which a staff team told us reduced the number of handoffs between different professionals and promoted continuity. All out of hour’s work was recorded on the local authorities’ electronic system, which supported safe handover of information to other teams. A partner told us the service was responsive in relation to Mental Health Act Assessments, which were completed without delay.

The urgent care team had access to resources and were able to put immediate services in place to support people to remain safe. A staff team told us they received good management support and there were clear escalation systems for out of hours work which worked well. For example, in a crisis situation due to floods, they were able to get groups of staff together quickly to support people after escalating the risk.

Information sharing protocols supported safe, secure and timely sharing of personal information in ways that protected people’s rights and privacy. Staff teams told us there were good information sharing agreements in place with housing and other partners. The local authority had a shared information system with health to support hospital discharges. Staff told us this ensured everyone involved with the person’s discharge had the most up to date information. Carers assessments, completed by the commissioned partner, were recorded on the local authority’s electronic system so relevant staff could access them. An area where staff teams told us information sharing was more difficult was for people with mental health needs. They said not having access to a person’s health records within the mental health trust system made information sharing more difficult on a day-to-day basis, although in an emergency, managers ensured the necessary information was shared. Other health records were also available for teams through the Great North Care Record, for example.

Most hospital discharge processes and pathways were clear. Local authority staff were part of a Transfer of Care Hub within the acute hospitals, which was an integrated discharge team with multi-disciplinary staff. Staff teams told us the hub model worked well, and the multi-disciplinary team met every day to discuss and agree people’s discharge pathways and the support they required, which enabled safe and timely discharges. The local authority also had specialist hospital brokers to source homecare and care home services, who were also part of the hub. There were systems in place to highlight urgent needs to brokers so these could be prioritised appropriately. Staff teams told us this worked well.

Some specific pathways for hospital discharge were not always clear. For example, the local authority often worked with a different health trust for people living in the South of the Cumberland area, in Millom. Partners told us they had worked with the local authority to improve discharge processes in this area, but staff teams said there still could be some confusion with this pathway. They told us, for example, there were occasions where care was being sourced for people on discharge without the local authority being aware and so this was not recorded on local authority systems. Referrals for this area were low in number and staff teams had taken steps to support partners to follow transfer of care hub processes. There was opportunity to continue to strengthen this approach.

Feedback from people about their experiences of hospital discharge was mixed. Positive feedback included examples of staff going above and beyond to provide emotional support to the person and ensuring their discharge was safe and well planned, whilst there was other feedback about a lack of communication prior to discharge. Care providers also shared mixed feedback. Partners told us there were some difficulties with embedding the local authority’s home first approach as more people with complex needs were being discharged home and there were delays in sourcing care provision to meet their needs as it was more difficult to find a care provider. This was also confirmed by staff teams we spoke with.

Staff teams told us they could access support to ensure people’s homes were suitable to be discharged to from hospital. They accessed ‘Homelife’, the council’s home improvement agency which supported people with access to funding, information and signposting for in relation to home improvement. Examples included cleaning the person’s home and putting in appropriate flooring for someone who used a mobility aid. They also told us about an initiative to give people access to a ‘modular washroom’ to make their homes suitable following hospital discharges or to prevent hospitalisation. This was a self-contained unit which was built offsite and could be installed into someone's home for as long as it was needed rather than more intrusive adaptations.

Partners told us there were delays for people being discharged from specialist mental health hospitals, due to a lack of community provision, which could be significant. They also said there could be improvements with information sharing at the early point of discharge planning which could impact on a person’s timely discharge. A leader told us there had been recent discussions with partners to discuss all the care options available to people with mental health needs on their discharge from hospital, including intermediate care pathways.

Transition arrangements ensured people had a seamless transition of their care and support when responsibility moved from children to adult services. The local authority had transitions-focused practitioners who worked in the learning disability, autism and transitions teams. They attended Education Health and Care Plan (ECHP) reviews for young people from the age of 14, which helped to create links with adult social care before an assessment was required. The transitions worker completed the assessment with the young person and their family and then the person would be transferred to another staff member for ongoing work. This was so the transitions worker could support new young people coming to the service. Staff teams told us this handover could be challenging for the young person; due to the relationship they had built with the transition’s worker. If a young person’s primary need was mental health, the mental health team would complete the assessment.

Staff and leaders said there were good relationships between children’s and adult’s services which helped to ensure young people were identified and not missed out of the process. This included a meeting every 8 weeks with children’s services, relevant partners and the young person (if they wished to attend) to discuss transitions planning. The transitions workers also worked closely with schools and special education needs coordinators to identify young people who might be eligible for a Care Act Assessment and other young people who may require support.

Overall people’s feedback about their experience of transitions was positive. We heard about transitions workers becoming involved with the young person at an early age and the assessment being carried out before the person transitioned into adult services. Some more negative feedback we received included lack of communication. There were some staffing pressures for the transitions service due to increasing numbers of young people going through transitions, which could impact on elements of the service and consistency of approach. For example, staff could not always attend initial ‘year 9’ review meetings and other staff had to pick up transitions work. The local authority told us they were fully staffed to established transitions social worker posts and staff were supported by the wider learning disability, autism and transition teams when demand dictated the need. They told us there was not an expectation to attend ‘year 9 reviews’, but staff were invited to begin the transition process at year 9 and work was prioritised accordingly.

There was mixed feedback from care providers about how the local authority ensured people received coordinated and safe support when moving between services. Some providers described a good transition process involving the person and their families whilst others had experienced some difficulties due to lack of information and contact from local authority staff.

The local authority’s system for contingency planning to ensure preparedness for possible interruptions in the provision of care and support, were not always effective. Partners told us contingency planning for carer breakdown and for people with more complex needs was poor and at times resulted in the person and carer being admitted to hospital due to lack of alternative support. Partners said there needed to be stronger contingency planning to stop the situation reaching crisis point.

Staff had good awareness of the importance of contingency planning. They spoke consistently about ensuring there were contingency plans in place as part of support planning with the person and told us managers checked this when they approved the care plan. They shared examples of care they had put in place to support the person in an emergency due to carer breakdown, which included reablement support, extra calls in the night and respite care. However, staff also spoke about challenges to find care providers and arrange care for people with more complex needs. This gap in provision, impacted on contingency planning and the alternative options for people when their current care was no longer available.

Carers feedback was mixed in this area, with some carers telling us they had support to develop contingency plans whilst others did not. A leader acknowledge contingency planning for carer breakdown was an area for development and told us this was something the local authority were addressing as part of the new commissioned carer service contract.

The local authority had clear processes to respond to interruptions to people’s care and support such as in the event of provider failure, emergencies and service disruptions. Their Service Interruption and Provider Failure Policy had been initiated several times in relation to home care providers. An example of this was when a home care provider could no longer provide a service and people’s care was transferred to another provider. The local authority was able to work with the care providers to agree transfer of staff to enable people to receive consistent care.