Bristol City Council: local authority assessment

National data from the Adult Social Care Survey for 2023/24 showed 80.78% of people felt they had control over their daily life. This was similar to the England average (77.62%). However, national data from the same source showed 41.79% of people reported they had as much social contact as they wanted with people they like, which was somewhat worse than the England average (45.56%) and 58.81% of people were satisfied with care and support which again was somewhat worse than the England average (62.72%).

Most of the feedback we received from people in relation to their experiences of assessment and care planning were positive. Examples included being given a choice in relation to care, feeling listened to and people's opinions being considered. People praised the approach of staff and felt assessments were person-centred reflecting people's strengths, choices and wishes. Some areas which were identified could be improved were in relation to people not always having a named social worker and feeling some staff lacked knowledge in certain areas such as in relation to complex conditions or autism.

Assessment teams were skilled in carrying out assessments. Staff told us the local authority's approach and commitment to person centred practice enabled them to form meaningful relationships with people they supported. Staff had freedom and flexibility in how they approached interventions and could work closely with colleagues when appropriate. Assessments were person-centred and holistic, considering all potential needs, including assessing unpaid carers needs. Staff considered support from other community services where appropriate.

Areas staff felt which could be better were improvements at the 'front door' to the local authority. Care Direct were the initial point of contact for new referrals and staff felt systems could be confusing at times with people being moved from team to team. Feedback was there could also be significant delays in allocating work into the receiving teams. The recording system was also described as cumbersome where information had to be repeated. The local authority had recognised these issues and there was evidence that it was taking positive steps to address them through the new target operating model.

The local authority had introduced measures to reduce waiting times at the front door which had delivered improvements with an approach to 'build on your strengths, networks and resources available in the local community'. Care Direct staff had had strengths-based training to embed this approach resulting in a reduction in onward referrals from 45.5% to 22.4%. The duty system had recently been updated to follow the ethos of 'understand and resolve' at first contact which at the beginning of June 2024 had resulted in a reduction on waiting lists of over 100 people. The local authority continued to work on systems around managing demand. For example, they now had some voluntary sector partners as part of the front door team who worked directly with individuals to provide support and make referrals when necessary. People could access the local authority’s care and support services through other channels, including online and self-assessment options.

The Swift Response Team was the first point of contact in adult social care for new referrals. The team was multidisciplinary and worked collaboratively to ensure people benefited from the right professional expertise at the earliest opportunity. The team undertook work which needed a high priority or urgent response to avert crisis, prevent hospital admission, carer breakdown or to safeguard individuals.

Staff worked in ways to maximise their contacts with people. For example, OT staff told us if a social work team knew they would be assessing someone for equipment, they could also be asked to review the existing package of care or support plan.

Overall, feedback from partners was more negative. Some partners explained once a person had a named worker the system worked well, referrals to their services were not always appropriate and sometimes they made referrals to the local authority but had to chase up or resubmit these again.

National data from the Short and Long Term Support for 2023/24 showed 46.11% of long-term support clients were reviewed (planned or unplanned). This was similar to the England average (58.77%).

Data provided by the Local Authority for care assessments in January 2025 showed a waiting list size of 499 people. The target timescale for contact was 42 days. A lack of staff was cited as the reason for the delay and extra resources were now in place resulting in steady progress with a 47% reduction in the number of people waiting for an initial assessment since June 2024. Over 12 months to January 2025,1911 assessment were completed with 57 median days to assess. The local authority confirmed there had also been a 1.8% increase in demand in the numbers of people receiving long term care from 5,458 in January 2024 to 5,557 in January 2025.

Data provided by the Local Authority for care reviews in January 2025 showed a waiting list size of 1479 people from 2434 in January 2024 which was a reduction of 39%. There was 45% of people overdue for reviews in December 2023 to 26% in January 2025. Feedback from the local authority was that the number of people now waiting for a review in Bristol was significantly better than the England average. The citywide review teams prioritised the most overdue reviews and people in receipt of a direct payment. A waiting list was not held for services such as hospital discharge and reablement as staff referred in daily due to the quick turnarounds.

Feedback from people was that assessments and reviews were not always completed in a timely way, however when they were done, they were good. Senior staff told us they used data to help identify risk where there was the highest demand. For example, indicating additional staff capacity might be needed or detailing waiting times. One of their challenges, was now introducing more capacity to proactively contact and support people waiting on lists. Other waiting lists were reducing such as their Accessible Homes Team who had a significant waiting list in 2024, however the numbers of people waiting was now reduced by a third.

Staff were communicating with people on the waiting list by writing to them and providing advice and guidance. They also held 'shut down' days where non priority work was paused and staff focussed on ensuring people were ‘waiting well’ by speaking with them, to ensure their needs had not changed.

Staff had seen an increase in agency staff usage to reduce the waiting lists. A duty system triaged referrals coming into teams, helping to prioritise cases and put in any interim measures to help manage risk while people were waiting. However, there were duty capacity issues, and staff said it could take a week for a person whose referral was high priority to be contacted, with those lower priority taking longer, those with urgent needs were assessed immediately. This could be a small short-term increase to existing funding, a referral for equipment or technology enabled care, or signposting to the community services.

Some teams described the waiting lists as a challenge to manage, which resulted in constant reprioritisation of cases. They said there was always a risk that people waiting who were not making regular contact could get missed. Staff told us there was a need for more resources and staff as there was limited capacity and this was causing delays across services.

The local authority had been aware of the length of waiting lists for care assessments and reviews and had taken a multi-pronged approach to address this. This included commissioning additional social work capacity to undertake up to 1000 initial Care Act assessments and up to 1000 planned reviews in 2024. Recruitment of more staff, better use of data and use of a prioritisation tool were strategies to address this. The prioritisation tool included who was waiting, where, what for and how long, as well as an agreed priority level for allocation. This allowed the local authority to consistently prioritise people who needed a more urgent assessment or review across teams.

The local authority shared their data on their pathway 3 discharge to assess (D2A) (where someone went into a 24-hour care setting) and the number of care act assessments completed. The data showed there had been a reduction in the length of stay for people in hospital since October 2023 (when the transfer of care hub was set up) from approximately 80 days in October 2023 to 50 days in December 2024. The local authority recognised a key area for improvement was the time from referral to allocation. This was sometimes delayed as people were still undergoing intervention with other professionals or services.

Overall feedback from partners was people were not always followed up by staff in a timely way, especially if there was a change in their needs which impacted them negatively. Processes could sometimes be too slow, and they felt a contributing factor to this may be a lack of resources and funding in the social care front door teams. One partner said delays had caused them to raise a safeguarding concern in the past because of the impact of waiting on one person. One health partner commented having a better understanding of how the local authority prioritised cases may be helpful. Some care providers also felt they could be better consulted with when reviews were undertaken so they could contribute.

National data from the Survey of Adult Carers in England for 2023/24 showed 69.72% of carers felt involved or consulted as much as they wanted to be in discussions. This was the same as the England average (66.56%). Additionally, the same national data showed 35.65% of carers were satisfied with social services which was the same as the England average (36.83%), and 85.00% of carers had enough time to care for other people they were responsible for which again was the same as the England average (87.23%).

In most other national data from the Survey of Adult Carers in England for 2023/24 this was either somewhat worse or worse for Bristol. For example, 54.04% of carers experienced financial difficulties because of caring. This was worse than the England average (46.55%). Additionally, only 15.53% of carers felt they had control over their daily life, which was somewhat worse than the England average (21.53%), and 27.33% of carers felt they had encouragement and support which was somewhat worse than the England average (32.44%).

Data provided by the local authority for carer assessments showed 326 unpaid carers were waiting in January 2025. This was a 9% reduction from December 2024 when there were 358 people waiting, however an overall increase from January 2024 where there was 262 people waiting. The median wait time was 18 days down from 20 days in the last 6 months with the target timescale being 6 weeks. A continuous improvement plan was in place with regular updates to the local authority Adult Social Care Quality, Improvement and Performance Board and oversight was carried out by the Principal Social Worker (PSW).

The experiences of unpaid carers we spoke with in Bristol were positive overall. Comments included feeling listened to (although the local authority was not always able to meet their needs). Another unpaid carer talked about the social worker taking a whole family approach and really helping them. People told us about assessments resulting in a one-off payment being provided which enabled them to take a short break. Also, assessments considered the impact of caring responsibilities and if there were any adjustments needed to ensure the unpaid carer continued to get the right support in their role. Feedback from unpaid carers was they valued the assessments that had been completed and the support that was provided. However, other people felt the local authority had not taken future needs into consideration, had not heard anything about their assessment and cited delays, for example, in relation to waiting for the one-off carer’s payment.

Staff told us about several priorities they were involved with to improve support to unpaid carers, such as better identifying unpaid carers and carers breaks. They were currently working with an organisation who specialised in working with local authorities to support unpaid carers. For example, by ensuring flexibility of carers assessments to enable these to be done to suit people better. Some staff felt the local authority support options could be improved as this was primarily a one-off payment of £300 or a sitting service. This support also could take time to be agreed through the local authority processes. Support for unpaid carers was provided in a few other ways including the Carers Line (phone and online), carer support groups, Information, advice & guidance and through the Carers Emergency Card.

The number of carers assessments had risen year on year. Senior leaders were aware of the long waiting time for unpaid carers to receive assessments and support through statutory complaints they received and feedback to carers support organisations. They had been engaging more with people at unpaid carers events and workshops. They were aware there remained significant challenges, but improvements were underway. Overall waiting times were getting better, and this was due to a mixture of new staff roles, recruitment, use of some agency workers, better use of data, having clearer KPI's (key performance indicators) and better oversight and management of teams. This had given them a greater understanding of the demand and trends in relation to unpaid carers. For example, the use of direct payments was high for carers, for accessing breaks, sitting services and companionship.

Practitioners across all teams could undertake assessments and reviews for carers but the local authority also had a specialist carers team dedicated to this task. Third sector carers support organisations were commissioned to undertake assessments on behalf of the local authority. The local authority had good working relationships with the carers support organisations and drew regularly on the feedback unpaid carers provided, to assist with a continuous improvement strategy and planning. The local authority grant funded some community groups to support unpaid carers too.

An 'All Age Carers Strategy' was being launched in 2025 along with a coproduced working group with the aim to deliver on actions against the strategic priorities, including reducing unpaid carer wait times. People were given information about waiting after an assessment, such as useful telephone numbers and information to seek help. The local authority had put this in place to help manage expectations, keep people safe whilst waiting for services and help keep them informed. The Integrated Carers Team Plan 2024-25 was produced to ensure it met the commitments of the vision for adult social care in Bristol.

Partners told us people waiting for an allocated social worker, carers fatigue and social isolation were the biggest challenges faced by unpaid carers. This had been fed back to the local authority who were keen to learn, but they reported a large turnover in staff and some partners were unsure what more was happening to address this.

With people’s care records reviewed as part of our assessment, we found evidence of clear records of eligibility decision-making. This included recording ineligible needs, and identifying any actions required to meet those needs. For example, one person had been originally assessed in 2020, however most recently reviewed again in 2024. It was clear ongoing occupational therapy involvement had continued during this time although the person was not eligible for support under the Care Act due to their increased independence.

People were given help, advice and information about how to access services, facilities and other agencies for help with non-eligible care and support needs. Staff told us about the range of prevention and early intervention services they regularly used which included the Technology Enabled Care (TEC) service, ‘Help When You Need It’ services, and working with some further charities and support services. ‘Help When you Need it’ services were funded by the local authority so local services could provide support to people who fell below care act eligibility. This time limited support included help with housing related issues, independent living skills and connecting to the community. Sometimes people's needs would be addressed by for example, providing simple equipment.

Some staff felt there was a gap in support for those who don't meet eligible care needs under the Care Act. For example, young people with mental health needs as they transitioned from children's and adolescent mental health services to adult mental health services as this was only in specific circumstances.

Feedback from partners was that communication could be better at times from the local authority when people's eligibility changed and there was currently no support for people who were waiting to hear about an autism diagnosis.

National data from the Adult Social Care Survey for 2023/24 showed 67.72% of people did not buy any additional care or support privately or pay more to 'top up' their care and support. This was the same as the England average (64.39%).

Support Options Forums (SOFs) were held for initial practice discussions and cases with requests for increases in care packages or new care packages costing under £350 per week. Case Discussion Forums (CDFs) were held for cases similarly, but for over £350, and for all placements. These forums provided assurance that staff were considering the best options for people, and these remained within the scope of budgets. Changes to the process for approval of care were consistently mentioned by staff as lengthy. Some staff felt the senior leadership team did not understand the impact of this process on people waiting, which could cause delays in meeting needs (although this was improving). Some staff felt there was a high level of scrutiny and systems could hinder creativity. Staff were getting used to the processes but had found it difficult. Feedback from partners was similar as they felt cases at SOF and CDF were delayed and lengthy and they were concerned cost was considered over people's needs.

Local authority guidance documented the SOFs and CDFs were robust, critical, and friendly discussions where all members contributed to critically deliberate and develop creative solutions for individuals requiring support from Adult Social Care. The aim of forums was to provide a strategic and multi-professional lens to the support provided to people to ensure practice was safe, in line with the Care Act 2014, evidence based, and cost-effective. Emergency cases were reviewed separately.

Data provided by the Local Authority in July 2024 for financial assessments confirmed the current waiting list was 32 with a median wait time for people of 7 days. This was also the target time for first contact. Staff wrote to everyone needing a financial assessment giving them details of the online financial assessment tool and a copy of a paper self-assessment form.

One person told us they had challenged a decision around charging in relation to being in a care service where they wanted to return home and had been successful in this decision being reversed by the local authority. Feedback to Healthwatch by one unpaid carer was they felt they would benefit from additional information on financial support and direct payments. Healthwatch is the independent champion for people who use health and social care services. Healthwatch gathers and represents the views of the public about health and social care services in England. The local Healthwatch network supports people to share their experiences of care or access advice.

Staff had established links between teams with good reporting systems around financial assessments. Financial assessments were normally carried out remotely but could be done in person if preferred. Feedback from staff was they could be done quicker, so people could know how much care would cost, information could be improved and the number of processes staff had to follow could be streamlined.

The Financial Protection Team managed corporate appointeeships and deputyships. They reported having good capacity and worked well with social work teams providing guidance and support. There was a project worker on the team who could support people to try and resolve their financial difficulties and maintain financial independence, so formal financial protection measures were only implemented when there was no other option.

The local authority produced a leaflet for people in relation to pricing and charging (dated April 2024 to March 2025). It contained a tool which individuals could use to calculate their probable financial contribution to care, in both residential and non-residential settings. Sections included deferred payments, third party top ups and self-funding care. The leaflet concluded with a list of organisations who could offer independent advice and information for people.

Feedback from partners was there could be occasions when it was difficult to obtain one to one funding for people to preserve placements and delays in getting funding agreed.

Timely, independent advocacy support was available to help people fully participate in care assessments and care planning processes. Staff were aware of when and how to refer for advocacy support which was straightforward. The advocacy service had recently changed but referrals were the same and there were good relationships where staff could call to discuss referrals.

A new advocacy provider took over in November 2024 to provide statutory advocacy services to the local authority. Several existing staff remained which ensured continuity for people. There was a range of support across Safeguarding, Independent Mental Capacity Advocates, DoLS, Community Advocacy and Health and Social Care Complaints. The local authority undertook joint commissioning with the ICB to fund elements of advocacy support. Partner feedback was the local authority were approachable and responsive.

With the new provider, the local authority ambition was to improve advocacy services further to be more streamlined and easier for people to navigate. In some cases, referrals could be made sooner to advocacy and be for the whole assessment process, not just specific decisions. The advocacy provider planned to promote the service further by attending events, use of social media and having an advocacy presence in acute settings. Promotion of advocacy had been done to increase usage by talking to staff teams. Following this, the number of referrals increased slightly for Care Act assessments.