Bristol City Council: local authority assessment

Work to review the local authority existing operating model had commenced 3 years ago, with the issues identified being subsequently verified by a Local Government Association Peer Review in 2023. These included identification of waiting lists being too long, there was a need for clearer team parameters and boundaries that would reduce the number of internal transfers, the need to address safeguarding and pressures on staff. This had been the focus of the changes the local authority had made and were evident in our findings. All the areas identified were being addressed, some were improving, such as waiting lists and more work was continuing on the other areas. The main area of risk remained the number of people waiting for assessments and the length of time they were waiting.

The roles of the Principal Occupational Therapist (POT) and Principal Social Worker (PSW) were well defined and embedded, connecting the pursuit of good practice with research and development. Separate Social Work and Occupational Therapy Forums provided staff with opportunities for reflective learning and innovation in practice.

An Inter-professional Practice & Competency framework had been developed, bringing together existing systems but focusing on strength based, relationship and trauma informed practice. This was built on the Vision for Adult Social Care which was co-produced with key stakeholders in early 2024. It was a model and map that set out what practitioners do and why, as individuals and as teams, to deliver on the Vision for Adult Social Care.​ Leaders showed a commitment and enthusiasm for ensuring that the vision was embedded in both strategy and practice. Staff told us about working well together so people only had to tell their story once and felt there was a real commitment to the vision in how they were working with people.

The profile and awareness of occupational therapy had improved since the POT had been in post with feedback from OT’s that they felt valued, involved and represented in more decision-making meetings. The POT told us their role was to drive quality assurance in practice and workforce development. They had been in the role since February 2021 and it had been 'a journey' where their main focus had been fulfilling the vision of adult social care, embedding interprofessional practice and developing a competency framework. The local authority had taken a decision in recognition of the value that OT’s bring, to recruit more OT's and there was a preceptorship programme in place for newly qualified OT's.

The PSW post was held by an interim senior manager, and feedback was the local authority placed importance on this role. They had strategic influence as well as direct contact with staff and had been encouraged to bring their ideas to the role. The PSW took a lead in workforce planning which had been a particular area of focus for the local authority and although staff turnover rates had reduced, it was still difficult making sure they had the right balance of experience in teams.

Workforce sufficiency remained challenging in terms of meeting Care Act duties, however had improved and stabilised. There was a rolling programme of recruitment and agency staff were used, with conversations to try to retain some of these. Staff wellbeing had been another area of focus and the PSW told us about an employee assistance programme which was well received and used by staff. Consequently, they had seen an improvement in the retention of workforce from 21.1% turnover down to 12.1%. A pay increase alongside a progression pathway made their offer much more competitive regionally, along with a monetary referral scheme to any staff member who referred someone who went on to gain employment with the local authority.

There were clear and effective governance, management and accountability arrangements which provided visibility and assurance on Care Act duties for the corporate team. For example, a monthly Quality Improvement and Performance Board (QUIP) was held with senior leaders present and chaired by the Director Adult Social Care. Service managers produced reports which enabled the board to identify trends, and a deep dive was done into some. Complaints and compliments were reviewed. Where needed, performance improvement plans could be produced which were then monitored. Information from QUIP could be escalated to the Divisional Management Team, the Executive Director meeting, then to the Corporate leadership Board and the ASC Policy Committee Chair’s Briefing. Systems were embedded and had been adapted and strengthened over time. Although the numbers of people waiting for an assessment were falling, the local authority maintained a close scrutiny of risk through the strategy and auditing processes, which allowed them to assess risk and address safety within the system.

The local authority used their Quarterly Assurance Report to provide assurance on how adult social care had delivered its Care Act duties in the previous quarter. This also reported on in-house CQC regulated services and provided an update from the PSW. The report highlighted key risks and the potential impact of these and set out mitigations. This reporting system provided a clear escalation route where risks and good practice were identified and supported corporate ownership, championed by the Chief Executive and the Adult Social Care Policy Committee Chair.

Staff had a range of views about working at the local authority. Some staff felt they would benefit from more staff, improved supervision and a more stable management team. Feedback was although leaders did understand practice issues and challenges, action could feel more reactive than proactive sometimes. The online briefings with the senior leadership team were widely attended by large numbers of staff and were positively interactive but staff were not always clear what happened with the information after and sometimes felt unclear about the high-level language used.

Other staff understood recruitment challenges but said once they had staff working there, they often stayed. One newer staff member was impressed to see people using services as part of interview panels. Plans for increasing the number of OT's was welcomed for supporting teams and with early intervention and prevention. However, a planned reduction in social workers was causing some anxiety amongst staff. Social Care Practitioners expressed some concern about the level of responsibility they had and complexity of cases which was increasing. They felt lines were sometimes very blurred between them and social workers, however this had been recognised by the local authority.

A number of positive comments from other staff teams included, being well supported by managers, valuing the local authority approach to well-being and feeling morale was good. Some staff said their caseloads were manageable and they had regular supervision with managers to discuss cases. Other staff told us communication between them and senior management was the best it had been.

Partners told us due to capacity issues local authority staff were not always able to attend meetings and they were aware of issues with staff resources, which meant agency staff were used at times. Feedback was that local authority had some excellent operational staff however it could be a struggle to influence change with leaders, and that over the past few years there had been changes at senior levels, which had made it difficult in terms of partnership working. However, leaders were willing to work together with them and they hoped to see this moving forward now. Another partner told us the local authority worked hard to meet the needs of the local community, although communication could be better. Others however felt the leadership was already improved and leaders were listening to feedback.

In early 2024, the local authority developed its Vision for Adult Social Care. The local authority described the vision as acting as a 'north star' and a starting point for everything they did. The vision aligned with the values set out in the Bristol City Council Corporate Strategy 2022 to 2027 and were 'to enable all people in Bristol to enjoy independent, fulfilled lives in their communities with access to personalised support if they need it’. Local authority leaders told us the Vision was about proactive care and support with the aim of supporting people to lead ‘glorious ordinary lives’ which they believed if done right the first time, would be cost effective.

Leaders wanted to see a one council approach, as they felt this was needed. Bristol is one of 11 'core cities' in the United Kingdom and whilst there is a strong sense of Bristol identity, there are differences between the localities of the city, known as the North and West, Inner City and East, and South Bristol. Due to this, Bristol is often described as ‘A Tale of Three Cities'. It was described as a city where partners wanted to come together and where there was a culture of pride, commitment and passion, across all staff groups, especially adult social care.

The was an ongoing transforming adult social care programme underway and the key drivers were delivering adult social care within budget, whilst developing a sustainable model of care that built upon community assets and improved outcomes for people. For example, managing demand for and transforming the supply of Adult Social Care services and optimising the adult social care workforce to ensure productivity and value for money.

Staffing and retention was an ongoing issue for the local authority and remained a risk, however had improved and stabilised more. The Bristol Workforce Development Plan, June 2024, was developed to address the issues of staff working in adult social care teams which included low staff capacity, fragmented pathways for people, and with longer-term teams having to operate like emergency teams at times, resulting in a lack of focus on people's personal outcomes and preventative working.

The local authority used information about risks, performance and outcomes to inform its adult social strategy and plans, allocate resources and understand the actions needed to improve care and support outcomes for people and local communities. The local authority continued to develop data and reporting capability along with confidence of managers and staff to use the data and insights available to them. The improved use of data systems had had a huge impact on leaders being able to understand where resources were needed and where to prioritise these. Data enabled them to understand what they could expect to see in the future and set expectations. Leaders worked with teams to ensure that they were capturing the right data recognising their old reporting systems did not fully capture certain types of demographics, but this was something they were addressing. Partners feedback was that the local authority used complex needs data more effectively and the quality of data being shared with them had improved.

Most staff felt change was being managed well by the senior leadership team. They told us about the briefings that had taken place around the new Target Operating Model (TOM) and said these had been helpful in communicating what was happening whilst allowing time for questions. The TOM was described by the local authority as the blueprint of how they would achieve their adult social care vision and objectives by aligning core capabilities, resources and processes, and was aligned to their continuous improvement plan. It was co-produced and co-designed with people and data informed. Written information was provided to staff about the changes, although feedback was this was sometimes lengthy and there was not always the time to read it fully. Some staff were unsure how the changes were linking together into an overarching strategy and felt this could be clearer and communicated better. However, staff were being offered training on managing change and a transformation lead was available to provide support.

Senior leaders understood their roles were in ensuring strong oversight, meeting people's needs under the Care Act and looking at preventative measures. There would be an increase in spending in adult social care for complexities as they needed to be able to delivery differently with more preventative measures through the target operating model and transformation. They still had work to do in relation to waiting times for assessments, there had been significant improvement over the last few years, which could be sustained, but they were aware they could not get complacent and still needed to improve. They felt there was a strong approach in how they shape and commission, and that quality assurance was good, but they could still sustain this and diversify. Quality assurance work in commissioning was established and the local authority saw high CQC-rated provision at levels above national averages. Initiatives such as ‘Make it Work’ and ongoing work with community partners demonstrated progress in diversification of care provision.

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 considered in decisions across the wider council. The council had changed and now worked to a committee system from May 2024 with 8 policy committees, one of which was adult social care. Feedback was this system was robust. Policy Committee members told us they worked hard to be accessible, available and approachable and were there to give challenge and scrutiny. The focus was that they wanted to do the best for people. The public Adult Social Care Policy Committee received regular performance, finance, risk and transformation reports. The Policy Committee chair and vice-chair received more regular information, and member briefings were arranged should further dissemination of information be required. When questions were asked for more details, for example in relation to spend and waiting times, officers were responsive.

The Executive Director of Adults and Communities (DASS) told us with the new committee systems, adult social care got a lot more time publicly. They were finding conversations were much richer and more considered. They felt enthusiastic about the significant work undertaken and this was an opportunity for them to show what they are proud of. There had been significant improvements with some short-term work and they wanted to sustain this, feeling they have learned a lot and really developed.

Cabinet members told us there was a mix of people on the overview and scrutiny committee from a range of diverse backgrounds. They had open conversations and dialogue with health colleagues and with partners in the integrated care partnership. Health scrutiny was statutory, however adult social care was taken seriously too.

Cabinet members had faith in the local authority executives, who were described as a strong team, with a balance of performance and people focus and told us work had been done which was to be acknowledged. Feedback was of good working relationships with the adult social care senior leadership team and in terms of integrated working.

Relationships in the senior leadership team were good and had been collaborative, moving towards making change and getting feedback. The team was strong and cohesive, offering support and with a drive around performance. They described teams as now facing more in the same direction with a greater sense of purpose and shared values.

Some partners had attended monthly meetings with the local authority and told us there was motivation to improve relationships. Care partners told us it had been really difficult to communicate with the local authority in the past, but engagement was improving. Other partners told us the local authority's leadership was strong and the DASS was approachable with relevant experience.

The local authority had robust information governance arrangements in place supported by an internal service which provided oversight and guidance and implemented their information governance framework. The Director of Legal and Democratic Services was the Senior Information Risk Owner, and the Executive Director of Adults and Communities was the Caldicott Guardian responsible for protecting the confidentiality of people’s health and care information and making sure it was used properly. Lead information custodians were in place for all Adult Social Care programs and information systems.

Staff had mandatory annual training around information security and data protection with automatic reminders when this was due. Identifiable personal information was removed from documents such as quality assurance reports, which were shared via secure email. Staff told us they sought consent of people to share information (including assessing mental capacity if this was in doubt), and when information was shared online, emails were always encrypted. Staff in data and performance teams had built reports so these did not contain any sensitive data to allow them to share these across teams. If sharing externally staff had a different format, which further removed data, to fully redact information. They also had the ability to see who was viewing documents and what information was accessed, which added an enhanced level of security.