Bristol City Council: local authority assessment

The local authority had developed relationships with local partners and providers including health, and the voluntary, community and social enterprise sector (VCSE). The local authority worked closely with health partners and took an active role as part of the ICB and in wider system discussions. Practical commissioning examples of joint work included the Learning Disability and Autism Programme, a new Discharge to Assess model (D2A) and unpaid carers support work. The first two being examples of system wide transformational work taking place.

In most areas relationships between the local authority and health partners were strong, for example some reciprocal training was now taking place between Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) and front-facing teams in each organisation to meet and learn more about each other's role, and referral pathways. However, senior staff told us they would still like to improve their relationships with health partners and care providers in some cases to strengthen these.

The partnership with mental health services was particularly highlighted as an area of focus. For example, in relation to section 117 aftercare funding (the purpose of Section 117 aftercare is to support a person safely back into the community, to prevent them from having to be readmitted to hospital because of their mental health needs). A health partner told us both the local authority and health were committed to working together in relation to funding, communicating and ensuring people using services were central to all the decisions made. Consequently, a newly created section 117 ‘hub’ was about to be launched. This example of joint working would bring services together in one place with the aim of improving people’s access to support.

The local authority recognised the need to develop at a greater pace the level of integration with NHS partners at a practical level that delivered pooled or aligned budgets, integrated multi-agency operational teams, and joint commissioning and brokerage. Also to look for opportunities to align co-production principles.

Staff told us one of the challenges they faced was different services were using different systems to record information which could hinder good communication. This was essential to make sure people were cared for correctly and a shared system would improve this process. For example, to share safeguarding information with the GP they had to call them, which took time when it was crucial information the GP needed to know. As a consequence, the local authority data and performance team were in conversation with health care partners in relation to data sharing.

The transfer of care hub (ToC) was an example of effective partnerships working where health partners had worked closely with the local authority since 2023. Staff were co-located in hubs and worked together on a daily basis. Strategic meetings were held regularly including with other local authorities in the ICB.

The Commissioning and Discharge to Assess Teams, along with provider services (Reablement Service) had worked with the ICB to review data around hospital discharge, particularly the number of people waiting in hospital for an assessment of need. This had led to a service being jointly developed that enabled people to be discharged and then assessed.

Partners told us funding was provided to the voluntary and community sector to help improve hospital discharge outcomes for people. They felt the local authority listened to them when they gave feedback in relation to the support people required and the local authority were creative and innovative in their approach. For example, they had funded ‘step-up’ beds for 18 months. Step-up beds assisted with preventing and reducing hospital admissions. Feedback was this service was working well with effective communication between the hospital and reablement team involved.

The local authority Commissioning Team were building strong, effective working relationships with partners, including the ICB, AWP, housing and other local authorities. They attended a number of partnership boards and meetings. There had been a real drive and commitment to working with partners since the start of the COVID-19 pandemic, and this was now more embedded.

The local authority, partners and people were able to share positive experiences of partnership working in Bristol. People receiving care told us they found services generally worked well together. In one example, wheelchair services and occupational therapy worked together to provide adaptations to support one person to be able to continue to drive. In another example for one person in hospital, their accommodation back in the community was arranged by the local authority, but care and support jointly funded by the local authority and the Integrated care board. This resulted in them being able to return to live independently in their own home after a long period of time away.

An OT gave another example of successful partnership work with health. A person living in a care home had wanted to return to supported living where they had lived previously. There were risks around mobility and their skin where specialist equipment would be needed. The OT told us how they worked with the care home, district nurse and tissue viability nurse to enable the person to return home fully independent.

Staff explained they had good working relationships across teams, especially with the housing team, who also delivered training to build staff knowledge. Staff gave an example of how housing staff had worked with one person by allowing further flexibility in the housing process to support them with managing their anxiety in relation to this.

The local authority Technology Enabled Care Hub had been involved in a number of trials funded by NHS England and the ICB. This had included a trial with a community health provider to provide technology enabled care to people with ineligible, or low-level needs as part of the hospital discharge process. Equipment had included memory prompting devices, pendant alarms and bed and chair sensors. Data from the ICB had shown that hospital readmissions had been reduced as a result.

Feedback about the work the local authority did with the VCSE sector was positive overall. Partners told us they felt Bristol had a strong and vibrant voluntary and community sector and this was due in part to the support the sector was given by the local authority. The local authority worked hard to support VCSEs, even in the face of difficult funding constraints. They ensured different communities were represented, and there were various grants available which could be used for local organisations to address health inequalities. One partner told us local authority commissioners were also good at listening to feedback and acting upon this. For example, commissioners supported the group in accessing additional funding to support staff wellbeing.

The local authority had in place a ‘Make it Local’ initiative, which commenced in 2019, and brought together partners to explore opportunities to sustainably provide services and interventions in Adult Social Care. This enabled some voluntary sector partners to develop services to support self-directed care at a local community level. They had used the relationships built through this initiative to further develop other pilots such as the Hospital Link Worker Scheme (Link Workers are independent support workers, based in local hospitals who talk to people before they are discharged and make suggestions around independence and wellbeing at home). This had encouraged voluntary sector partners to join the Adult Social Care Single Framework so they could target future commissioning opportunities, creating a more sustainable environment for the sector.

One partner told us they found an invitation for collaborative working with the local authority quality assurance team to be encouraging and supportive. Local authority staff had actively sought their feedback and opinions, listened to any concerns raised, followed up and reported back to them in a timely way. Meetings were held monthly online with health colleagues invited, fostering an even stronger approach.

Partners from the VCSE told us the local authority worked with them in relation to strategy development. One partner told us how the local authority, in collaboration with themselves and other partners, were involved with ‘The Bristol One City Approach’. They described this as a very positive piece of work which brought together different local organisations to work together on common goals. The VCSE sector were able to highlight any risks which may be present within the system to leaders, which supported effective market shaping and oversight. A Community Resilience fund was also set up by the local authority which local voluntary and community groups could use to support the sector in providing services.

The local authority had a good understanding of advocacy, and partners said they had had a strong relationship with both the previous and current provider of advocacy in Bristol. They had undertaken a consultation exercise to decide how an advocacy services should be commissioned. The result of this was that they would use a single lead provider delivering all elements from an “Advocacy Hub” whilst also developing a non-statutory offer from VCSE partners so supporting an increased level of self-advocacy within communities.

Staff told us they had good partnerships in place with the VCSE such as the Carers Support Centre. Staff from the centre attended team meetings and engaged well with the local authority. They supported the local authority to manage risks whilst unpaid carers were waiting to be assessed. The local authority had a partnership board called the Bristol Carers Voice. Membership included carer and parent carer representatives, carers support organisations, the ICB and senior leadership from Adult Social Care. The local authority told us how Bristol Carers Voice played a key role in highlighting key emerging issues for carers and served as part of their governance for strategy and improvements.