Staffordshire County Council: local authority assessment

People could easily access the local authority’s care and support services in multiple ways, for example, through their GP, via an online assessment form, or by telephoning or emailing Staffordshire Cares, the local authority’s advice and guidance hub. Access and referral pathways were clear, and people were quickly directed to the local authority’s First Contact Team for advice, information, assessment, and onward referral to a specialist or locality team as required.

The local authority’s approach to assessment and care planning was person-centered, strengths-based, and holistic. For example, staff said an assessment of a person’s sensory needs would involve a full exploration of their wellbeing needs and goals, including any needs for an unpaid carer. Staff worked with people and their families to understand their unique situations and offer support and adjustments that built on their strengths and reflected what they wanted to achieve and how they wished to live their lives, while maintaining their independence as far as possible. This was reflective of data indicating a similar proportion of people in Staffordshire, 64.84%, were satisfied with their care and support compared to the England average of 62.72% (Adult Social Care Survey, October 2024). People also said the local authority supported their right to choice over their care. For example, a person with care needs and their family were supported to try out different levels of care as part of their assessment until they found the right level of support that kept the person safe and independent.

People’s experiences of care and support ensured their human rights were respected and protected, and their protected characteristics under the Equality Act 2010 were understood and incorporated into care planning. People and their families were involved in decisions about their care. For example, a person’s family member told us they were involved in every stage of the person’s care as their Lasting Power of Attorney. This included attending mental capacity assessment meetings to advocate for the person in their best interests, in line with the requirements of the Mental Capacity Act 2005 and being regularly updated by the person’s local authority worker.

Although processes were in place for people’s care and support to be coordinated across different agencies and services, people sometimes had to repeat information about their care to different services. Staff told us people could experience many touchpoints with different staff groups along their care pathways which they said could be confusing. However, they explained they worked collaboratively to draw on information from health partners and record systems to build a picture of people’s needs. People and staff agreed that while many different professionals could work with a single person on their care journey, communication between staff was good and outcomes for people were positive.

Most assessments and care plans were reviewed at least annually, or sooner in response to changes in people’s needs. Some partners told us people did not aways receive the outcomes of their Care Act assessments or reviews in a timely way which they said caused anxiety for people. This indicated the local authority could improve the way it was keeping people informed of decisions even when no change to their care or support was required.

The local authority had assessment teams who were competent to carry out Care Act assessments. Staff told us the local authority had a continuous culture of learning, and development opportunities for them to increase their knowledge and understanding of the Care Act, including assessments for people with specific needs and protected characteristics. For example, staff had completed mandatory training such as the Oliver McGowan Training on Learning Disability and Autism which supported them to develop knowledge of specific needs such as autism.

People were given timely information, advice, including signposting or a referral for assessment by the First Contact team at their point of first contact with the local authority.

As of December 2024, the local authority was receiving approximately 300 requests for support per week. Of the 596 people whose Care Act assessments had been started but not yet completed, 318 had been engaged with their assessor for more than 28 days from the point at which they first contacted the authority. In the 12 months prior to December 2024, the median waiting time from initial contact to completion of a Care Act assessment was ten days. Leaders said longer waits for the completion of Care Act assessments were due to practitioners agreeing with the person an extended timeframe that suited their needs, challenges with contacting and meeting the person, as well as higher complexity of people’s needs which required longer time frames to understand and plan for. There was clear oversight of where people were in their care journeys, and leaders were assured that people seeking care assessments and support did not experience lengthy waits.

As of December 2024, 7823 people were receiving long-term support from the local authority. Of these, 1518 people were awaiting a review of their needs, 604 reviews were overdue by more than 90 days, and 897 people were waiting to be allocated to a worker to have their needs reviewed. In the 12 months prior to December 2024, the median waiting time for a review was 54 days. Local authority data indicated 82% of people receiving services for over a year had received an annual review of their needs in the 12 months prior to December 2024. Leaders were aware that, although this was above the target of 80%, it indicated a decline in performance from August 2024, when 90% of reviews were completed in a timely manner. They said they were working to reduce waits for annual reviews; local authority data from February 2025 indicated this work was increasing the proportion of people receiving a review within 12 months to 83% and brought the waiting list from 1518 to 1337 people. National data also indicated that 97.66% of people receiving long-term support had received a planned or unplanned review of their needs, which was much better than the England average of 58.77% (Short- and Long-Term Support, October 2024). Additionally, leaders had oversight of the reasons people waited for reviews, such as peaks in demand due to winter pressures and changes in people’s circumstances requiring a more detailed Care Act assessment to be carried out.

The local authority had robust processes in place to monitor and manage any risks to people's wellbeing while they were waiting for an assessment, support, or review of their needs. For example, staff told us risk and prioritisation matrices were used to flag people with higher wellbeing or safety risks at their first point of contact with the local authority, or by the teams already supporting them. Changes to people’s needs and risks were actively monitored by social work teams to ensure they were appropriately prioritised and kept safe while they waited for support. Local authority leaders also said practitioners actively worked with people while they waited for a review to ensure oversight of any changes to their needs without recording a specific review.

Staff and unpaid carers told us the needs of unpaid carers were recognised as distinct from the person with care needs by the local authority. All unpaid carers we spoke with said they knew how to access or had been offered a carers’ assessment from the local authority. Assessments, support plans, and reviews for unpaid carers were undertaken separately or jointly with the unpaid carer and the person receiving care, and in-person or virtually, according to the preferences of each unpaid carer. For example, an unpaid carer told us the local authority offered them a carers assessment at the time and place of their choosing to ensure they were relaxed and could focus on their own needs.

Unpaid carers told us assessments accounted for their needs for information, training, support, and equipment required to undertake their caring role safely and effectively, and to maintain their personal well-being. For example, an unpaid carer said they were signposted to meet-ups with other unpaid carers at a café and attended community walks as a result of the local authority’s identification of their needs through their carers assessment. They said this increased their social networks and positively impacted their wellbeing. This feedback was reflected in national data indicating more unpaid carers in Staffordshire felt they had as much social contact as they wanted than the England average; 37.37% compared to the England average of 30.02% (Survey of Adult Carers (SACE), June 2024). Additionally, 43.58% of unpaid carers in Staffordshire said they were satisfied with social services, which was slightly better than the England average of 36.83% (SACE, June 2024).

We heard from staff and leaders about the local authority’s clear and consistent approach to the management of carer assessments. For example, staff told us they supported unpaid carers to plan for unexpected interruptions in their ability to provide caring duties. However, feedback from some partners and unpaid carers we spoke to indicated not all carers were supported to develop a contingency or emergency plan. This suggested a more consistent approach to providing unpaid carers’ guidance and support around emergency planning was needed.

The local authority had oversight of carers’ assessment waits, including waits for young carers which sat within the remit of the adult social care directorate. They assessed or reviewed approximately 7000 unpaid carers each year. As of December 2024, 76 adult unpaid carers were waiting for an assessment. Local authority leaders said the complexity of people’s individual circumstances was a reason unpaid carers might wait longer to be assessed. Adult social care workers approached carers assessments in a person-centered way which allowed them to engage with the local authority how and when they wanted to, which could lead to longer lead-in times for assessments.

The local authority had received 378 assessment requests for young carers over the 12 months prior to December 2024, and 168 young carers were waiting for an assessment at that time. There were plans in place to reduce young carers waiting times for assessment, such as the introduction of a streamlined referrals process with the aim of identifying young carers earlier. Staff also said young carers waiting more than 28 days for an assessment were contacted regularly by the local authority to monitor changes in needs and mitigate any risks to them while they waited. Leaders told us where completion of young carers’ assessments exceeded the 28-day target, this often reflected the complexity of their caring role or their preference for a slower pace of assessment.

When contacting the local authority, people were given advice, information and signposting to other services and facilities in the area for help with care and support needs that did not require a Care Act assessment. Staff referred people to other teams and agencies where appropriate. For example, staff told us people with a learning disability requiring support not eligible under the Care Act were signposted to community resources that helped them build connections and keep socially active. Staff said people valued this support and told them it positively impacted their quality of life. However, feedback we received from some people with lived experience of certain neurodivergent diagnoses requiring support not eligible under the Care Act, and young people with a learning disability said more needed to be done to reach and support them.

Local authority leaders were aware of the need for improved community resources to meet people’s non-eligible support needs. Staff told us about current work which included the development of a network of local community services, the Integrated Care Board (ICB), and the county’s voluntary sector infrastructure partner, Support Staffordshire, to understand the support needs for these groups and gaps in local support provision. As a result, training for voluntary, community, faith and social enterprise sector (VCFSE) partners to upskill community groups around needs for those with learning disabilities and/or neurodivergent diagnoses was under development, with the aim of improving accessibility to community resources.

The local authority’s framework for eligibility for care and support was transparent, clear, and consistently applied. Decisions and outcomes were also transparent.

People were given information and support to appeal against eligibility decisions if they wished to do so, which included access to independent advocacy where required.

Staff said the process for identifying and addressing eligibility appeals had been reviewed and updated following internal feedback that appeals were becoming merged with complaints and were not easy to identify. The updated system supported them to identify and address appeals consistently and quickly.

Of the 17 appeals received for the theme of ‘Support Plans’, 5 appeals were upheld; and of the 10 appeals received due complaints about ‘financial assessments’, 4 were upheld. Data gathered by the local authority indicated key themes for people successfully appealing their eligibility decisions were around poor staff communication and human and administrative errors. Staff said they aimed to gather more granular data to understand trends regarding eligibility appeals to further improve the eligibility framework.

The local authority had a clear process for charging adults who received care and support services after their individual needs and financial situations had been assessed. These processes, as well as decisions and outcomes from them, were transparent, clear and consistently applied. For example, a family member of a person receiving care told us that although they did not agree with the local authority’s policy regarding how a person’s debt was accounted for when assessing their contributions, the explanation the person received from the local authority was fair and consistent. As a result, the person said they felt comfortable discussing the person’s future support options with the local authority.

Feedback from people, staff, and partners about the timeliness of financial assessments was mixed. As of December 2024, 774 people were waiting for a financial assessment to be completed, of which 338 had been waiting more than 45 days. Reasons given for people waiting for assessments included delays caused when people submitted incorrect financial information or supporting evidence to the local authority. Leaders were aware that people experienced waits for financial assessments to be completed, and they were working to reduce any delays and had started to see improvements. For example, in the 12 months up to June 2024, 36% of financial assessments were completed within 45 days, and this had increased to 68% in the six months up to December 2024. Additionally, staff said complaints regarding financial assessments had reduced since delays had begun to be addressed, further indicating improvement in this area.

Support had been provided to staff to increase people’s access to and uptake of advocacy support in the local area, which helped them to participate fully in care assessments and care planning.

There were low recorded levels of advocacy for people who were subject of a Section 42 enquiry. This was reflected in national data indicating that 58.13% of people who lacked capacity were supported by an advocate, friend, or family member to participate in their care assessments and planning. This was significantly lower than the England average of 83.38% (Safeguarding Adults Collection, August 2024). Leaders and staff told us that audits identified that adults were appropriately supported by advocates, however where support was provided by an informal rather than a paid advocate, this was not always recorded. The local authority had identified that practitioners were uncertain about how to record this information, and this had been addressed by working with the contracted advocacy provider to develop staff knowledge and understanding.

This work resulted in improved uptake of advocacy, leading to a need for the local authority to expand its contract capacity with the provider. For example, referrals in the three months prior to December 2024 had increased by 9.6% and local authority data indicated advocates were developing longer term relationships with people due to their increasingly complex needs. Additionally, the local authority had continued work to increase staff confidence around recording advocacy referrals and outcomes and the impact of this was to be re-audited in March 2025.