Torbay Council: local authority assessment

Summary of people’s experiences

People and carers gave us positive feedback during our assessment and records we reviewed showed positive experiences across all areas in the assessment. Unpaid carers were particularly positive about support and services available to them. We spoke with ‘ambassadors’ who had strong relationships with council officers and elected leaders and they gave us examples of impact on services and genuine co-production. There was a real sense of listening, involvement and power-sharing with ambassadors from different groups such as carers, people with learning disabilities and autistic people.

National data used in the report generally showed a positive picture. Most data showed performance around the national average, for example in the proportion of people satisfied with care and support. Unpaid carers data showed significantly higher numbers of unpaid carers accessed support or someone to talk to in confidence, than national average. There was also a high proportion of people who received short term support, who no longer needed support, and a high proportion of people accessing reablement. Although fewer people remained at home after 91 days following a hospital stay than the national average. Direct payments were well used and available for carers, but less so for people with care and support needs. 

Waiting times were evident but not usually high and we heard some impact on people from waiting times for assessments and reviews, although we saw how the local authority provided waiting well information and used triage and risk prioritisation. Higher waits were experienced for annual reviews than other assessments. Staff and partners said the proportion of people going into residential care services had been high. However, work was underway to change this, with reablement facilities already effective, and extra care housing being built. 

Summary of strengths, areas for development and next steps

The local authority was achieving many outcomes well and there were some areas for improvement. Adult social care staff had been fully contracted to the NHS trust to merge functions and teams in 2005. The experience of staff differed depending on which team they were in. Many staff reported consistent social care leadership and strength-based practice, but some reported a lack of consistency and a more health focus on their leadership and working culture. People’s experiences were universally positive, however, and carers reported very high satisfaction to us. Alongside good performance in national data, this local authority has achieved an overall ‘Good’ rating in this assessment.

Access to the local authority’s social care service was equitable and strength-based with the Voluntary Community and Social Enterprise sector embedded in the ‘front door’. Arrangements could be complex, however, and sometimes processes were described as complicated in assessing people’s needs. We found some waiting lists for services, but these were risk-managed, however there were higher levels of care plan reviews outstanding. Actions had been taken to reduce waits for people which were starting to make an impact and the local authority had made efforts to simplify the ‘front door’ with a current review ongoing.

Tackling deprivation and generating economic growth was a key driver for the local authority in its support for people and generating better health and wellbeing. They had a range of advice and support available and were consistent in describing their efforts to improve people’s lives through housing and employment. Reablement was improved with a new facility for step-up and step-down support to avoid hospital admission, with wrap around support. The technology enabled care offer had been enhanced to support people at home. Hospital discharge rates were excellent and reablement was offered to a high proportion of people. There was a focus on reducing bed-based care and people moving to long-term care placements, which had started to make an impact.

The local authority were able to describe some efforts to reach seldom heard groups and their co-production work was good. There was a strategy to tackle issues such as domestic abuse and there was a new equality, diversity and inclusion strategy. They had recruited an equality and diversity lead and recent equality impact assessments had been undertaken. However, this work was quite new and had not been embedded at the time of our assessment. The local authority also relied on census (2021) data to understand diversity within its population, partly as a result of limitations with the electronic systems they used.

The care provided in the local authority was generally good quality and there were systems and processes to manage and monitor placements and relationships with providers. There was less availability locally for people with specialist needs, those with mental health needs and supported housing, however staff reported an ability to place people. There were two all-age extra-care facilities in development and a clear intention to shape the market.

Partnerships and the deep level of co-delivery, overall, was a strength, with some challenges noted. Partnerships with the VCSE were strong and delivering, with significant numbers of VCSE organisations working in the area, supported by a commissioned infrastructure organisation. Within statutory health and care services there was sometimes a health model prevailing, but we saw impact and benefits of co-location and multi-disciplinary teams on people and carers. Partners worked well together, had strategic alignment and understood the challenges and demonstrated plans to improve. 

The out-of-hours services worked well, including access to Approved Mental Health Professionals (AMHPs). Hospital discharge was swift and identified risks prior to discharge and embedded teams supported safe discharge. Transitions from children’s to adults services provided a clear and safe pathway for young people and a strength-based approach. There was a multiple and complex needs alliance, which linked housing with health and social care to ensure people were safe. There was some feedback about gaps for people with complex mental health needs. 

Safeguarding processes were effective, although we heard about some Deprivation of Liberty Safeguards (DoLS) waits for decisions, although these were risk managed. The local authority learned from Safeguarding Adults Reviews (SARS) and there had been a significant reduction in outstanding SARs action in recent years, alongside a more defined threshold for SARs. Leaders and partners listened to people in their safeguarding work and had worked with the Scrutiny committee. Hoarding and cuckooing and emerging safeguarding themes were being addressed by the system. 

There had been a lack of visibility of social care leadership in some teams, partly due to health focus of management and delegated arrangements with mixed supervision practices. Although we heard about a recent change in approach and greater visibility with the new Director of Adults Services. We found elected leaders were well briefed and involved in oversight and governance arrangements. Partners were embedded and represented on governance boards and committees, and we saw risk and governance delivery arrangements between the local authority and the Torbay and South Devon NHS Foundation Trust. The electronic recording system had limited improvement work on governance, management and accountability and this was being addressed at the time of our assessment. 

Recruitment and retention was reported as positive by staff and there was energy and optimism for the future in the staff teams. Integration had allowed rotational posts between hospital and community work, and they had a good team culture between the multidisciplinary teams. Leaders, alongside the Integrated Care Board, commissioned an external consultancy as a delivery partner to support improvement in reablement and intermediate care. There was a good level of provision of training available to staff and Ambassadors (people with lived experience) trained as facilitators. Co-production with people, particularly Ambassadors, was a genuine listening and power sharing arrangement, with people reporting they had shaped and impacted positively on services.