Norfolk County Council: local authority assessment

Summary of people’s experiences

People sometimes experienced waits for Care Act assessments and reviews but these had improved in the two years leading up to this assessment. People’s assessments were strengths-based, and staff were implementing approaches that focused on prevention and harnessing community assets to meet people’s needs. Unpaid carers experiences were mixed, for example we spoke with unpaid carers who did not feel their needs had been met but we also saw examples of personalised support provided to meet their needs.

There was a growing prevention offer of resources which people could access to prevent and delay future needs from developing, but in some parts of the county this was not yet fully implemented. People faced delays to occupational therapy assessments but these were also starting to improve and access to equipment was usually timely. Some people did not access reablement when they needed it, this was also improving at the time of this assessment. People did not access direct payments as frequently as they could, whilst the local authority overcame challenges to improve their uptake.

The local authority had undertaken work to understand barriers or health inequalities people faced, with further work ongoing. People from marginalised communities could usually access support that was tailored to their specific needs and staff often worked with people to overcome barriers they faced.

People could not always access the care and support they needed, particularly when people required nursing care or supported living for people with a learning disability and autistic people. This had started to improve at the time of this assessment and people had been involved in shaping the services they would use in the future. People had more consistent experiences when they needed homecare, as work to improve capacity was more advanced.

The local authority and partners worked in an integrated way which meant people could easily access health and social care services and information about people was shared well between partners. The local authority had well-established relationships with partners and a good understanding of how people interacted with the system.

People usually moved between services well, such as at hospital discharge. Some people’s experiences were less positive but there had been partnership work to improve discharge pathways which had become embedded before this assessment. Young people transitioning to adult services benefited from a collaborative and planned approach that involved people, families and partners at the right time.

When people were subject to safeguarding concern they did not always receive a consistent response, particularly if concerns were placed with providers. Staff took steps to put people at the centre of safeguarding and created a system where partners shared learning. However, we identified instances where people may not have met the threshold for safeguarding but feedback about this was not passed on. There had been significant work undertaken to improve safeguarding but not all the benefits of this were experienced by people consistently.

The local authority was undergoing significant transformation, under a new leadership team and structure. People’s experiences were used to plan and implement strategy and measure performance. There was an established approach to co-production which received positive feedback but also highlighted opportunities to involve people and partners more. People’s feedback about adult social care was routinely reviewed and learnt from by the local authority.

Summary of strengths, areas for development and next steps

People and partners said delays to assessments, reviews, accessing care provision and safeguarding were consistent themes. Our findings showed whilst there had been significant improvements in most areas, they were sometimes recent and not always fully embedded. Local authority and national data showed there had been improvements, but these were still being implemented at the time of this assessment

Waiting times for Care Act assessments and reviews had reduced consistently over the previous 2 years and there had been extensive work to achieve this. The experiences of unpaid carers were less positive and improvement work in this area was less advanced. The local authority was working to overcome challenges in gathering and monitoring data about the experiences of unpaid carers. People received strengths-based assessments from staff who were committed, competent and were specialists in their roles.

The local authority was implementing a new strategy with a focus on prevention and developing community assets. This had led to the creation of a variety of new preventative services as well as the development of an artificial intelligence-drive proactive falls prevention tool which received consistently positive feedback from partners. Data supported this, demonstrating positive impacts on hospital admissions and falls. Work was still underway to further develop the wider prevention offer, with challenges in some communities. Feedback from partners and staff showed the strategic approach was improving the local authority’s ability to delay and prevent future needs for care and support.

Improving access to reablement was an ongoing challenge. Despite some improvement, there remained gaps in capacity which the local authority was working to overcome alongside partners. However. Local authority data showed there was a reduction in waiting lists for occupational therapy, and access to equipment was timely.

The local authority had taken steps to understand its population and to reduce inequalities, by using data and co-production to inform services. Whilst there was engagement with some communities, gaps in data around sexuality and marital status limited the local authority’s ability to fully assess and address inequalities. The local authority used demographic and health data alongside equality impact assessments to target interventions, such as suicide prevention work.

There had been a long-standing challenge around ensuring sufficient capacity and quality within the care market. The local authority had a good understanding of the scale of the challenge, using data and engagement to target projects. There was a wide variety of projects underway across specialisms to build market capacity, these would take time to fully develop into new care provision, however data showed these were having a positive impact on shortfalls in supported living and nursing capacity.

Work to develop the homecare market was more advanced and data showed the local authority had overcome significant challenges in homecare capacity. There had also been extensive work carried out to build quality within the provider market, the local authority’s integrated quality teams received consistently positive feedback from partners for the impact they had made.

There were well-established partnerships with health and housing, which were evident in the coherence of vision we heard about from leaders, staff and partners. Local authority strategies aligned well with those of partners and the local authority was a system leader in driving much of this work. Partners gave us positive feedback about progress made in achieving shared strategic priorities, such as falls prevention and developing community hubs.  The local authority and partners were bought into working together to overcome the challenges faced across the county.

Safeguarding was another area of challenge and improvements were also underway. There had been work to reduce waiting times and to apply risk frameworks more consistently. Urgent safeguarding was acted upon in a timely way and decisions were reached promptly. There was still work underway to improve the timeliness of closing safeguarding cases, but the local authority had increased their oversight of these cases and were implementing actions following a recent external review of safeguarding.

Feedback received from partners showed there were still inconsistencies in experiences of safeguarding, particularly where people were subject to safeguarding when placed in a provider setting. However, we also saw examples of personalised approaches to safeguarding and local authority data showed people’s desired outcomes were routinely gathered and usually met. The local authority worked with the safeguarding adults board to share learning across partners, and we heard positive feedback about this.

The local authority had made significant progress in implementing their ‘Promoting Independence’ strategy (2024-2029), particularly in enhancing their prevention offer and reducing waiting times for assessment. The local authority had a good understanding of their performance but were still working to address issues in their data around the visibility of unpaid carers and occupational therapy (OT) waiting times. Staff told us senior leadership were visible and responsive and staff had a good understanding of the strategic direction of the local authority.

The corporate leadership team had been restructured to provide better oversight of Care Act duties and the ongoing improvement work. There was a new adult social care leadership team with clear roles, responsibilities and accountabilities. Despite having been in post a relatively short time, feedback about the impact the DASS had made, including their approachability and visibility, was consistently positive. The local authority’s political and executive leaders were well informed about the potential risks facing adult social care. These were reflected in the corporate risk register and taken into account in decisions across the wider council

The local authority was going through an extensive transformation and was working to overcome significant challenges in a number of key areas. There had been extensive work to address challenges in areas such as waiting lists, commissioning and safeguarding. Action plans and data showed the local authority had made progress in all of these areas but had not yet fully achieved their ambitions.

Local authority staff had ongoing access to learning and support. Staff feedback about the training on offer to them was consistently positive and we heard about how staff had been supported to gain professional qualifications, develop specialisms or build their knowledge base. There was support for continuous professional development and the local authority had a workforce development plan which outlined a number of pathways for staff to develop into leadership roles or specialist areas of social work or occupational therapy. Work to understand the experiences of the workforce was ongoing. The authority was updating its equality strategies and workforce standards.

There were well-established systems in place to learn from people through feedback and co-production. Partners feedback about being able to work with the local authority through co-production was positive and the use of co-production was consistent. Staff gave us positive feedback about the learning offer and the local authority had collaborated with partners to develop this.