Cumberland Council: local authority assessment

The local authority recognised the need to strengthen its prevention approach. Senior leaders told us there had been a shift in the approach of the local authority to achieve better outcomes for people through improvements to both the front door and pre-front door. This was reflected in the Council Plan (2023-2027) which outlined a focus on prevention and early intervention. Some partners felt the local authority’s prevention offer needed to be developed. A partner told us there had not been investment in prevention such as through maintaining people’s independence and building more structured community networks for people. They told us this meant more people’s first point of contact was the statutory sector as a result. Despite this feedback, there was evidence of preventative investment, including across community-based support services, technology enabled care and home adaptations and housing support, for example. Preventative investment also included approximately 70% of the Better Care Fund budget.

The local authority had a strategic ambition to improve and embed prevention, as demonstrated by the Joint Health and Wellbeing Strategy (2023-2028). The strategy outlined the shared direction of the local authority and its partners to encourage a greater focus on prevention and early intervention. The strategy demonstrated an oversight of health inequalities and local challenges for people. It also outlined its approach to support across a range of areas, including employment, reduction of poverty, smoking cessation, gambling and substance use, housing and homelessness, emotional and mental health and wellbeing, social isolation and loneliness, for example. A Health and Wellbeing Framework and Delivery Plan set out how the local authority would take forward its priorities, with evidence of ongoing progress. Actions included the launch of local community hubs and work to enhance the pre-front door offer, for example.

Prevention support for mental health needs, suicide and substance misuse were recognised as a key challenge for the local authority. For example, the Public Health Annual Report (2023-2024) highlighted high rates of suicide, hospital admissions from intentional self-harm and drug-related deaths relative to national averages. Leaders told us there was ongoing work to better understand the higher rates of suicide, with a research project underway. There was also a suicide prevention leadership meeting to support oversight in this area. A staff team told us the local authority utilised the VCSE to support mental health and substance use prevention, with multiple organisations referred to. A senior leader told us the local authority also worked with partners to support relatives and loved ones following a suicide to reduce risks to them.

National data from the Adult Social Care Survey for 2023/24 showed that 64.13% of people said help and support helped them to think and feel better about themselves. This was similar to the England average (62.48%). National data from the survey also showed that 50.15% of people who used services reported that they had as much social contact as they wanted with people they like. This was somewhat better than the England average (45.56%). This showed around half of people receiving services were having the social contact they wanted with people, but around half were not.

Housing quality and availability was recognised as another local challenge. A senior leader told us there had recently been a housing condition survey and knew there were challenges for people with the condition of their housing, due to, in part, the age of buildings. They told us while there was almost no ’street homelessness’ or rough sleeping in Cumberland, there was a wider challenge of homelessness, including ‘sofa surfing’. However, they told us there were temporary accommodation resources available for people and had an example of several families being housed following an emergency incident. Staff and leaders told us a delivery plan was being developed for the new housing strategy to support local housing availability and quality. The strategy was signed off in July 2025. . The Homelessness Prevention and Rough Sleeping Strategy (2025-2030) also sought to address homelessness in the local area.

The local authority had a new Housing Adaptations and Assistance Policy which was focused on embedding the concept of healthy homes and in turn preventing increased use of adult social care statutory services. Staff teams told us about approaches to support healthy and safe homes. For example, there were opportunities for people to access grants or deep cleans and repairs to roofs. Staff also told us about VCSE resources they could access to support people with housing issues.

There was opportunity for the local authority to develop identification and support of unpaid carers to support prevention. A commissioned Healthwatch report published in April 2025, ‘Ageing Well in Cumberland’, highlighted the need to make services more accessible to carers through reasonable adjustments; create tailored support for older carers taking their age and health into account; identify and support carers earlier and involve carers in planning services. In response to some of these issues, the local authority had commissioned a provider to reach out to carers and the creation of the carers’ forum supported with the upcoming carers’ charter. The local authority recognised this as a continued area for development.

Staff teams told us they utilised partnerships with the VCSE to support people. For example, a staff team told us they utilised support for young people around employment opportunities. In a positive example shared, a person was supported to learn new skills and was eventually offered a job role following support from the VCSE partner.

There was an opportunity to better develop resources for staff with information about local services. For example, the ‘Joy’ app was being used by some staff as an information base to support people to access local services. However, this app was only applicable to the Copeland area of Cumberland as it was a legacy resource from the previous local authority organisation. A senior leader told us a new information, advice and guidance app was under development which would be used across the whole of Cumberland.

The local authority’s health and wellbeing coaches (HAWCs), who were part of the public health directorate, positively contributed to prevention. HAWCs worked directly with people to support early intervention and in 2023 additional resources expanded the remit of HAWCs to engage more fully with people living in the top 20% most deprived areas. Their key focus was on supporting people with mental health and well-being needs but they supported a broad spectrum of people. A senior leader told us they were a multi-skilled team, which empowered people through techniques such as motivational interviewing. A staff team told us the HAWCs ‘coached’ people to progress to specific outcomes, with action planning and steps toward set goals. In an example, a staff team told us the HAWCs had supported a person to learn how to use transport to access their day service provision which supported them to a positive outcome. There was no set time frame for the involvement of HAWCs and they could work in conjunction with frontline teams to help prevent escalation of needs.

Data provided by the local authority showed, in 2023/24, the Health and Wellbeing Team received 1,436 referrals, 70% of referrals came from an organisation (rather than an individual). The percentage of cases closed with a positive outcome reported, such as reduced anxiety or depression or improved wellbeing or resilience, was 60%.

The local authority had shown improvements in its use of prevention through its information and advice offer at the front door. For example, a peer challenge exercise in May 2024, highlighted only 20% of calls received by the SPA were being redirected with information, advice and signposting. This meant most people were referred to frontline teams. Following transformative work and improvement planning, there were signs of improvement of prevention provided at the front door. As of January 2025, there had been an increase of 45% of contacts signposted, with an ambition of 70%. This supported a reduction in pressure on frontline teams and supported a preventative approach.

The local authority worked with partners to deliver intermediate care and reablement services that enabled people to return to their optimal independence, but this was a continued area for development.

The local authority had a reablement service jointly funded through the Better Care Fund (BCF). The service was offered to people in their own homes to support them to regain or maintain independence following hospital discharge or where at risk of hospital admission. An intermediate care pathway, which provided therapy, rehab and rehabilitation for people usually in residential care services, was also jointly funded through the BCF. This service supported both hospital discharges and community step-ups with the aim of maximising peoples' independence and supporting them to return home with no or reduced ongoing long-term care.

National data showed the need to improve the effectiveness of intermediate care and reablement pathways in supporting people to remain independent. For example, data from Short- and Long-Term Support for 2023/24 showed that 71.43% of people aged 65+ were still at home 91 days after discharge from hospital into reablement/rehabilitation. This was worse than the England average (83.70%). Data from the Adult Social Care Outcomes Framework for 2023/24 showed better performance, with 78.28% of people who received short-term support no longer required support. This was similar to the England average (79.39%).

Leaders told us the local authority was committed to support people to remain independent and in their own homes. The local authority provided their own data for between January and December 2024, which showed, on average, 59% of people supported by reablement services had no immediate ongoing care needs and 21% had reduced care needs. This demonstrated a positive direction of the reablement and intermediate care services, as most people were benefitting from the services.

There were examples of positive outcomes for people when supported by reablement services. A staff team told us personalised reablement plans were created based on the person’s own wishes and goals. In a positive example of reablement use, a staff team told us about the reablement service working with an existing care provider to support a person to work toward new independence goals. The person had remained in the same condition for a prolonged period but had decided they wanted to improve their independence. This led to reablement involvement with the person showing improvement in their condition.

The reablement service did not include OTs, with a leader telling us the service was not therapy-led. Staff told us there were previously OTs based within reablement, but positions remained vacant after staff had left the team. The reablement service made referrals to OTs in other frontline teams, which were said to be very short-term interventions, or if appropriate, utilised the health OT community teams. There were trusted assessors within the reablement services who could provide low-level equipment which helped to reduce the need for referrals to other OT services. A senior leader also told us there were plans for a fully integrated therapy-led reablement and intermediate care service. They told us OT vacancies were mitigated using health and social care OT colleagues and they felt the current structure was not problematic. There remained, however, the opportunity for more embedded therapy within the reablement service.

National data showed reablement and intermediate care pathway use was a continued area of development. The Adult Social Care Outcomes Framework (2023-2024) showed 1.07% of people aged over 65 received reablement/rehabilitation services after discharge from hospital. This was significantly worse than the England Average (3.00%). Despite this, a partner told us they felt this may not have been reflective of use of these pathways and could have been a data issue. Another partner also told us reablement flow for discharge was working well. In response to ASCOF data, the local authority provided additional data which suggested a higher proportion of people using reablement pathways, which was more in line with partner feedback.

There was increasing use of intermediate care and reablement pathways to support people’s independence. The local authority had invested in increased capacity of the intermediate care beds. A partner told us the intermediate pathway was a strength for the local authority and the pathway worked well. The local authority used their in-house services, ‘Cumberland Care’, to provide intermediate beds, which coincided with increased use of the pathway. From monthly data submitted by the local authority between April 2023 and December 2024, there was a clear trajectory of increased intermediate care placements per month from hospital discharges.

Data provided by the local authority in September 2025 also highlighted 97% of people using the intermediate care service returned home with an average length of stay of approximately 19 days. This showed how the intermediate service promoted people’s independence.

The local authority had also invested in increased capacity for the reablement pathway. People discharged from hospital who were new to adult social care, or had a change in need, accessed reablement. Data provided by the local authority showed an increase of 51% in reablement capacity compared to 2023. While a staff team told us sometimes people who did not have reablement potential accessing this pathway could take up staff capacity, the local authority used this as an opportunity to support people to access the right level of ongoing care. This reduced the risk of providing too much support for people. Following accessing the reablement pathway, reviews were completed within 48 hours for staff to assess if people required reablement ongoing or were moved onto interim care while a long-term care package was sourced. When there were increased capacity pressures, staff told us they worked closely with health colleagues, who supported if required.

Reablement had also seen an increase of use, particularly from hospital discharges between April 2023 and December 2024. The local authority had plans to further expand their reablement offer, especially for step-up care from the community as part of their Achieving Excellence Plan. Improvements to pathways were supporting more people to be discharged from hospital and to regain independence.

Access to equipment was not always timely. People faced delays to OT assessments and delivery of equipment. Those at the highest risk were prioritised.

Local authority data showed, as of June 2025, there were 219 people waiting for OT assessments with a median wait of 27.02 days and maximum wait of 133.98 days for the previous 12 months. There were also 185 people waiting for equipment, with a median time of 6 days and a maximum wait of 136 days for the previous 12 months. This demonstrated potential waits for people in accessing assessment and support.

The local authority used a Better Care Fund (BCF) funded community equipment service (CES) to support people to access equipment. A leader told us there had been problems in getting people the equipment they needed. They told us there were gaps in the service and unprecedented demand and there was a need for more funding. They told us people with technical expertise had left the equipment service following the Local Government Reorganisation and there had been a closure of a third-party equipment provider in the West of Cumberland in 2024. Staff teams told us when an item was not in stock, there could be waits for people except for urgent need.

The local authority employed waiting well procedures for OT assessments and equipment. The highest priority referrals meant people were contacted within 2 days, for example. People were also reprioritised if their needs changed and staff took steps to mitigate risks for people while they waited for assessments and equipment. Staff teams told us sometimes they needed to be creative, and they did keep some equipment in the office such as slings and bed management equipment. Staff also utilised health colleagues for some equipment in emergencies. There were systems to support oversight of waits for assessment and equipment.

The local authority had acted to reduce delays to OT assessments and equipment. For example, the local authority was utilising mobile and static clinics. Mobile clinics involved visits to more remote areas so multiple arranged assessments could be completed and equipment provided immediately where possible. Static clinics were an alternative to the conventional waiting list for people with lower-level equipment needs. Clinics were held regularly and a senior leader told us they were popular. A staff team shared a person’s positive experience following a visit to the clinic, where further needs were also identified and referrals made to other services. While static clinics were not accessible for some people, due to location and transport needs, it offered some people the opportunity to have needs addressed more quickly.

There had been challenges in recruitment for the CES service but there was now said to be an improved position with positive proactive, knowledgeable management with OT experience in place. The local authority also highlighted a recruited service lead for the store supported a consistent and visible leadership approach. Staff also told us they worked closely with the equipment stores to reduce delays where possible. For example, a staff team told us there was a pilot where staff were working with the equipment store to gather stock and spare parts and a further working group to gather information on understocked items. A leader told us, however, they were concerned staff were losing time as they were spending time chasing delays in equipment delivery for people.

The local authority was also completing a review of the CES as part of its transformation, with plans to improve the operational efficiency. The review had found some of the demand coming to the equipment store was outside the available stock catalogue. A multi-agency review group had been established to update the stock catalogue and future funding arrangements outside of the BCF to support adequate resources.

The local authority was monitoring timeliness of equipment delivery and equipment collections when it was no longer needing. Data showed some improvements in this area, with an 84% rate of equipment delivered within 7 days for May 2025 (as compared to the previous quarter rate of 76%). Equipment collections were being collected within 7 days 57% of the time in May 2025 as compared to 51% the previous quarter.

When people accessed assessments, equipment and minor home adaptations, this supported them to maintain their independence and continue living in their own homes. For example, a person told us an OT had brave discussions with them about future plans and about promoting their independence. Another person told us equipment had been a big help in their life and enabled them to become more independent inside the home.

The local authority was also working with partners to help support prevention. For example, there had been targeted work with a local prison, with OTs providing training and advice on moving and handing as the prison had an ageing population. A senior leader told us this had resulted in no new referrals for people in the 10 months following this, helping to reduce need to access services.

Performance in providing major adaptations for people through Disabled Facilities Grants (DFGs) was an area of strength. From data provided by the local authority, for quarter 3 of 2024/2025, 100% of DFG cases progressed from complete application to approval within the 6 months statutory target. The local authority also highlighted high satisfaction scores from people (94%). Staff told us improved relationships with housing was also supporting DFG performance. They told us there had been changes to the way DFG was managed since the forming of the Cumberland Home Improvement Agency and adaptations under £10,000 were no longer means tested, which supported flow.

The local authority had a focus on improving the provision of information and advice on their rights under the Care Act and ways to meet their care and support needs. This included unpaid carers and people who fund or arrange their own care and support. 

National data showed accessible information and advice was a continued area for development for the local authority. For example, the Adult Social Care Survey for 2023/24 showed that 61.88% of people who used services found it easy to find information about support. This was somewhat worse than the England average (67.12%). The Survey of Adult Carers in England for 2023/24 showed that 59.92% of carers found it easy to access information and advice. This was similar to the England average (59.06%). This suggested there were still large proportions (over a third) of people and carers who felt information and advice could be more accessible.

This was also reflected in some mixed feedback from people and carers. For example, a carer told us they wished more information was available to them about all services, but they were aware they could contact the commissioned carer’s service for information and advice. A person also told us they were not initially aware of some community-based services, but when they spoke to the local authority, they were given information around this.

There was a focused resource in development of both the pre-front door and the front door within the Transformation and Service Improvement Plan (2024-2026). The local authority had invested in an external consultant, which a senior leader told us was supporting improvements to the front door and supporting development of the prevention model across the adult social care pathway. Transformation at the pre-front door included targeted improvements to the website to support people to better self-serve and provide self-assessment options. This was in the development stage, with a staff team telling us a self-assessment tool pilot needed to be refined to capture better information as more information was needed from people to support decisions on priority and risk. There had also been a recent alignment of customer services with revenue and benefits, and library services, which came under the Public Health directorate. A senior leader told us this was the development of a ‘prevention service’, which would explore with people whether they needed other preventative support beyond their initial contact.

Staff and leaders were mindful of the potential of digital exclusion for people when accessing information and advice. The local authority utilised local media, community settings and community groups to share information with people. There were also community hubs pilots, which brought together a range of co-located services to support people in their local communities and provide face-to-face information and advice on areas such as health and wellbeing, employment and adult learning courses. The local authority shared the positive impact of this approach for a person, where they were able to access further VCSE support for their needs. While each of these developments presented opportunities to better embed prevention, the impact of these approaches was not yet clear. Leaders told us there would be an expansion of the hub approach over the next 12 months.

The local authority had invested in improving their information and advice offer for unpaid carers. The local authority had commissioned an online partner to increase their reach to carers and since its launch, the partner had actively engaged with 2024 carers. Of the people accessing this service, 49% were in rural areas and 82% had not accessed support before. A staff team told us this service was a positive approach, especially because carers could access information and advice 24/7.

The local authority recognised direct payment uptake as an area for development. A leader told us uptake was an area the local authority needed to work on. They told us this was partly a legacy issue with the previous local authority organisation, but they felt the local authority could have been clearer with its messaging. A staff team also told us they felt the direct payment process could be a lot of paperwork for some people and could be overwhelming meaning the person may not complete it.

National data from the Adult Social Care Outcomes Framework for 2023/24 showed that 19.20% of people who used services received direct payments. This was worse than the England average (25.48%). Data also showed that 29.59% of people using services aged 18-64 received direct payments. This was somewhat worse than the England average (37.12%). This was consistent with people who used services ages 65 and over, with 9.72% receiving direct payments, which was also somewhat worse than the England average (14.32%).

Current systems meant initial conversations about direct payments were undertaken by frontline staff, while the brokerage service provided an administration function around direct payment accounts. Staff signposted people to a VCSE organisation, who gave people support to set up and manage direct payments, including support to identify personal assistants. A third-party website provided a list of micro enterprises working as self-employed personal assistants for people.

Staff and partners told us how direct payments were used creatively to support people and unpaid carers. For example, staff teams gave us examples of where direct payments had been used to help purchase equipment, including a recliner chair and a handrail which matched people’s preferences. Another person with sensory impairment used their direct payment to support them to access specific computer software and updates. A partner also told us how a direct payment was used to support a person to access a community activity, although this solution was led by the partner and not the local authority.

As of 30 January 2025, over the preceding 12 months, there were 113 people who ended their direct payments. Of the 113 people who ended their direct payments, 102 ended direct payments to receive further, alternative services. Other people’s direct payments ended due to the end of the service, moving to another area, self-funding or declining their service.

Direct payment systems and oversight were included in the local authority’s Transformation and Service Improvement Plan 2024-2026, but this was in its early phases, and it was not yet clear what a new model might look like. National data on direct payment uptake was being used as a performance measure for improvements.