Bristol City Council: local authority assessment

The local authority had taken steps towards ensuring equity was high on people’s agendas and actions were being taken to address any areas identified for improvement. We received positive feedback from partners and people accessing services regarding the work the local authority had done so far. However, further work embedding equity in experience was needed in some areas such as ensuring data collection and recording improved, and information was accessible and clear.

The local authority acknowledged recording around equality and diversity needed to improve. They shared they did not yet know enough about all the people who attempted to access their services. This meant they did not fully understand if there was an inequality of access to services, or what barriers there might be for people. In June 2024, local authority data showed 7.7% of people receiving care and support in Bristol did not have their ethnicity recorded on the client record system. These gaps in recording had also been consistently noted in the local authority quality assurance audits. They were aware that further work was required to ensure a consistent and accurate recording of people’s demographic data, and this recording was regularly reviewed and understood. Improvements could be seen in the use of a new software data tool which allowed the data team to identify gaps in data and give feedback to relevant teams if improvements in recording were needed.

Staff involved in quality assurance told us records like assessments and case notes could better reflect the identity of the person and the impact of this on their needs. For example, the local authority had undertaken an equality impact assessment for commissioned services in HMP Bristol (His Majesty’s Prison Bristol). This revealed there was a lack of profile data on race. Only 38% of prisoners had their race recorded, all of which stated they were ‘White British’. The local authority was aware that people from Black African, Caribbean, Black British and White Other backgrounds were over-represented in rough sleeping, within prison leavers, and there were disproportionate numbers of people identifying as Mixed Race. For people in prison the local authority told us internal reporting of protected characteristics at the care management assessment stage needed to be strengthened to ensure these are being considered in the care assessment and referral stage. They said they would resolve this by introducing mandatory answers at the assessment stage for care management teams.

In February 2024, the local authority adopted a Multiple Disadvantage Strategy (2023-2026) linked to a programme called Changing Futures, with the aim to achieve long term improvements in services for people experiencing multiple disadvantages, which included substance misuse, people experiencing homelessness and or domestic violence. The strategy recognised the number of people living with complex needs and set out how they would work in partnership to address these. The local authority provided an example of the Changing Futures programme and the ‘My team Around Me’ collaborative partnership approach. This approach had enabled the person to reconnect with services and secure accommodation which in turn had let to improved health, a reduction in offending and no longer having frequent attendance at the emergency department.

Partners told us people were falling through the gaps in systems currently especially those people with complex needs. They felt there was a need for more joined up working between the local authority, health and the voluntary sector to better address these problems and improve outcomes for people. Senior staff told us some work had already been done within the local authority. For example, with the commissioning team working more closely with the transitions and homeless teams, to better consider people’s needs in these areas. The Homelessness Move on Team supported people that had never used services before, and ensured they were reaching out to people as far as possible. Leaders also told us of a range of co-production and equality forums that were held to help promote a diverse care market, bridge inequality gaps and improve outcomes for people.

The Bristol One City approach brought together partners to mobilise action around health, the economy, and the wider social determinants of health through several boards, including Bristol’s Health and Wellbeing Board. The local authority showed a good understanding of the health inequalities which existed in Bristol, which had become more prominent since the COVID-19 pandemic. There was a city-wide approach to reduce inequalities and to understand and reduce barriers to care and support. Partners were confident the local authority worked with communities to gain a good insight into how the barriers needed to be addressed. Leaders within the local authority told us 20% of children had been recorded as having special educational needs and this was an area the local authority needed to consider and to put in place an effective approach for the future. Bristol also saw a steady growth in the number of people aged over 75 and the local authority needed to ensure they were prepared for both these changes in demographics and meeting changing needs.

Partners told us there were some areas of work which needed to be improved. For example, there were some unpaid carers from ethnically diverse communities who were unaware of how to access carers support services, however due to the support of other voluntary and faith groups within the city people had been identified and supported.

Feedback about the Bristol Impact Fund (2017-2021) was that this had been greatly supportive of the voluntary and community sector. The grant aimed to support community groups in Bristol which experienced the most inequalities, through building capacity and giving people the ability and resources to act on issues which they were affected by. Partners felt more work needed to be done in supporting other marginalised communities within the area who may experience inequalities. For example, more provision was needed for the LGBTQ+ community and those with complex needs. The local authority acknowledged this was an area where improvements could be made.

The local authority’s Equality Action Plan 2023-2024 set out to review its mechanisms and processes for hearing the voices and experiences of people who draw upon care and support to help them understand whether services were being inclusive and enabling citizens of Bristol. The plan stated they aimed to build an inclusive organisation where the workforce reflected the city they served and the needs of all citizens, and where staff felt confident about being themselves at work. Leaders told us they were working to ensure their workforce was becoming ethnically diverse in both staff and at senior management level to better reflect the community. They acknowledged there was still work to do, however they were reviewing their recruitment strategies and continuing to look at ways they could achieve this. For example, the local authority had taken positive steps towards this through their ongoing involvement in the Workforce Race Equality Standards (WRES) pilot by Skills for Care, and by launching ‘No Space for Hate’ guidance for staff and managers, supporting them to address racism and other forms of discrimination against staff, commissioned carers and other professionals.

The Equality Action Plan set out that service specifications would require all care providers to deliver services that were culturally appropriate. Staff told us the brokerage team were sensitive to people’s cultural needs and always tried to identify culturally appropriate services for people. For example, the local authority had provided support to meet the individual and cultural needs of an unpaid carer and the person they cared for by arranging respite care from a suitable home care provider, supporting the person in their family home and enabling the unpaid carer to go away for a period of time.

The local authority through the Adult Social Care Equalities Forum worked with partners across the city, including voluntary organisations, community led groups and disabled people organisations. They held collaborative gatherings which provided opportunities for feedback about matters that concerned their communities and an opportunity for both individual and collective voices to be heard.

The local authority actively worked with minority communities to recognise barriers in relation to the current commissioning process. Work was being carried out to develop systems which were inclusive and transparent. The objective was to encourage smaller organisations to understand and tender for services. Leaders told us how the local authority utilised the ‘Make it work’ programme to ensure inclusion of black and minoritised organisations, supporting them to win adult social care contracts. Its primary goal was to strengthen their business position for securing commissioned programs in health and social care, which also boosted overall business sustainability and development. The local authority used the views of the community in developing the care commissioning framework.

Leaders told us about their social value policy for procuring care which resulted in them having an abundance of care services who were locally owned. For example, a Somalian owned organisation was one of their biggest care providers. One partner told us however, they felt that care home provision was mainly 'euro-centric' and didn't provide anything for the South Asian population and so further consideration was needed in this area.

The local authority Quality Assurance Team were able to tell us about how they ensured equality in service delivery. They gave an example of a provider who was commissioned to deliver home care services in prison and also provided support in the community. They carried out quality assurance processes for both aspects of the service side-by-side with a view to being assured the services were equitable and people in prison were receiving the same quality of service.

All staff had access to annual online equality and diversity training which was mandatory. Some staff had received additional training around anti-oppressive and anti-racist practice, others had undertaken some training to provide a better understanding of the cultural needs of certain communities. There were mixed responses in relation to the training provided with some staff telling us that given the cultural diversity of the local population, they felt the formal training offer around equality, diversity and cultural awareness was limited. However, others spoke about anti-racism training and Oliver McGowan training (training in relation to Learning Disability and Autism) as positive training. They also shared that equality and diversity issues were a standing item at supervision and team meetings, where they were encouraged to discuss cases and share learning and knowledge with colleagues. The local authority had also implemented anti-racism team action plans. The template for these had been developed by the Black Lives Matter Working Group which promoted a clear commitment to anti-racism and racial equity. The outcome of these plans was to provide evidence to inform and develop their departmental Equality Action Plans and target resources in the future. 

People’s experience of accessing services and support around their communication needs was good overall. A person who had additional needs due to English not being their first language commented that the social worker was understanding and gave them time to process some of the words they were not sure about, were patient and considerate to help them consider their needs.

People’s communications needs were considered by the local authority and staff had access to translation services although there could be times when staff had found it difficult securing translators in sufficient time. Staff told us improvement was needed to get all documents translated to reflect the range of communication needs they worked with. For example, a partner told us the local authority could do more work around supporting people living with a learning disability including having more accessible, easy to read information.

The sensory team were able to adapt information to a person’s communication preferences. They produced information in braille, large print, and text speak. They also had access to British Sign Language (BSL) interpreters and relay interpreters as well being able to use BSL in the team. Co-production workshops identified there was a need for increased access to culturally appropriate services including the ability to support people who don’t speak English. The local authority had committed to producing information related to adult social care in an accessible format.

Staff feedback was that the authority’s website translation function could be better and was not user friendly. They gave an example where a person had to use email to access care support instead as the website translation service was too complex. By contrast a partner told us they found that the website was accessible for someone with a sight impairment, but it wasn't clear how accessible services would be if everything was to become digitalised, especially for the older population who sometimes struggled with technology or those people with a number of complex conditions. They were concerned that digital exclusion could be a risk for some people.

Partners told us there were lots of different community and faith groups who were involved in the carers sector within Bristol and that it was a difficult task to knit all the groups together as Bristol was such a diverse city, however they felt the local authority did a good job. The local authority had helped organisations to build up connections with groups such as the Somali community, a Chinese community society and a Bristol black carers group. These groups worked with the local authority to provide targeted support to these members of the community.

The local authority had identified that members of the Bristol Somali community were the second largest group of citizens using direct payments. This had been achieved by staff understanding that written information on this subject was not as accessible to the Somali community as verbal information was, so a Somali language video had been made to promote direct payments, working with a local Somali centre. Additionally, one of the local authority direct payment support organisations had recruited Somali speaking staff to support that community with setting up and maintaining their direct payments.

The local authority provided dedicated social work capacity in a community autism spectrum service. This was a multidisciplinary team supporting with post-diagnostic support and training and liaison support for professionals who worked with autistic people. The service had worked with the local authority to develop practice guidance for working with autistic people and included an accessible leaflet about what to expect from a Care Act assessment.

The local authority sought feedback from people and held a Sensory Support Service drop-in to support people with sensory needs as well as gaining feedback about services. They then used the information gained to consider themes and trends for improvements. Actions were then agreed against the identified areas.