Staffordshire County Council: local authority assessment

The local authority worked with local people, partners, and providers to understand the care and support needs of the population. This included people who were most likely to experience poor care and outcomes, people with protected characteristics, unpaid carers and people who funded or arranged their own care, now and in the future. For example, a voluntary, community, faith and social enterprise sector (VCFSE) partner told us the local authority gathered feedback from 400 people living with dementia to understand where gaps in care home provision were. This feedback, which highlighted issues such as people wanting to spend more time outside, was reflected in an updated commissioning strategy for care home provision, which emphasised the importance of outdoor activities to maximise wellbeing. Other commissioning priorities, such as those aimed at supporting people affected by substance misuse or co-occurring health and social care needs, were developed in partnership with other agencies and people with lived experience.

The local authority also used population and demographic data to understand the care needs of the county’s communities, including a multi-agency Joint Strategic Needs Assessment (JSNA). This data indicated a growing ageing population and increasing complexity of co-occurring conditions. Commissioning staff said they aimed to use this information in conjunction with people’s and provider’s feedback to inform strategic decisions. Staff also said they were starting to use data to understand sourcing blockages for certain care types, which would further inform commissioning strategy and direction. An updated and interactive JSNA had been developed with system partners throughout 2024 with the aim of providing a data repository that could evolve with the needs of the population.

The local authority shaped and developed the market so people had access to a diverse range of local support options that were safe, effective, affordable and high-quality to meet their care and support needs. For example, domiciliary care and support was widely available across the county, which enabled timely allocation and access to support for people. National data collected between April 2023 and March 2024 indicated that 64.72% of people who used adult social care services felt they had choice over services, which was slightly worse than the England average of 70.28% (Adult social Care Survey). However, data collected by the local authority in July 2024 indicated people’s choice over their care had since improved: 100% of people receiving domiciliary or supported living support, and 84% of people residing in care homes, strongly agreed or agreed they were ‘able to make choices about how they live their lives'.

Feedback from staff, providers, and people was used to develop commissioning strategies, and there was an aim to further develop this approach. Staff worked with the local authority’s contracted advocacy partner, a multi-agency Neurodiversity Partnership Board, and groups and forums led by people with lived experience and their families to gather feedback about care and support. They told us they aimed to use this information to inform commissioning decisions and strategy around day service and respite options for people with learning disabilities.

The local authority’s market shaping strategies were aligned with the strategic objectives of other agencies, including those of health and housing partners. For example, commissioning staff worked with each of the county’s district and borough council housing teams to ensure housing with care strategies were aligned to the needs of each area. This included ongoing work to ensure the needs of eligible young people approaching adulthood had access to accommodation that was appropriate for their care needs.

The local authority worked collaboratively with people and partners so that it commissioned models of care and support that were in line with recognised best practice. For example, local authority commissioners were working to introduce new supported living contracting arrangements for providers in line with Care Quality Commission (CQC) Right Support, Right Care, Right Culture guidelines. These guidelines aimed to ensure services commissioned to support people with learning disabilities and/or autism were focused on outcomes rather than process.

Robust partnership and joint commissioning arrangements were also in place between the local authority and health partners to respond to people’s specialist needs, such as providing support to people under Section 117 of the Mental Health Act 1983 (which refers to aftercare for people leaving hospital who have been detained under the Mental Health Act 1983). This achieved better outcomes for people, and there were clear roles and accountabilities for monitoring the quality of the services being provided and outcomes for the people using them.

There was sufficient domiciliary, residential, and nursing care provision to meet demand in Staffordshire; local authority data indicated that 95% of requests for domiciliary care, 88% of requests for residential care, and 92% of requests for nursing care were sourced within the local authority’s designated timescales in the 12 months prior to December 2024. As a result, waits for this care and support were minimal. Where people waited longer than the designated timescale for support, the local authority had clear oversight of the delay and the impact it had on the person’s needs and safety.

In the 12 months prior to December 2024, 63% of requests for supported living services were sourced within the designated timeframe, which was below the local authority’s target of 75%. Leaders told us longer timescales for arranging supported living services were due to the time needed to allow people to visit their potential new homes, allowing providers time to assess their suitability in being able to meet the person’s unique needs, and arranging for people’s tenancy agreements to be put in place. Where required, alternative care was provided to keep people safe until their ideal support could be sourced. For example, people had been temporarily placed in residential care settings while supported living support that supported their individual needs was sourced.

Leaders were seeking to address any gaps in local service provision. For example, local authority commissioners were working to commission supported living services to improve provision in areas where demand exceeded the available supply. The local authority was also looking at options to increase the availability of nursing home support for people living with dementia based on predicted increases in demand.

874 people were receiving care and support outside the county which was commissioned by the local authority, with 90% of those people living in other local authorities bordering on Staffordshire. This was for a range of reasons, including people wishing to be closer to their families, to enable people to access specialist support, or for younger adults to experience continuity of their care. When support was being accessed from outside of the area, there were plans to provide it in the local area, so that people could move back there if they wish to do so. For example, plans to recommission supported living services aimed to increase complex and specialist provision, which would meet the needs of some people currently being supported by services outside the county’s boundaries.

The local authority gave specific consideration to the provision of services to meet the needs of unpaid carers. Unpaid carers could use a ‘quick fix fund’ to pay for resources that would help them fulfil their caring duties and support their wellbeing. For example, an unpaid carer for a person with incontinence was able to purchase a bigger washing machine which decreased the amount of time they spent washing each day and positively impacted their wellbeing. However, some unpaid carers told us that while they valued available in-person carers resources, online workshops would extend this support to those unable to attend in-person sessions due to their caring roles. Additionally, feedback from unpaid carers, staff, and partners about the access unpaid carers had to respite care in both planned and unplanned situations, was mixed. National data indicating that 18.54% of unpaid carers were accessing support or services that allowed them to take a break from caring for between one and 24 hours (which was in line with the England average of 21.73%), and 10.53% of unpaid carers were able to take a break from caring at short notice or in an emergency (which was in line with the England average 12.08%, Survey of Adult Carers, June 2024). Leaders were aware of potential gaps in respite provision and work was underway to review solutions to meet this need.

The local authority had clear and robust arrangements to monitor the quality and impact of regulated and non-regulated commissioned care services, and to drive improvements at individual service level and across the care market. Staff and leaders told us quality assurance and oversight was monitored through proactive means such as annual quality visits to providers, and reactive methods such as gathering feedback on service quality through Quality Assurance Forms (QAFs). The local authority reviewed quality concerns through internal monitoring and multi-agency Quality and Safeguarding Information Sharing Meetings (QSISM). Local authority staff followed up with providers to ensure any recommendations to improve their practice were acted on. At the time of the assessment, 71.08% of residential homes, 66.73% of nursing homes, 55.07% of supported living services, and 52.71% of domiciliary services that had been regulated by the Care Quality Commission (CQC) were rated as ‘Good’. The local authority was providing support to drive improvements in home care provision, including multi-agency work focusing on risks and challenges relating to international recruitment.

The local authority had policies and processes to manage and reduce risk to people where any quality concerns were raised with regard to provider performance. These included contract monitoring, suspension of commissioning new placements where they identified quality concerns, and providing training and development support for providers. This ensured commissioned care was delivered to a high and consistent standard that aligned with the Public Sector Equality Duty. For example, staff told us quality concerns identified in their QAFs were promptly acknowledged and processed, leading to the use of certain care providers being paused or suspended where appropriate while they addressed any identified issues. The local authority had a robust multi-agency process for managing provider suspensions. Between August 2023 and July 2024, seven domiciliary and 12 supported living services had been suspended by the local authority as a result of quality and financial concerns, or international recruitment licencing issues. In this time period, nine in-county and 13 out of county care homes had also been suspended due to quality concerns and/or ‘Inadequate’ CQC ratings. The local authority did not commission further support for people from ‘Inadequate’ rated services, but staff said the providers were kept on the local authority system and supported to improve and develop, after which they could be reinstated as active providers.

The local authority had an effective support and development offer in place to support provider quality improvement. For example, a commissioned online platform, provided access to a range of tools and guidance to support providers in managing risks in care settings in line with the evolving needs of the population and care market. Additionally, a provider told us their staff had benefited from training provided by the local authority’s Social Care Academy regarding support to understand culturally appropriate care. This indicated the local authority was aware of quality issues in the social care market and was actively supporting providers to improve and increase positive outcomes for people.

The local authority had effective mechanisms for routinely engaging with care providers, both individually and collectively on all matters relating to the provision of adult social care in the area. For example, a voluntary, community, faith and social enterprise sector (VCFSE) group told us they had quarterly meetings with the local authority to discuss quality reports and areas of improvement.

The local authority worked collaboratively with partners so that contracting arrangements were person-centered, efficient, and effective. A care provider told us they worked well with the local authority’s brokerage team, who promoted choice of care to people and their families. Additionally, the local authority’s social care workforce strategy acknowledged a shared mission to develop person-centered and innovative ways of working in the care sector through provider arrangements. Co-produced priorities and arrangements within this strategy aimed to support the delivery of high quality care, experiences and outcomes for people. 

The local authority also engaged well with providers to ensure its commissioning and contracting arrangements supported continuity for providers and enabled them to develop sustainable business models. For example, they reviewed provider fees annually, and provided fee increases to support the sustainability of care providers. The local authority monitored sustainability through cost of care exercises, which supported the transparent and fair cost of care in the county.

Local authority leaders had knowledge of local market gaps and vulnerabilities and used this to inform its market shaping activities. The local authority had retained some in-house services where they identified potential gaps in the provider market. A VCSFE partner also told us the local authority offered small grants to community health projects with the aim of broadening the range of different types of support people could access locally. Supporting these projects at grass-roots level was increasing the level of sustainability in the care market.

The local authority understood market risks and work was ongoing to mitigate key areas of risk, for example risks associated with an aging social care workforce and sector recruitment issues. This included upskilling social care staff to meet local need. Progress had been made by care providers with local authority support to improve pay and conditions to attract candidates to the workforce. Although national data indicated turnover (0.26%) and vacancy rate (9.34%) in the adult social care sector was in line with the England averages of 0.25% and 8.06% respectively (Skills for Care Workforce Estimate, October 2024), leaders, staff, and partners were aware recruitment and retention continued to be a risk to delivering safe and person-centered care. This was a focus of the local authority’s social care workforce strategy and the risks to people were monitored regularly by internal and multi-agency forums such as the Safeguarding Adults Board.

The local authority understood its current and future workforce needs. Staff and leaders worked in partnership with system partners to develop, support and promote a joined-up workforce plan. This facilitated and supported quality improvement and encouraged training and development for the social care workforce, which was reflected in national data. 62.78% of adult social care staff across the sector were in the process of completing or had completed a care certificate, which was slightly better than the England average of 55.53% (Skills for Care Workforce Estimate, October 2024).

The local authority worked with providers and stakeholders to understand current trading conditions and to ensure services were sustainable, affordable and provided continuity for people. Leaders told us about mechanisms for anticipating care provider failure. For example, provider reliance on international recruitment presented care continuity risks, as workers were at higher risk of having their licenses revoked and being unable to work, which could lead to provider closure. The local authority had contingency plans in place, such as provider of last resort arrangements, to ensure that people had continuity of care provision in the event of a provider failure or closure.