Plymouth City Council: local authority assessment

Summary of people’s experiences

People shared with us their experiences of care and support in Plymouth. Positive feedback from people was their assessments considered their wishes and views, involving the people closest to them. People were supported to identify their needs and goals to ensure these were relevant and meaningful for them. 

Some people, however, told us they did not have an allocated worker, and felt getting their care reviewed could be difficult. Other people had different social workers allocated and felt these changes were not always communicated. However, another person told us they had the same social worker for a long time and appreciated the continuity of care. 

Timeliness of assessments were mixed, with some people telling us these were quick however others mentioning delays. Positively, people told us they had the direct contact details for relevant teams and felt confident to make contact, as they trusted them and felt they would be listened to. 

People provided a range of examples of where steps had been taken to reduce barriers to care and reduce inequalities. One person with lived experience had worked with the local authority in relation to some work to improve services and felt the impact of being part of this had a positive and profound impact on them. Feedback from people in relation to the community Well-being Hubs reflected people were positive about what these offered and the benefits for them. 

An unpaid carer was happy the placement offered for their family member was close to home, so they could visit them often and the quality of care provided was good. Another unpaid carer had some difficulty in finding a day centre placement which was close enough to their home however with accessible transport.   

Summary of strengths, areas for development and next steps

Strengths based practice was an area identified which could be improved when assessing people’s needs. Work had already been undertaken by the local authority in relation to Care Act assessment and reviews to reduce waiting lists. Support for unpaid carers was positive overall although respite was an area people, staff and partners all told us could be improved. Data was used to identify and support young unpaid carers. Financial assessments were carried out in a timely way and an online assessment tool had been developed to make this process easier. Staff told us they were confident in relation to arranging support from an advocate with the process and the advocacy offer being good. Partners felt people were not always offered advocacy support when this could have benefitted them. 

National data for direct payments was similar to the national average. Plans were underway to bring the direct payments service back to the local authority so this could be developed further. Work was planned in relation to occupational therapy to improve management of work and waiting lists. Following some challenges around delivery of equipment, the local authority was working closely with the equipment provider to address these. There was an increased interest in technology by the local authority and in the use of creative design solutions, for example, in housing adaptations. Reablement supported people to increase their independence on discharge from hospital, with other teams able to support people including an intermediate care service if more urgent support was required. A range of work took place across Plymouth to prevent, reduce and delay people’s needs for care and support, from Well-being hubs, to staff teams and public health initiatives. The local authority was keen to do more work to tackle some of the health inequalities identified through their data. 

Numerous examples were provided by people, staff and partners in relation to how different communities in Plymouth were supported. The local authority worked hard to understand any barriers to care and support and reduce inequalities for people. This was either through working with partners, funding initiatives, training staff, or understanding data to improve their knowledge of where gaps were or identify where people were not accessing services equitably. Work continued to ensure improvements were ongoing, and people were listened to and understood. A co-produced approach was used to ensure any work undertaken was meaningful and impactful. 

National data for Plymouth was considered similar to the England average in terms of staff turnover and vacancy rates, however below average for staff who had completed the Care Certificate. Support was provided by a care partnership to ensure there was a sustainable care workforce with support given to care providers. The local authority used data from the Joint Strategic Needs Assessment to understand the needs of the local community and inform commissioning priorities. A Plymouth Plan had been developed in conjunction with this detailing delivery plans. Some gaps in the market were identified by staff and partners, for example, in relation to younger people in care placements and people with complex needs in relation to dementia and mental health. The local authority had arrangements to monitor the quality and impact of the care and support services being commissioned for people, supporting improvements to take place where needed.

Partnership working was a strength. The local authority worked closely with voluntary and charity sector groups and as part of a Plymouth Alliance to enable people to be supported flexibly and receive the right care, at the right time, in the right place. Work had taken place in terms of improving hospital discharge and preventing admissions. Staff worked closely together with partners and were co-located with health colleagues, which ensured people received joined up care and support. A Creative Solutions Forum enabled partners to co-ordinate and achieve good outcomes for people with more complex needs. The Plymouth Local Care Partnership strategic aims and priorities were aligned with the local authority. 

Contingency planning was in place in the event of a provider failure. The local authority and health partners were positive about the number of people returning home from hospital, using a home first ethos. However, some providers felt there was a need to improve processes and communication in relation to discharge planning. A number of staff teams fed back IT systems were not always effective and were concerned this may mean risks were missed when supporting people. Further funding had been sought in relation to developing mental health services to enable staff to work in more of an outreach way. Although people had some mixed experiences around the transitions of young people to adults’ services, staff felt this was more positive with the flexibility to support people according to the levels of need. 

Work was underway to further improve when people were asked about their desired outcomes in safeguarding enquiries. Although data for people receiving support in relation to mental capacity was lower, staff told us about the longitudinal approach they took to ensure assessments were done correctly and thoroughly. Waiting lists in relation to safeguarding had reduced concerns and Section 42 enquiries. However, further work was underway in relation to the Deprivation of Liberty Safeguards (DoLS) waiting lists and particularly DoLS for people in the community. Overall staff and partners felt safeguarding processes and practices were effective. The local authority worked closely with the Safeguarding Adults Board and learning was taken from Safeguarding Adults Reviews with actions taken in response to themes identified to prevent recurrence. 

Leadership changes had taken place at the local authority which had driven some changes and improvements to systems, processes, oversight, and governance. Practice audits had been developed to enhance quality and identify where there were gaps. Learning was shared with staff to drive improvements. There were good working relationships across partnerships including with the commissioned partner. Feedback from staff teams was that overall staff felt supported by line managers and staff well-being was considered. The local authority had arrangements to maintain the security, availability and confidentiality of records and data management systems. The local authority’s political and executive leaders were well informed about the potential risks facing adult social care, with reporting mechanisms in place to ensure any key information was shared. 

There was a strong inclusive and positive culture of continuous learning and improvement across the local authority and commissioned partner. Staff spoke positively about the quality and delivery of training which aligned with their individual learning and development goals and was also extended to partner organisations. Staff described working in integrated teams as supportive and collaborative. The local authority was fostering a culture of shared responsibility to ensure services were better aligned with the needs of the community. There were processes in place to ensure learning occurred when things went wrong, as well as from examples of good practice. Co-production was a core principle in the local authority’s approach to delivering services.