Our guide to adult social care in Devon

Our self-assessment is in two parts, of which this is the first.

This guide to adult social care in Devon is designed to describe:

• the context in which we work
• how we are organised
• how we deliver our key Care Act and other duties

While intended as a guide for CQC assessors, it is made available to any interested parties as an overview of adult social care in Devon, when read alongside our self-assessment. 

It will be reviewed quarterly with a major update annually in the winter of each year, forming part of our Annual Report to Health and Adult Care Scrutiny Committee and other stakeholders.

Introduction

Tandra Forster, Director of Integrated Adult Social Care

I was appointed as Director of Adult Social Services in Devon two years ago, and in that time I have developed a real understanding about who we are in Devon, as a Council, as a Directorate, as a workforce and most importantly as a population of many communities.

Our landscapes and geographies are as diverse and unique as the communities and individuals that we serve, and like our landscapes we need to ensure that our communities are healthy and flourishing and resilient. That means we must listen to and hear each and every community, and by community, I mean the community people live in and the community they identify with. We need to spend time understanding their hopes, their aspirations, what’s important to them and what they want to achieve, shaping everything we do around that. We are increasingly doing more of this, and our three conversations model, which is now embedded, is one of the tools our incredible workforce is using.

We need to go faster and further with our preventative approaches and short term interventions to avoid, delay or reduce people’s need for long term support that limits their independence. We have introduced empowering lives through three conversations – our practice model to support our workforce to adopt a strengths-based approach at every contact. The next step is ensuring we are being consistent in how we do that for everyone we have contact with, wherever they are in Devon and whatever community they are from or represent.

To support this work, and our on-going improvement we have invested in our own approach to Practice Quality Assurance. This vitally important work is building on our culture of learning and improvement and bring additional rigour and discipline to our practice to support the experience and outcomes that the people we serve have and can achieve.

We have also introduced our Adult Social Care Practice Standards and Values which underpin our Practice Quality Assurance framework. They set out the expectations staff have of themselves and their work. The Standards and Values have been co-produced with staff, partners and those we serve, defining how we do what we do, how we do it well and what people can expect.

As communities constantly change, so must we. Many approaches over many decades have benefited our health and wellbeing and given us opportunities as individuals, within communities, and as a society. These positive outcomes bring different challenges. Over the next 15 years the number of people aged 85 and over will increase by 60% in Devon. We’re already ahead of most areas in terms of the age profile of our population, but this growth will bring unprecedented challenges that we can only meet in partnership across the council, with the NHS, the providers and voluntary sector organisations we work with, and with people in their communities.

We’re seeing changes within the younger adult population too. Lifesaving and life-giving medical advances mean more children and young people are living much longer into adulthood and into older age with complex needs requiring ongoing care and support. And with a positive focus on mental health and neurodiversity, more people are accessing diagnoses and seeking the help and support they need.

These challenges more than ever mean that we need to ensure we have a sufficient and sustainable workforce, equipped with the right skills and tools. This includes increasing use of Technology Enabled Care Services and Artificial Intelligence which our staff are enthusiastically embracing. We need to make sure we’re there when people need us and working in a way that builds individual and community resilience.

Over the next few years local government reorganisation, and devolution will provide further opportunities for statutory services to be more coordinated and impactful for the people of Devon. This is the new journey we are on, and we are working to ensure those opportunities are maximised in the delivery of adult social care in the future including the continual improvement in the equality of access, experience and outcomes for everyone in contact with adult social care.

This Guide to Adult Social Care in Devon is a prelude to our Self-Assessment of how well we are delivering on the duties defined by the Care Act (2014); together they make-up our annual report or ‘local account’ which we intend to review quarterly and update annually. We publish them online to give all stakeholders an overview of the context in which we work, the approaches we take, the evidence we have of the impact on people’s lives, and our own assessment of how we are doing.

We are publishing our Guide and Self-Assessment in this way because we have engaged many stakeholders in their production and intend to use the information they contain to reflect on our performance and seek to improve, including through any assessment by the Care Quality Commission. I hope you find the content accessible and informative and feel inspired to fulfil your role in delivering services that improve people’s lives.  

Tandra Forster – Director of Integrated Adult Social Care

Tandra was appointed as Director of Integrated Adult Social Care in August 2022 having previously been the Director of Adult Social Services in Southend-on-Sea and West Berkshire.

She is an active member of the Association of Director of Adult Social Services, being co-lead on the workforce group and chairing the National Commissioning Network.

Councillor James McInnes, Leader of the Council

Last year I became the Leader of the Council, stepping down from my role as Cabinet Member for Integrated Adult Social Care and Health, a role I’d held for 3 years. I’ve taken and drawn on all my experiences and understanding of adult social care, and the wider local and national health and care system with me.

I want to put on record the gratitude and awe I have for the caring workforce, and of course I include unpaid carers in that, the system would collapse without them. I was clear when I became Lead Member that I saw unpaid carers and the caring workforce as two of my key priority areas for ASC, that remains the case as I become Leader.

When I became Lead Member for Integrated Adult Social Care and Health, we were in the middle of the pandemic, we’ve come a long way since then and I want to thank all those who work in the sector for all they continue to do on our new journey. I have always enjoyed meeting and spending time with staff, whether that be hearing our challenges, listening to ideas, or joining them to celebrate successes and receive awards. I have really appreciated how honest and kind people have always been with me; there’s a culture of openness in adult social care that we should all be proud of.

Change can often be difficult, but I have been incredibly heartened by how staff are embracing the need to be always learning and always evolving. Staff are up for the challenge, and as Council we’re better off because of that. It was a remarkable effort for the Directorate in 2022-23 doing difficult things and doing things differently to make saving of over £28m without compromising on quality, continuing to focus on what matters to people most. Savings in 2023-2024 have been similarly remarkable, doing the right things and doing them better.

We know it’s a pressured time across local government and further reorganisation in pending; there’s an imperative to live within our means, to collaborate, and we know the best outcomes for people, the outcomes they want to achieve are the best value outcomes too.

I welcome Councillor Phil Bullivant as our new Lead Member for Integrated Adult Social Care and Health having recently launched a new set of Practice Standards and Values, and a recently refreshed Promoting Independence Vision and Strategies. Our preparations are well underway for our participation in the new CQC Inspection regime, and I know all Members have the opportunity to ensure they are connected to and aware of this work, supported through the invaluable contribution from the Health and Adult Care Scrutiny Committee.

Councillor James McInnes – Leader of the Council

James has been a county councillor since 2005, holding a number of roles in that time including Cabinet Member for Children’s Services.

Until May 2024, James was the Cabinet Member for Integrated Adult Social Care and Health and Chair of the Devon Health and Wellbeing Board as well as Chair of our Integrated Care Partnership Board encouraging public services to work together to address the wider determinants of health to the benefit of the people and communities we serve.

Councillor Phil Bullivant, Lead Member for Adult Social Care and Health

It is a huge privilege to have become the Cabinet Member for Integrated Adult Social Care and Heath. A special thank you to our Leader for his support and handing over the portfolio in such a supportive and positive manner. And also to the staff, partners and those in receipt of care support, and the unpaid carers that I have met during my time so far and the warm welcome that I’ve received. It’s incredibly important to me that I understand the diversity and the characteristics of the population of Devon and that this shapes what we do and how we do it.

As we continue on our improvement journey it is essential that across the council there is an understanding of our performance: what our strengths are; what our challenges are; what are opportunities are, and what we are proud of. This document provides a deep dive into that, taking us all on a path to better understand who we are and who we serve.

In my time so far as Lead Member I have continued the work of other colleagues to ensure adult social care has the necessary profile across the council and that our preparedness for CQC inspection remains on track, that we learn from other areas and share the insights we gain. I must thank Sara Randall Johnson for all the work that she and her scrutiny committee have done to provide learning and engagement opportunities to the entire membership through the scrutiny work programme.

Councillor Phil Bullivant – Lead Member for Adult Social Care and Health

Phil has been a county councillor since 2021, alongside roles as a district and town councillor, giving him valuable insights and connections to communities and neighbourhoods. In addition to Phil’s Lead Member role for the county council he is the Chair of the Devon Health and Wellbeing Board, Chair of the Carer Partnership Board, member of the Torbay and Devon Safeguarding Adults Partnership Board, and also the Integrated Care Partnership Board.

Councillor Sara Randall Johnson, Chair of Health and Adult Care Scrutiny Committee

For the 2024-25 budget, the savings required were shown to be significant with a growing gap between the amount of funding received by the Authority and the cost of meeting its statutory responsibilities. The Committee has closely tracked these savings and will continue to do so moving into 2025-26 financial year to ensure the Council balances its budget. Members have also continued to monitor the ‘One Devon’ Integrated Care Board budget deficit through regular update reports and looks forward to a time when there is no overspend.

The effects and legacy from the lockdowns are still being felt within the health and care system. While workforce challenges persist, we have seen and heard first-hand the extraordinary work that is going on across Devon, the achievements and success. We on the Health and Adult Care Scrutiny Committee want again to put on record our thanks to everyone working in the Devon health and care system both employed and volunteers for all they are doing and their continued commitment. The work of the Health and Adult Care Scrutiny Committee has vulnerable residents’ welfare at the heart of everything we do.

During 2024, our agenda focussed on adult social care with a number of items including reports on services for unpaid carers; transitions for young people with Special Educational Needs and Disabilities (SEND); Safeguarding adults, Healthwatch feedback; Integrated Adult Social Care (IASC) in-year financial and performance updates, highlighting the key risks facing the Directorate; and Ombudsman complaints. Members also presented a report from the Committee’s Standing Overview Group focussed on Devon’s healthcare providers’ Quality Accounts and their progress to meet the improvement priorities.

Health and Adult Care Scrutiny, responding to the concerns of local people, produced a series of recommendations to Cabinet on the future of the North Devon Link Service, which were accepted, to assure a smooth transition process for those affected. Members recommended the development of community-based solutions to meet identified needs and the emerging long term pattern of community based mental health support as a result of this process. The Committee will continue to monitor progress against these recommendations.

The Committee has continued to champion health improvement and prevention in their communities. Members undertook Local Government Association’s Prevention Matters training which centred on the opportunity to shift the focus from treating sickness to actively promoting health and wellbeing. This session was followed by a comprehensive report from IASC and Public Health on the Council’s approach to prevention and the role of Members.

Officers from IASC and Customer Relations provided a presentation to the Committee’s Standing Overview Group in July 2024 aimed at helping Members understand the various mechanisms in IASC to gather, understand and act on feedback and the lived experience of people using services in Devon and for Members to check IASC are identifying and acting on recurring themes.

The Committee have maintained a focus on the policies of the Council including inequalities, understanding the importance of the wider determinants of health and local actions to reduce these. Members continue to develop their knowledge base, benefiting from the independent advice of the Committee’s Special Advisor, a former Director of Adult Social Services, and attendance at the ongoing masterclass series with regular sessions on topics such as the IASC Annual Report and the Peninsula Acute Sustainability Programme.

The Committee continues to receive regular updates on Domestic and Sexual Violence and Abuse (DSVA) from the Members appointed to raise awareness on DSVA.

We have greatly valued the time officers have given to the Committee, especially during the many masterclass sessions we have hosted. These sessions have enabled trusting, mature and candid relationships to develop. Masterclasses are often attended by fellow Scrutiny members from Plymouth and Torbay, demonstrating the maturity of relationships across the ‘One Devon’ partnership and a commitment to joint working and collaboration.

Members have continued to visit health and care settings as part of furthering their Scrutiny role. These visits are incredibly insightful for Committee members, providing the opportunity to see and hear the experience of health and care delivery from both the workforce and recipient point of view. We look to continue this programme into 2025.

Devon faces mounting pressure to deliver health and care services, in particular to our non-urban residents in smaller isolated settlements yet still has so much to be proud of. As Chair, I try to ensure that we remain focussed at every Committee meeting to champion the wellbeing of our residents. As we move into the new year, the Committee will need to maintain attention on Integrated Adult Social Care as the service continues to evolve. As the Council remains committed to its vision of promoting independence via a strengths-based approach alongside managing the key pressures the service faces. It will be essential that scrutiny is both the critical yet challenging friend supporting officers and listening to the people of Devon to continually improve our services for the benefit of our residents.

Councillor Sara Randall-Johnson

Chair, Health and Adult Care Scrutiny Committee

Sara is a Devon county councillor representing communities across the Broadclyst Division of the East Devon District.

Sara has been Chair of the Health and Adult Care Scrutiny Committee for over seven years where she maintains and provides overview and scrutiny of health and care services, outcomes and experiences for communities across the whole of Devon.

Context

Our place and its population

The Devon County Council area is a mainly rural county including one city and over twenty market and coastal towns accommodating a population of 810,000 people that is among the oldest and most rapidly ageing in the country.

Although known for the beauty of its landscape, its road network of over 8,000 miles and its widely dispersed population also challenges service delivery, as do its low wage and high house price economy. 

Within the area eight districts: East Devon, Exeter, Mid Devon, North Devon, South Hams, Teignbridge, Torridge and West Devon. Devon also includes Dartmoor and Exmoor National Parks and two coastlines, as well as five Areas of Outstanding Natural Beauty.

Plymouth City Council and Torbay Council are responsible for services within parts of the geographic county and partners within our One Devon Integrated Care System.

The following are highlighted in the Joint Strategic Needs Assessment as the main current and future health and wellbeing challenges across Devon:

• An ageing and growing population, with significant differences in the demographic profiles of communities.
• Access to services, including the challenge of delivery in rural areas socio-economic and cultural barriers.
• Complex patterns of urban and rural deprivation, which is often hidden and hard-to-reach.
• Housing issues including its quality and affordability with increasing levels of fuel poverty.
• Earlier onset of health problems in more deprived areas and households.
• Comparatively poor mental health and wellbeing, social isolation, and loneliness in some areas.
• Comparatively poor health outcomes caused by modifiable health-related behaviours in some areas.
• Pressures on health and care services caused by increasing long-term conditions, multi-morbidity, and frailty.
• Shifting to a prevention focus across the health and care system when financial sustainability is challenging.
• Unpaid care and associated health outcomes for carers, sometimes with multiple responsibilities.

In adult social care, our particular challenges are:

• a more aged and rapidly ageing population than nationally with growing levels of frailty and dementia
• extending life expectancy and increasing complexity of need of people with learning and physical disabilities
• the growing number of people with long-term conditions with sometimes insufficient capacity to address
• a changing profile of mental health needs including growth in demand from autistic people
• more younger adults being served than is typical, especially those with learning disabilities
• service costs rising more rapidly than elsewhere, especially for older people
• high levels of social isolation resulting in loneliness in all age groups exacerbated by the pandemic
• a sparse and predominantly rural population with patterns of hidden and hard-to-reach deprivation
• significant inequalities in healthy life expectancy between the most and least deprived parts of the county
• the growing number of people with often multiple unpaid caring responsibilities
• improvements in health-related behaviours in younger age groups not mirrored by older generations
• a disparity between the quality of indoor and outdoor environments in Devon
• incomes lower than the national average, house prices higher, and housing quality variable
• changes in the benefits system having unforeseen consequences, exacerbated in rural areas
• a working age population that is not growing at the same rate as the non-working population
• consequent workforce recruitment and retention challenges meaning more reliance on overseas recruitment
• a complex organisational geography with multiple NHS partners and district councils

The pandemic, cost-of-living crisis, and recovery

As elsewhere, during the COVID-19 pandemic we experienced significant numbers of outbreaks of COVID-19 in care homes and other care settings requiring a whole system response and enhanced infection prevention and control protocols.

Looking back over the pandemic period through to the end of 2022:

• There were 199 deaths in care homes attributable to COVID-19 per 100,000 of the 65+ population in Devon, ranking 27^th lowest of 152 local authority areas in the country, with most of those being London boroughs where there are fewer care homes.
• The percentage of deaths in care homes attributable to Covid-19 as a percentage of all deaths in Devon has been the 9^th lowest of 152 local authority areas in the country.
• Almost thirty local authority areas experienced double or more this percentage of fatalities.
• Some of the approaches to working with care homes in outbreak management developed by public health and adult social care colleagues in Devon were picked up and used regionally, and influenced the national response.
• Our vaccination rates are high, with 96% of residents and 94% of staff in care homes in Devon receiving at least two doses, among the highest in the country.

We mourn the deaths of the 414 people whose deaths are attributable to COVID-19 in care homes in Devon during the pandemic period, many of whom could have looked forward to a longer life, and thank all of the staff who’ve been involved in the response across the health and care system, especially frontline care-giving staff who have often been working in trying circumstances.

During the pandemic, much of our capacity was dedicated to pandemic response involving senior managers in leadership positions and frontline managers chairing Outbreak Control Meetings and working closely with care providers in their patch.

Frontline operational staff were focussed on ensuring people were receiving the right support in the right place for them in the circumstances, including ensuring discharge from hospitals operating under additional pressure and with reduced capacity. Registered managers and frontline care staff were working under trying circumstances and received our round-the-clock support.

Our integrated management arrangements in community services meant that we were able to pull together health and care capacity to support the care sector, and that this made a material difference in effective outbreak support and survival rates

Consequently, some of our non-vital activities were stood or slowed down, meaning during 2022 and 2023 we have faced the challenges of recovery under budgetary pressure as government has withdrawn additional funding.

The longer-term impacts of the pandemic and the new challenges that have emerged are articulated in the 2022 Annual Public Health Report.

Recovery has coincided with the cost-of-living crisis meaning our income has fallen below inflation, but our costs have often exceeded the headline level, with care homes in particular impacted by escalating food and electricity/gas costs and by increases to the National Living Wage while the costs of community based services in rural areas are also sensitive to volatile fuel costs.

For the first time for many, leaders are managing budgets in a highly unpredictable environment after years of low inflation. Meanwhile, national government funding has been further constrained by servicing the debts accumulated during the pandemic and cost-of-living crisis, leading to cuts to public services coinciding with higher taxes. Furthermore, demand for key services such as children’s social care, special education and adult social care has been increasing. Consequently, the Council has necessarily been focussed on securing its financial sustainability, without which services cannot be reliably delivered, let alone improved.

Also, while our relationships with each other, our providers, other parts of the council, and our partners were galvanised by the pandemic, the post-pandemic period has thrown up unexpected changes. After a long period of stability, there has been significant change in council and NHS leadership. Providers confronted by challenges to their financial sustainability have been faced by a Council less able to support them than during the pandemic.

As a ‘One Devon’ partnership we have published our five-year Integrated Care Strategy and Joint Forward Plan to address our shared challenges in these changed circumstances such as the increasing number of people with dementia in Devon. Corporately we have reviewed our ‘Best Place’ strategy and plans and within the service we have updated our vision and associated strategies and are resetting our priorities and delivery plans to be clear on our intentions and constraints, and manage the expectations of stakeholders facing their own challenges in recovery.

In doing so, we have sought to maintain our ‘promoting independence’ principles; our Director of Public Health made prevention the theme of his 2023 Annual Public Health Report, encouraging members to attend related masterclasses and workshops.

His 2024 Annual Report addresses healthy ageing as both a challenge and an opportunity, with most older people in Devon living in their own homes, being active in their communities, and having better health and wellbeing in many parts of the country but with demographic change a growing number being physically frail or having dementia, some of whom requiring care and support.

Our services and who they serve

In Devon, of the 468,700 people (2022/23) aged 18-64 resident in the county, the County Council was supporting 4,702 working age adults at the end of January 2025, approximately 1% of that age group:

• 54% were men, indicative of the higher prevalence of some health conditions and disabilities among men.
• 12% were in long-term residential and nursing care, with almost all of the remainder supported to live in their own home, which can be in a housing with support setting such as supported living or shared lives.
• 44% were supported mainly because of their learning disabilities although many clients have more than one reason for their support.

The significant majority of people receiving care and support in Devon in this age group are funded by the council. Of the services they receive:

• The number of people aged 18-64 in residential and nursing care has been reducing over the long term as the Transforming Care Partnership and subsequent initiatives has brought many of those with more complex needs back into their communities, and locally we have been working to place people in housing with support settings such as supported living and shared lives. This trend slowed in the pandemic period due to some community-based services being suspended. Typically, fewer than 50 people this age are in nursing care at any one time.
• The number of people aged 18-64 receiving personal care over the 2017-23 period and the total number of hours provided has been consistent at around 500 people receiving 7,000 hours of care. In March 2023, we improved our recording of Supported Living activity and spend, which resulted in an overall reduction in the number of working aged adults in receipt of personal care support, averaging around 400 people receiving 5,000 hours of care per week.
• Because there is no national benchmarking information regarding unregulated support, this significant and most rapid growing spend on adults aged 18-64 is often overlooked, while being a significant change in adult social care provision in the last decade in Devon and elsewhere
• For many years, we have seen a long term rising trend in the number of working aged adults in receipt of direct payments. More latterly, the number of recipients has been reducing, some transferring to Individual Support Funds, and now average 1290 per week. Overall expenditure has consequently reduced, but the average direct payment has increased from £479 (April 2024) to £513 (December 2024) per week (up c.a. 7%).

In Devon, of the 217,400 (2022-23) people 65 or over resident in the county, the County Council was supporting 6,552 older people at the end of January 2025, approximately 3% of that age group:

• 63% were women, indicative of their longer life expectancy, but also raising the concern that older men may be more reluctant to come forward.
• 43% were in long term residential and nursing care, with almost all of the remainder supported to live in their own home.
• 62% were supported mainly for physical reasons and 24% mainly for dementia with many others also having that condition.
• Additionally, up to a third of recipients of personal care and a half of people in a care home fund themselves.

Of those receiving services that the council funds in part or whole:

• The number of older people the county council supports in residential and nursing care in Devon until recently was broadly stable, fluctuating around 2,500 with notable reductions some winters associated with influenza and now COVID-19. Typical numbers in nursing care have increased by over 25% in the same period, mainly due to more people from hospital being transferred into these settings; in the last two years we have seen an increase in the number of older people in residential care homes for the same reason. Residential and nursing care placements have stabilised more latterly.
• While our personal care market is currently broadly sufficient, due in part to international recruitment, continuing pressures on hospital discharge have also increased the risk that short term placements into care homes become long term, contrary to our conviction that home is the best place for the majority.
• The number of older people the county council supports in their own homes through regulated personal care has been on a downward trend since 2017, reducing by a third in that period; the total number of hours delivered has also been falling, with unmet assessed need of up to 6,000 hours two years ago now typically below 800.
• Given the growth in those aged 65 and over and especially those aged 85 and over, older people now are about half as likely to receive local authority funded support now as they were before the austerity period began, partly because we are more effective at promoting their independence by preventing, delaying, and reducing the need for care and support.
• Although on a rising trend, some 500 older people are in receipt of unregulated support, far fewer than working age adults.
• Although the numbers of older people in receipt of direct payments have typically been around 600, this has reduced more recently to around 540 in January 2025. Consequently, we have seen a reduction in overall expenditure, although the average package cost per week has increased by 8% to £433 from £398.

Our adult social care providers and workforce

The adult social care market in Devon is dominated by small and medium sized enterprises, with care homes often owner operated and singular or in small groups. Most of these are in converted rather than purpose-built buildings and a comparatively low proportion are of 60 beds or more.

A consistently higher proportion (84.6%) are rated Good or Outstanding by the Care Quality Commission than the national, regional or comparator average.

Of the 311 care homes in Devon, 67 (2,733 available beds) are with nursing, 244 (5,160 available beds) without.

Occupancy levels are currently as high as at any point in the pandemic or post-pandemic period at c.a. 87%. Vacant beds which are available for admissions are around 700 or 8% at any time.

About half of people in care homes in Devon fund themselves.

In line with our commissioning intentions, the number of nursing care homes has been growing and residential care homes reducing in recent months.

At the end of January 2025, 524 long term placements (funded wholly or jointly by the Authority) were out of area in three cohorts:

• 252 (48%) within the Devon Integrated Care Board area.
• 191 (36%) in the south-west region, where mutual quality assurance arrangements are generally in place.
• 81 (15%) further afield, usually because of family choice, or those with specialist needs.

Of these out-of-area placements:

• Over three-quarters are known to be in settings rated Good or Outstanding by the Care Quality Commission with one placement in an Inadequate setting.
• Around 80% are funded by the council alone, with 20% funded by NHS partners.
• Around a half of residents have had a review in the last 12 months. We currently have 43 people due a review in homes that are less than good.

On 1 December 2024, there are 184 locations in Devon providing regulated community-based services, 155 being personal care providers, the others are specialists in accommodation with support such as extra care housing (7) or supported living (45)

Again, the proportion rated Good or Outstanding consistently exceeds all comparator averages at 70.1%.

In recent years our challenge has been maintaining sufficiency and coverage, especially in isolated rural areas, with more than 6,000 hours per week being unallocated as we emerged from the pandemic due to workforce issues; initiatives such as overseas recruitment and attracting new providers to the market have reduced this to around 800 hours and we are now seeking to consolidate capacity and capability and maintain quality.

The capacity of the unregulated care market is more difficult to assess but our own data suggests that while the hours of regulated personal care have been reducing over time, especially for older people, the number of hours of unregulated support we are purchasing from a diverse market of providers including many self-employed personal assistants has been increasing and these sectors are an area of commissioning and quality assurance focus.

The recruitment, retention, and development of staff across the adult social sector continues to be our top priority, where we have lead the way nationally through our Love Care programme and Proud to Care initiative, attracting attention from the Department of Health and Social Care and others as we seek to raise the profile of the sector as a key employer, with 28,000 people working in adult social care across Devon, contributing to the health wellbeing of fellow residents of the county and boosting our economy.

The profile of this workforce is not atypical for the South West region:

• 11,000 in care homes, 6,400 in regulated community-based settings, the remainder being employed in the local authority, by unregulated providers, or as personal assistants.
• 51% full-time, the rest half-time, with 91% being in permanent roles and only 16% on zero-hours contracts, a far lesser proportion than nationally.
• 81% female, 87% White British, with an average age of 45. On recent years we have seen a reduction in workers from EU countries and an increase in those from elsewhere in the world who now make up 8% of the workforce.
• High turnover (33.2%) and vacancy (9.1%) rates but with notable improvements in 2023 as the impacts of the pandemic diminish. Absence rates have fallen from 7.4 days to 4.8 days in the last year, significantly below regional and national levels.
• Higher than typical fees with wage levels less than the regional but more than the national average and with real-terms pay reducing over the last two-years due to the cost-of-living crisis.
• Similar levels of training and experience to elsewhere, with 48% having a relevant qualification.

A joint initiative in international recruitment with NHS partners and independent care sector providers has proved successful, with significant work done not just in attracting new staff, but ensuring they are accommodated and made welcome in their communities. Changes in national regulations are now having a negative impact on international recruitment due to restrictions on family dependents. Of some concern has been a recent trend in residential and nursing care homes of filling gaps in rosters by the greater use of agency staff, often at greater cost.

Looking at professionally qualified roles in the adult social care sector in Devon using data published by Skills for Care for 2023-24:

• Registered Nurses: the turnover rate (22.2%) and vacancy rate (6.4%) were better than the England average, with the average number of days absence low at 2.7. At £39,500, pay is somewhat less than the regional and national averages. 43% now originate from outside the UK.
• Social Workers employed by the local authority: the turnover rate (6.5%) and vacancy rate (9.3%) in Devon were better than those nationally, with absence at 4.3 days; 99% are white, 77% women, and 92% British with an average age of 48.6; pay at £41,500 is higher than the regional but lower than the national average.
• Occupational Therapists employed by the local authority: the turnover rate (16.3%) and vacancy rate (7.5%) in Devon are low than nationally, and absence is also comparatively low at 2.1 days; 98% are White, 95% are British, 92% are women and the average age is 47.3.

Our activity, cost and spend

We use our intelligence on comparison and trend in activity, cost and spend to annually benchmark and highlight opportunities to realign our strategies and spending plans.

For adult social care services to people aged 18-64 we conclude:

• We continue to support more working aged adults than all comparators, particularly in the community, with no evidence that our population is significantly different.
• This is especially so for people with low and moderate needs who elsewhere may live independently with the support of their local communities.
• Whilst our unit costs for care home placements and personal care are high, our higher levels of expenditure are driven mainly by our activity levels.
• Our focus needs to be on continuing to promote people’s independence, especially at key transition points such as when they become adults or no longer have the support of parents.

For adult social care services to people aged 65 or over we conclude:

• Our cost base is a bigger issue than activity levels for our older people’s population.
• To achieve financial sustainability, we need to focus on containing costs particularly in the care home market. 
• Activity levels have risen marginally in 2023/24 with the greatest impact in residential or nursing care. 
• With an aged and ageing population, we need to keep focussed on managing future demand for services by preventing, delaying and reducing the need for ongoing care and support.

The outcomes that people achieve

The Department of Health and Social Care uses an Adult Social Care Outcomes Framework (ASCOF) to assess the performance of the 152 local authorities with adult social care responsibilities by the outcomes people who receive those services achieve.

These are derived from statutory collections of data:

• Short and Long Term (SALT)
• Adult Social Care Finance Return (ASC-FR)
• Adult Social Care Survey (ASCS)
• Survey of Adult Carers (SACE)

The ASCOF framework has recently been reviewed and is due to change in 2023-24 with some measures being removed and others introduced, including from other statutory returns and sources of data:

• Safeguarding Adults Collection (SAC)
• Care Quality Commission ratings of Adult Social Care Providers (CQC)
• Skills for Care data on the adult social care workforce (SfC)

The data has now been collected and published and ASCOF outcomes indicators derived for 2023/24:

• 22 ASCOF indicators were published, including 5 derived from the biennial Survey of Adult Carers in England
• In Devon, 9 indicators improved, 11 declined and 2 were maintained.
• In England, 18 indicators improved, 3 declined, and 1 was maintained.
• In Devon, our ranking improved in 11 and declined in 11.
• In Devon, our national quartile improved in 4, declined in 4 and was maintained in 14.

In targeting improvement we focus on those indicators where performance is worse than comparators; those in the third and fourth quartiles that are being maintained in ASCOF going forward.

The Survey of Carers in England is biennial and run during 2023/24. From it, we can conclude that for unpaid carers in Devon:

• Their overall satisfaction has improved for five consecutive surveys and remains above the national, regional and comparator benchmarks.
• However, while their quality of life has improved marginally it remains in the third quartile nationally.
• This is mainly because they feel more socially isolated than almost anywhere else in the country, with less time for themselves, and feeling more pressured in their caring role.
• This is despite far more feeling well supported than elsewhere and more saying they have access to breaks, especially longer breaks and breaks at short notice.
• And also, while those saying they find information easy to find has fallen to below benchmark, those that do are more likely to find it useful.
• Seeking to understand this paradox is a focus of our Carers Partnership Steering Group and the Carer Ambassadors.
• We look closely at the free text comments carers add to help us in this and know carers would want us to acknowledge the many compliments they leave for those at the Council and Devon Carers who have supported them. 

Our Health and Care Scrutiny committee has put a spotlight on how we support carers, using this information alongside direct feedback to inform their insights and recommendations.

Nationally, service users are surveyed annually, and their outcomes tend to be better than those of unpaid carers. In 2023-24, we can conclude that in Devon:

• Overall satisfaction with care and support has improved once again and with Devon raking 4^th of all local authority areas in the country.
• Quality of life remains good, but with some decline in the last two years, taking us down to the second quartile. However, when we look at the impact of services on quality of life, this remains more than 90% and ahead of comparators.
• In contrast to carers, people who use services in Devon are more likely to say they have enough social contact and time for themselves with responses typical to the England average.
• People are more likely to feel they have control over their daily life than elsewhere, and we have seen an improvement in the perceptions of availability of choice of services. 
• There is now no national measure of the impact of services on people’s perceptions of safety: an area where we historically performed well due perhaps to the higher quality of local providers based on ratings by the Care Quality Commission. Drilling down our survey responses in 2023-24, we have continued to see an improvement in the safety perceptions regarding services with over 88% responding positively.
• However, the proportion of service users who feel safe has declined marginally in 2023-24 with performance typical to the region but below the England and Peer Group averages. 

We use the insights we gain from surveys along with feedback from people through complaints and our various involvement arrangements to inform our priorities for improvement. Activity will continue to be shaped by developing a better understanding of what really matters to service users and carers to enable them to lead as independent and fulfilling lives as possible. 

Currently we are focusing on improving the unintended consequences of changes to our social care ‘front door’ and how we can improve the consistency of how we respond to people who contact us. We are now seeing improvement in response times and continuing to receive positive feedback that staff are helpful and respectful.

In assessing how well local authorities with adult social care responsibilities are fulfilling their duties defined by part one of the Care Act (2014) the Care Quality Commission is supplementing ASCOF with the use of additional data specified in its assessment framework such as the waiting times experienced by people seeking assessment of their needs or their review. 

We highlight our good performance as:

• The quality of life of people who use our services.
• Their overall satisfaction with the services they receive.
• The quality of adult social care providers in Devon which are consistently rated by CQC as having a greater proportion rated Good or Outstanding.
• The proportion of adults aged 18-64 living in their own home where they are more likely to be independent, healthy, safe, and happy.  

We acknowledge our areas for improvement as:

• The quality of life of unpaid carers, in particular the high proportion that say they do not have as much social contact as they would like.
• The proportion of people who feel unsafe, despite their quality of life and the high quality services they receive.
• Waiting times and lists for assessments of needs, reviews, financial assessments and Deprivation of Liberty Safeguards assessments.
• The reach and effectiveness at keeping people out of hospital of our short term services.

The national situation

In its annual ‘State of Care’ report for 2023-24, the Care Quality Commission look across the system to consider access to health and care services, the quality of care people receive, the inequalities that persist, the health and care workforce, and how CQC is changing the way it works to meet these priorities and challenges.

Relating to adult social care in particular, CQC highlighted:

• More people are asking for adult social care, but many are not receiving the help they need.
• Delays in hospital discharges are common because care at home or in care homes isn’t available.
• Regions like the North East have fewer home care services, making it harder for people to leave the hospital.
• Staff vacancies in care homes have dropped, showing progress in recruitment and retention.
• The recruitment of overseas care workers has slowed, creating concerns about future staffing levels.
• Reports of modern slavery and worker exploitation in the care sector have increased sharply.
• Hundreds of thousands of people are waiting for assessments to determine their care needs.
• While waitlists for care assessments have decreased slightly, they remain a serious problem.
• Delays in care services are affecting the safety and well-being of vulnerable people.
• Regional differences mean some areas have far fewer care resources than others.
• Care services are under pressure due to rising demand and insufficient capacity.
• Patients are spending longer in hospitals because social care isn’t available when they’re ready to leave.
• Safeguarding concerns in the care sector, including exploitation, need urgent attention.
• The system needs significant improvements to ensure timely, safe, and accessible care for everyone.
• Health inequalities for autistic people and people with a learning disability is still an unacceptable issue.
• Record numbers of people are being diagnosed with dementia in England.
• The Deprivation of Liberty Safeguards has needed reform for over 10 years. Unless there is substantial intervention challenges will remain, and people will continue to wait too long for legal protection.

In beginning their assessment of adult social care in local authority areas, CQC reported:

• Many people struggle to access care due to long waits, digital barriers, and limited help for carers and rural residents.
• There is a shortage of care for specific needs like autism, dementia, and nursing home beds.
• Services for young people and autistic individuals often lack clear pathways.
• Collaboration between local services improves safety and care quality.
• Workforce campaigns are boosting recruitment and making care jobs more attractive.
• Technology is being used to help people live independently at home.
• Local authorities are tackling inequalities by adapting to community needs.
• Community spaces like “conversation cafes” are helping people find support.
• Information about care is being made easier to access in local languages and locations.
• Rural areas face unique care challenges, and strategies are being updated to reduce delays.

In their annual ‘State of the Adult Social Care Sector and Workforce’ report Skills for Care focus on the vital role of the adult social care sector workforce in providing care and support in England, highlighting:

• The adult social care workforce now totals 1.59 million people, showing steady growth over recent years, reflecting the increasing demand for services.
• Vacancy rates dropped by 14.6% compared to previous years, signalling some improvement in filling positions but still leaving many unfilled roles.
• International recruitment has risen in recent years as domestic recruitment struggles to meet demand, filling critical gaps, especially in roles requiring specialised care skills.
• A 13.5% rise in average pay contrasts with previous years when pay increases were more modest. The wage bill is now at £27.9 billion, which has risen in line with increasing workforce demands.
• Care workers have consistently represented over 50% of the workforce, but the need for more skilled workers is increasingly highlighted.
• Zero-hour contracts remain common, particularly in domiciliary care, though the prevalence has stayed relatively stable over the past few years.
• 88% of roles are permanent, showing stability. This proportion has been steady, indicating that the sector has succeeded in retaining permanent staff despite broader recruitment difficulties.
• Despite higher wages and investment in staff, turnover remains a challenge. Historical data shows persistent issues with retention and burnout.
• Investments in training have been a priority for several years, with an increased focus in recent reports to address skill gaps in the workforce.
• The adult social care sector contributed £68.1 billion to the economy, an increase over prior years, reflecting both growth in the sector and its economic significance.

In its Spring Survey 2024, the Association of Directors of Social Services highlighted:

• Government Funding: The report emphasizes the need for multi-year funding settlements to provide stability and certainty for councils and care providers.
• Overspending: Councils collectively overspent on adult social care budgets more than in recent history, with over 400,000 people waiting for assessments or care.
• Complex Needs: Increasing complexity of needs and long waiting lists for NHS treatment and GP appointments are leading to more complex support requirements.
• Investment in Workforce: Calls for improved terms and conditions for care staff and more support for unpaid carers.
• Integrated Care: Stresses the importance of viewing adult social care and the NHS as interdependent, rather than separate entities.
• Policy Engagement: Urges the Government to engage with social care workers and those who access care to shape policy and spending decisions.

In its Autumn Survey 2024, the Association of Directors of Social Services highlighted:

• Budget Strain: 81% of councils expect to overspend their adult social care budgets this year, with a total estimated overspend of £564 million.
• Savings Pressure: 35% of councils are required to make further in-year savings, with a projected increase to £1.4 billion in required savings by 2025/26.
• Prevention Focus: Directors have positive evidence of effective prevention interventions but face operational and financial barriers to expanding these efforts.
• Workforce Investment: Emphasizes the importance of investing in the social care workforce, including local professionals and allied health roles, to support community-based care.
• Digital Integration: Highlights the need for integrated health and social care data to inform policy decisions and empower individuals with more choice and control over their care.

In Devon, we recognise that many of the challenges we face are national, with potential solutions being developed and tested elsewhere, and so are active in ADASS regionally and nationally, with several officers taking up regional and national roles, giving us access to and influence on the evidence we all use to improve.

The government has initiated steps toward establishing a National Care Service (NCS) to improve adult social care in England. This will be led by an independent commission, chaired by Baroness Louise Casey, tasked with delivering any recommendations arrived at by 2028. The commission, reporting to the Prime Minister, will work with people drawing on care and support, families, staff, politicians and the public, private and third sector to make clear recommendations for how to rebuild the adult social care system to meet the current and future needs of the population. Although the NCS is yet to be defined, the anticipated impacts the government intent it will have include:

• Improved quality and consistency through the standardising or care services to ensure high-quality support across the nation.
• Enhanced workforce support and resources for care workers to improve job satisfaction and retention.
• Economic efficiency through streamlining services to reduce costs and improve the allocation of resources within the care sector.

The English Devolution White Paper was published by government on 16 December 2024. It describes and proposes a new framework for devolution and the legislative approach that will be used to deliver devolution in England along with the government’s vision to deliver devolution and Local Government re-organisation (LGR) at pace, including through the creation of Mayoral Strategic Authorities (MSAs) across wider regional geographies.

These Strategic Authorities will be made up of larger and more resilient Unitary Councils, which will replace the current two-tier local government structure as well as consolidating current small or failing Unitary Councils.

As one of only 21 remaining county councils across the country, Devon County Council will be part of this significant change alongside and in partnership with the district authorities across Devon and Plymouth and Torbay Councils. The government timeline for this significant change is that by 2028 LGR and MSAs will be in place.

How we work

Our vision and strategies to promote independence

The role of our vision and strategies:

• Our ‘Promoting Independence’ vision describes what we are trying to achieve for people who need adult social care services in Devon now or may do in the future.
• It seeks to align to the government’s vision for adult social care, One Devon health and care system strategy, and the Devon County Council strategic plan while articulating our distinctive role and objectives.
• Our ‘Promoting Independence’ policy sets the policy framework by which we operate and the ‘Commitment to Carers’ underpins our approach to unpaid carers.
• Our ‘Living Well’, ‘Ageing Well’ and ‘Caring Well’ strategies describe how we apply this vision and policy to people aged 18-64, people aged 65+, and unpaid carers and have been updated involving many stakeholders.
• These updates have been informed by changing national and local circumstances: the coronavirus pandemic, the cost-of-living crisis, financial sustainability challenges, and changes in legislation and leadership.  
• Our Annual Report or ‘Local Account’ assesses our delivery against our vision, strategies and plans each year, using national surveys, performance information, and activity/cost/spend data to compare with others.
• This informs our Self-Assessment for the Care Quality Commission who began to assure local authority adult social care functions from April 2023 and any sector-led improvement activity such as peer challenge.

Our vision and strategies are summarised in this infographic:

People tell us they want to live in the place that they call home, with the people and things they love, in communities that look out for each other, doing the things that matter to them.

We start with the assumption that the more independent people are, the better outcomes they will achieve, and at lower cost. Once someone is receiving adult care support, they risk their needs escalating unless we work with them, and the people who care for them, to keep them as independent as possible in the place most appropriate to their needs at that time.

For most people most of the time that will be in their own home which is where people tell us they want to be. For some people some of the time this will be in hospital or specialist settings where we will endeavour to get them home whenever it is safe.

The key points of our strategies are:

• Prevention: including providing accessible information and advice and responding to people in crisis.
• Community and the voluntary sector: with more focus on early intervention and enabling life experience.
• Housing: giving people more affordable and quality options for them appropriate to their time of life.
• Strengths-based and personalised practice: building on assets, recognising risks, providing contingencies.
• Safeguarding vulnerable adults at risk from harm: including through greater public awareness.
• Identifying and addressing inequalities: in our employment, commissioning, and the experience of services.

Aligned to our budget planning process, our Improvement Programme for 2024/25 has been informed by the priorities for change we have defined in our Improvement Plans. In doing so, we have defined our strategic aims:

• Find solutions to people’s needs that promote their independence without recourse to long term publicly funded care and support.
• Pay a fair price for care and support that is comparable to similar areas and maintains quality, sufficiency and diversity of provision.
• Be fair in our offer such as how and how often people are supported in meeting their social needs.
• Meet people’s needs at home wherever possible, minimising the use of care home placements especially after discharge from hospital.
• Work with the NHS to ensure decision making is guided by people’s long term health and wellbeing and funding is appropriate.
• Minimise carer breakdown and social isolation by ensuring unpaid carers have adequate breaks.
• Respond to people’s requests for assessment, requirements for regular review, and safeguarding concerns in a timely and effective fashion.
• Ensure people with different needs and characteristics enjoy equality of access, experience and outcome.
• Address risks not previously given sufficient focus such as out of area placements and unregulated care.
• Develop solutions that will support the long term sustainability of the health and care system e.g. through effective prevention and housing.

Our annual service plan

Each directorate in the Council produces an annual service plan showing how we contribute to ‘Best Place – the Devon County Council Strategic Plan for 2021-25.’ This focusses on how the Council will help the county to recover from the COVID-19 pandemic, build on the resilience of local people and communities to create a fairer, healthier and more caring place, and grasp the opportunity to create a greener, more prosperous and inclusive future for all.

It currently makes the following commitments:

• We are committed to being a child friendly Devon where all children and young people are safe, healthy, ambitious, and can fulfil their potential.
• We are committed to being a fairer Devon: inclusive, compassionate and caring, where everyone is safe, connected and resilient.
• We are committed to being a greener and prosperous Devon, with opportunities to create a sustainable future for all.

And sets the following priorities:

• Respond to the climate emergency. Lead on helping Devon respond to the climate and ecological emergency, and work to protect and improve our natural environment.
• Be ambitious for children and young people. Work together to ensure all children are safe, healthy and can thrive with opportunities to fulfil their potential.
• Support sustainable economic recovery. Help Devon achieve inclusive economic recovery and sustainable growth, ensure more people can take advantage of opportunities, and invest carefully to improve infrastructure.
• Tackle poverty and inequality. Make Devon a fairer place, address poverty, health and other inequalities, and ensure support for those people and families struggling most.
• Improve health and wellbeing. Help people to be healthier and more resilient, ensure everyone gets the care they need, and support people to live their lives well.
• Help communities be safe, connected and resilient. Support all our communities to be safer, better connected and more resilient with a focus on communities at greatest risk or in greatest need.

These are grounded in five long term challenges for Devon:

• Climate change.
• Devon’s changing population.
• Fairness and equality.
• Trust and confidence.
• Financial resilience and prosperity.

Adult Social Care in particular contributes to the priorities to ‘improve health and well-being’, ‘tackle poverty and inequality’, and ‘help communities be safe, connected, and resilient.’

Adult Social Care services deliver on the statutory duties defined by the Care Act 2014:

• Market shaping to ensure diverse, affordable, high quality services.
• Provision of social care assessment, support planning and review.
• Provision of preventative services and information/advice.
• Promotion of individual wellbeing.
• Promotion of integration between health and social care services.
• Safeguarding of adults at risk and system governance.

And by other legislation which interacts with the Care Act and impacts outcomes for individuals. including:

• Mental Capacity Act (2005)
• Mental Capacity Act: Deprivation of Liberty Safeguards (as introduced via the amendments to the Mental Health Act in 2007).
• Mental Health Act (1983): assessment of people with a Mental Health disorder.
• Health and Care Act (2022): integration with NHS through Integrated Care Systems.
• Health and Care Act (2022): responding to Care Quality Commission regulation
• Equalities Act (2010)
• Human Rights Act (1998)

Our key priorities and programmes through 2023/24 Adult Social Care were:

• Service Recovery:
  • Tackling demand and workforce capacity challenges relating to reviews and assessment waiting times.
  • Improve practice outcomes for adults with a disability.
  • Delivering on our Market Sustainability Plan.
• Budget Recovery:
  • Price control and market management.
  • Delivering on our Budget Recovery Plans.
  • Developing a Transformation Programme aligned to the Medium Term Financial Strategy.
• CQC Assurance:
  • Facilitating and responding to a Local Government Association Peer Challenge.
  • Being inspection ready in an evolving regulatory environment.

Our key priorities and programmes through 2024/25 Adult Social Care are:

• Improve practice quality and productivity:
  • Safeguarding Governance Group Improvement Programme.
  • Practice Quality Assurance Group improvement programme.
  • Productivity improvement e.g. via Leading and Managing Effective Workflow.
• Improve services in response to feedback from their users:
  • Joint work with Public Health on prevention, early intervention, information/advice/signposting.
  • Co-produce front door arrangements.
  • Address carer isolation via greater access to breaks.
• Maintain financial and market sustainability:
  • Delivery of 2024/25 savings plan.Strategic development of Medium Term Financial Strategy.
  • Address sufficiency gaps in market, for example, care homes that meet complex needs.

In assessing our delivery, we are paying particular attention to:

• The reach and effectiveness of our short term services.
• The proportion of the population (18-64, 65+) receiving long term services.
• The proportion of people receiving services reviewed in last year.
• The proportion of the population (18-64, 65+) admitted into care homes.
• The proportion of Practice Quality Assurance outcomes rated Good or better.
• The proportion of providers (care homes, community based services) rated Good or better.
• The proportion of safeguarding concerns that become Section 42 enquiries.
• The proportion of Section 42 enquiries where risk is reduced/eliminated.
• The proportion of Section 42 enquiries where the desired outcome is fully or partially achieved.
• Workforce turnover rate (internal, external).

The key risks we are addressing include:

• Operating within a constrained budget when inflation in the care market continues to be higher than headline level.
• Managing multiple care markets with small and medium size providers.
• Managing cultural change and changing practice across a large workforce.
• Working effectively in partnership across the health and care system given recent changes in leadership and financial pressures.
• Dealing with the increasing demand for Safeguarding adults and when concerns raised have tripled over five years.
• Meeting our Care Act market sufficiency duty in the residential and community sectors given workforce pressures.
• Maintaining Social Care Reablement capacity and capability to promote recovery and rehabilitation.
• Building systematic Practice Quality Assurance to improve our insight into the quality of operational practice.
• Addressing waiting lists and waiting times for assessments, financial assessments, DoLS assessments and reviews.
• Capacity challenge in supporting transitions to adulthood results in poor outcomes and experiences, and financial consequences.

Our council

Devon County Council has enjoyed political stability in its form and leadership since before the austerity period, with the current administration and leader of the council coming into power in 2009.

Links for further information on the above chart:

• Council
• Cabinet
• Lead Member for Integrated Adult Social Care and Health
• Health and Adult Care Scrutiny Committee
• Other relevant committees of the council
• Health and Wellbeing Board

For most of that period, there was continuity of Chief Executive and Director of Adult Social Services with Donna Manson and Tandra Forster who came into post in early 2023 and late 2022 respectively.

After a period of significant change in our Strategic Leadership Team in recent months, directors are now settled into their new roles and working together on our biggest challenges (financial sustainability, devolution and local government reorganisation, improving services and regulatory ratings) in a ‘one council’ approach. 

Following the appointment of our Chief Executive, a corporate review of our governance arrangements was undertaken, and we are planning a corporate Peer Review of our governance and performance management arrangements later in 2025. 

Leadership in Integrated Adult Social Care is comparatively stable; Keri Storey (Deputy Director of Integrated Adult Social Care Operations, shortly to retire) and Solveig Wright (Deputy Director Integrated Adult Social Care Commissioning) have enjoyed the majority of their careers in the Devon health and care system and are supported by experienced leadership teams.

Recent investment in the Head of Quality Performance and Redesign role held by Sarah Mackereth is bringing focus and impetus to priority areas for improvement, including on waiting times for assessment.

The appointment of an additional countywide Assistant Director for Disabilities brings dedicated capacity to overseeing and improving practice, services and outcomes for working age adults.

Emily West has been appointed to the role of Assistant Director for Health and Social Care in Western Devon on a one-year secondment, joining both our Operational Senior Leadership Team and the Livewell Leadership Team in a joint appointment.

Our partners

As the county council in Devon we work closely with our eight city and district council partners in Team Devon, taking joint approaches to shared challenges such as our housing taskforce and housing commission, and our joint responses to the Coronavirus pandemic or climate change.

As a council, we are proud to be part of ‘One Devon’: a partnership of health and care working with people in their communities and local organisations to improve people’s lives that includes three local authorities, four NHS trusts, five local care partnerships, and thirty-one primary care networks.

Links for further information on the above chart:

• Integrated Care Partnership
• Integrated Care Board
• Local Care Partnerships
• Health and Wellbeing Board
• Torbay & Devon Safeguarding Adults Partnership
• Healthwatch Devon
• Provider Collaboratives
• Community Health and Social Care Teams
• Primary Care Networks

The ‘One Devon’ Integrated Partnership Board has declared the twelve challenges our local health and care partnership needs to address:

1. An ageing and growing population with increasing long term conditions, co-morbidity and frailty
2. Climate change
3. Complex patterns of urban, rural and coastal deprivation
4. Housing quality and affordability
5. Economic resilience
6. Access to services, including socio-economic and cultural barriers
7. Poor health outcomes caused by modifiable behaviours and earlier onset of health problems in more deprived areas
8. Varied education, training and employment opportunities, workforce availability and wellbeing
9. Unpaid care and associated health outcomes
10. Changing patterns of infectious diseases
11. Poor mental health and wellbeing, social isolation, and loneliness
12. Pressures on health and care services (especially unplanned care)

As a result of this analysis, the ‘One Devon’ Integrated Partnership Board has determined its five-year integrated care strategy to achieve its vision of equal chances for everyone in Devon to lead long, happy, and healthy lives by:

• Improving outcomes in population health and healthcare.
• Tackling inequalities in outcomes, experience, and access.
• Enhancing productivity and value for money.
• Helping the NHS support broader social and economic development.
• Working through provider collaboratives, place-based partnerships, and neighbourhoods.

The Joint Forward Plan, refreshed in April 2024 describes how the Integrated Care System plans to deliver health and care services that meet population need and are sustainable in response to the Integrated Care Strategy.

It is underpinned by three key themes that reflect the system priorities, and foster conditions for successful enabling functions. Each theme is supported by a series of programme plans that articulate how the Joint Forward Plan will be delivered in the short, medium and long term. The programme plans encompass both delivery of services and the requirements to enable success.

The Better Care Fund is a partnership programme between the Ministry of Housing, Communities and Local Government , NHS England, the LGA and Department of Health and Social Care. The programme requires pooled budgets between ICBs and Local Authorities at place level to drive integration. The BCF is a key mechanism for how we work with NHS partners on jointly governed investments shaped by our Community First Strategic Framework including the delivery of the Devon Urgent and Emergency Recovery Plans to realise our vision for integration, with a particular focus on: 

• Anticipatory care and population health management with the aim of preventing, delaying, and reducing escalating needs.
• Enhanced health in care homes with a more proactive approach to reduce reactive hospital admissions.
• Urgent Community Response, with a 2-hour multi-disciplinary crisis response service active 365-days a year.
• Virtual wards and remote monitoring, to provide support for keeping people with long term conditions at home.

On the back of the Darzi review in 2024, the government launched a public consultation to support the development of new 10 year plan for the NHS. Local engagement is also taking place by NHS Devon understand the specific view of people across Devon. The outcome of the consultation will shape national and local action and support the three shifts being pursued: Hospital to Community; Treatment to Prevention; Analog to Digital.

Our approach to prevention

The 2023 Annual Public Health Report focusses on the importance of the Council and the wider system of developing and maintaining preventative approaches that promote the health and wellbeing of the local population while reducing and delaying demands on our services, including:

• Prevention and addressing health inequalities.
• The wider determinants of health.
• Primary, secondary, and tertiary prevention and how they can prevent, delay and reduce emerging needs.
• What our Joint Strategic Needs Assessment says about the population of Devon.
• Recommendations that the Council and its partners should pursue.   
• How we are delivering on previous recommendations.

We are clear that prevention is not solely the responsibility of Public Health, and that tertiary prevention in particular is a key aim of our promoting independence approach, where we support people manage long term, often complex conditions and situations to improve as much as possible their ability to function, their quality of life and their life expectancy. 

Through 2024, members of the Integrated Adult Social Care and Public Health leadership teams have worked together to align our approaches to prevention, commissioning a report on the evidence base for the interventions of highest impact, and deploying Devon Audit Partnership to explore whether local approaches are achieving their potential in areas such as Technology Enabled Care Services and our ‘front door’ arrangements.

This has informed the 2024 Annual Public Health Report which focusses on health in an ageing Devon, anticipating the demographic changes in Devon that will mean the increase in the number of older and very old people in Devon will not be matched by an increase in adults of working age. It recommends a range of behaviours, interventions and services that can keep people healthier for longer preventing , reducing or delaying their dependence on health and care services including falls prevention and supporting older carers.

The Joint Strategic Needs Assessment produced by the Public Health team informs our commissioning approach – both for the Local Authority and the wider Integrated Care Partnership. The JSNA provides the evidence we use to develop and shape services that address areas of greatest need. Adult Social Care commissioners work closely with Public Health to align our commissioning intentions and approach to prevention. The Health and Wellbeing Board has an assurance and overview function of this work, with the ICP-led Joint Forward Plan where actions are taken forward. 

The Voluntary, Community and Social Enterprise sector are key strategic partners in the field of prevention. We have refreshed our commitment to working with the VCSE, via the VCSE Assembly, in 2024. We recognise that the VCSE needs to be at the table (as equal partners) to inform our Strategic Commissioning intentions, and we know they often see the duplication/opportunities across the Council and the wider system and Integrated Care Partnership. 

Local Care Partnerships (LCPs) are a key vehicle for driving prevention in their local areas. Some Public Health funding is devolved to LCPs to support prevention and community support, and there are some good examples of a population health management approach. 

We have recently made changes to the operating model that had been in place since 2008, bringing together the Care Direct service that responded to first contacts from the public and the Care Direct Plus service that conducted phone-based assessments and reviews, co-located with arranging support and safeguarding functions. Our integrated Community Health and Social Care Teams that undertake work with people with more complex needs face-to-face remain embedded in local communities. These arrangements are intended to:

• Ensure staff with professional and local knowledge are responding to people’s needs at first contact.
• Put more emphasis on information and advice, signposting, strength-based support in the person’s network and community, and short term interventions as solutions.
• Prevent, delay and reduce the development and escalation of needs that may limit people’s independence and require on-going support.
• Reduce the number of hand-offs experienced by people making contact and needing an assessment for the first time.
• Enable the recording and tracking of contacts such that a history of interventions can be maintained, and their effectiveness assessed.

The public wishing to access information and advice about adult social care and our staff supporting them are supported by a number of online resources:

• Our online gateway to information and advice about adult social care in Devon.
• Connecting people to resources to help them live independently.
• A self-help tool that helps people assess their own needs and potential solutions to them.
• Connecting people to organisations and resources in their community.
• Connecting people to providers of regulated care home and personal care services.
• Connecting people to adult day care, respite and enabling services.
• Connecting people to personal assistants and micro care providers.
• Connecting people to support for unpaid carers.

In 2023, our website structure, navigation and content were redesigned through a co-production approach with a group of people who use adult social care services. We are continuing to fine-tune these arrangements using people’s further feedback including through ‘mystery shopper’ exercises and voice organisation reports.

Equipment and adaptations are fundamental to delivering on our vision to keep people as independent as possible, maintaining them at home and not in hospital or a care home where they are able, and using the least intrusive forms of support appropriate to their needs. Features of our offer include:

• The use of a wide range of Technology Enabled Care Services.
• The wider use of apps and smart technology. Including the AutonoMe app that uses the power of mobile technology to enable people with learning disabilities and autism to gain employment and develop skills for independent living.
• Promotion of aids and adaptations through our Independent Living Centre.
• Working with our eight district, borough and city councils on the Disabled Facilities Grant e.g. Exeter City Council.
• Provision of equipment via the Devon Independent Living Integrated Service through our provider Millbrook Healthcare.  ​
• Disabled Facilities Grants are delivered jointly with District Councils through the Better Care Fund. 
• Our Sensory Team supports people who are deaf, deafblind, visually impaired and hearing impaired to live as independently as possible including through the use of specialist equipment and technologies.

We have developed our short term services offer with the NHS, focussed on:

• Rehabilitation, Reablement and Recovery for those who experience a health-related crisis.
• Avoidance of admissions into hospital.
• Supported discharge from hospital.
• Preventing, delaying and reducing the escalation of care needs.
• Enabling people to gain the skills knowledge and confidence they need to maximise their independence.

Not all of these services are captured in the data we submit in our returns, but locally we have used national benchmarks and modelling tools to test whether people being discharged from hospital are receiving the right support for them to regain as much of their independence as is possible, and while we can demonstrate the benefits of specialist rehabilitative residential provision, we assess that better usage of community-based support has the potential to reduce the number of people going into care homes, too many of whom stay there in the long term.

Devon County Council continues to deliver adult social care provision where we believe the market is less able to do so (primarily these short term interventions that prevent, delay and reduce the need for ongoing support) including:

• Reaching for Independence services to help people develop their capacity to live independently.
• Social Care Reablement services to help people recover from crises or periods in hospital.
• Respite care for people with learning disabilities.
• Specialist residential care for people with dementia.

All the regulated services that Devon operates are currently rated Good or Outstanding by the Care Quality Commission.

Our support to unpaid carers

The 2021 Census reported 74,700 people identifying as carers living in Devon, likely an underestimate. Our ‘commitment to carers’ is rooted in the understanding that without their dedication, the financial impact on Devon’s health and care system would be an estimated extra £2.4 billion.

Our ‘Caring Well in Devon’ strategy underpins our commitment to unpaid carers, setting out our vision to empower carers and support their independence and that of the people they care for. It reflects the voices of carers, insights from our intelligence, and our strategic approach to delivering this vision. Key priorities include prevention, fostering a more carer-friendly Devon, assessing needs through strengths-based and personalised practice, and enhancing support—particularly by improving access to replacement and respite care, as well as implementing interventions to reduce loneliness and isolation.

Through our Devon County Council website, we provide a range of resources to carers on how to access:

• Covid and Flu vaccinations for carers.
• Health and wellbeing checks and assessments of need.
• Universal, targeted, and personalised support.
• Benefits and financial support.
• Free training courses.
• Replacement and respite care to take a break.
• Employment advice and support.
• Technology that supports people in their caring role.
• Advice on rights and advocacy.
• Specific support for parent-carers and young carers.

We commission the Devon Carers contract, which is delivered by our strategic VCSE sector partner, Westbank Community Health and Care. This service provides a wide range of support and interventions, working collaboratively with organisations across the county to improve the lives of carers. Their provision includes:

Devon Carers provide interventions to Prevent the Need for Higher-Level Support:

• Peer Support Groups: Devon Carers runs peer support groups both online and face-to-face. This quarter, a total of 2,443 carers attended, including 76 new attendees.
• Carer Training: Carer training sessions continue to be well attended, with 126 carers participating in 12 groups this quarter. Since the contract began, over 2,300 carers have completed training.
• Time for You Sitting Scheme: This scheme provides carers with a break by offering a volunteer to sit with the person they care for. This quarter, 411 hours of sitting support were provided.
• Carers Break Fund: The fund remains in high demand, supporting 878 carers in the first three quarters of 2024-25.
• Devon Carers Website: The website is widely used, with over 40,500 visitors in 2023/24 accessing information, advice, and guidance.
• Devon Carers Helpline: The helpline continues to be a vital resource, receiving over 4,000 calls in each of the first two quarters of 2024-25.

In 2024 Devon Carers reported the following activity:

• 45,000 carers are known to Devon County Council of the estimated 74,700 unpaid carers in Devon according to the Census 2021, providing care of a value of £2.4bn.
• It is estimated from census results that approximately 30% of these provide upwards of 50 hours care per week, making them far less likely to be economically active.
• 30,000 carers are registered with Devon Carers for support
• 2,400 carers accessed peer support during 2021-22 and this number is rising.
• Carers made 16,000 calls to the Devon Carers Helpline, 4,500 email contacts, and initiated 1,670 webchats.
• 479 carers accessed training – and more wish to do so.

When requested, our Devon Carers service provides Carer Assessments in line with the Care Act.

• In the last quarter of 2024, a total of 972 assessments were completed.
• The waiting list for carer assessments is at a reasonable level, at 51 cases by the end of the last quarter. Of these, 11 carers have been waiting 28 days or longer, while 27 carers have been waiting 14 days or less. This is a significant improvement compared to the previous quarter’s figure of 107 carers on the waiting list.

We work to createa Carer Friendly Devon through strategic partnerships with local businesses and organisations. Training for local businesses include:

• Recognising your caring role, registering for a Carers’ passport, and accessing a needs assessment.
• Information and advice including via a helpline, magazine, and newsletter.
• Specific advice on key topics including carer rights, finances, and self-care.
• Receiving support from peers, by developing skills, at hospital, and with health needs.

Our Devon Carers Contract supports the vital work of 30 Carer Ambassadors who volunteer to support people with caring responsibilities to navigate the Devon system, link them in with assessments and interventions to meet their needs, and represents their views at strategic meetings across our system. They are an invaluable partner in coproduction and help to ensure the needs and views of carers are at the heart of everything we do in Devon.

Work Carer Ambassadors undertook in our community this year has included:

• Carer Ambassadors in West, North and South Devon coordinated a designated response to the Devon and Torbay Transport Plan consultation in October 2024.
• One Carer Ambassador has been working closely with the Farming Community Network to encourage understanding of the caring role and the entitlements and support people have access to.
• Carer Ambassadors contributed meaningfully to the writing and implementation of the Carer experience section of Devon’s integrated Dementia Strategy. Carer Ambassadors also produced a Dementia Journey paper which is informing the work of local Dementia Alliances.
• Two Carer Ambassadors are attending monthly practice improvement meetings with Adult Social Care colleagues to review assessment rates and share knowledge to inform outcomes.
• Across the county Carer Ambassadors are attending and supporting a variety of carer related and peer support groups. These can be solely for carers or can have a specific focus, e.g. for carers of adults with learning disabilities.

Working in partnership with commissioning colleagues across Plymouth City Council and Torbay Council, we have utilised Accelerating Reform Funding to develop a ‘digital front door’ for carers in Devon. This platform, called Bridgit, provides free access to wellbeing, employment, finance, and care advice, as well as information on local and national support services, events, and training opportunities. Carers can also build their own self-care plan, all without needing to register, and access support at any time.

The service offers tailored support to young carers, enabling them to explore available help in a way that suits them. Through the AI-powered platform, young carers can privately access relevant resources on their phones, allowing them to consider their options before deciding whether to connect with services. This ensures they receive personalised support without feeling overwhelmed by unnecessary information.

We seek to ensure join up between our care management services however and by whomever they are provided including by following a consistent set of practice values and standards with a supporting infrastructure of practice quality assurance, with one of the ten standards we focussed on our work with carers:

• I am recognised and respected as an expert partner in care and involved holistically in planning care and support, decision making and reviews of care and support plans.
• I am supported and empowered to fulfil this role and have choice as to whether I am able or willing to have this role.

Our operational services

In 2008, Devon County Council took the opportunity of having good relationships with its NHS partners and being early implementors of electronic social care records to transform the delivery of its operational services.

Since then, we have sought to continuously improve by building on these foundations while adapting to changes in our population, government and council priorities, and advances in technology and models of practice and delivery:

• Building on a government pilot, our telephone-based Care Direct service became the heart of a Devon County Council customer service centre, aiming to resolve queries over the phone and online by deploying skilled and knowledgeable call handlers using web-based information systems.
• Introducing the innovation of telephone-based Care Direct Plus centres in each locality, undertaking assessment, review, care and support planning and brokerage functions for people with less complex needs.
• Forming Community Health and Social Care Teams based on Primary Care Network boundaries bringing together co-managed and co-located frontline health and social care practitioners in community hospital and other sites.

Having maintained these integrated arrangements for fifteen years, we believe they offer the following benefits:

• Leadership at Locality and Community level that works across community-based health and care services and are jointly employed by the Council and its NHS partners.
• Frontline staff at team level that are co-located and co-managed with community-based NHS colleagues in the most appropriate NHS or Council setting.
• Closer working between NHS and Council frontline staff with people with more complex health and care needs with Community Health and Social Care Teams aligned to Primary Care Networks.
• Involvement of the voluntary sector at locality and community level through Local Care Partnerships and Community Health and Social Care Teams focussed on preventative activity including social prescribing.
• Care Direct Plus hubs in each locality that balance economies of scale and local knowledge in a large county providing phone-based assessment, review, arranging support, and safeguarding triage.
• Hospital discharge arrangements that link work done in hospital settings with teams in the community and the support people need to get them home wherever possible as soon as possible.
• Specialist services, often across health and care, where it makes sense to concentrate capacity and capability to serve people with particular needs.

More recently, we have made changes to our ‘front door’ arrangements by bringing together our Care Direct and Care Direct Plus arrangements to minimise hand-offs with more qualified expertise with local knowledge available at the first point of contact taking a co-productive approach.

We are fine-tuning these changes in the development of our 3-conversations model of strengths-based practice. The initial feedback we received indicated that while the service was well-regarded, people waited too long for a response and changes we have made subsequently show significant improvement in this regard. We are also looking at how we record contacts, actions taken, and their impacts to better understand and meet demand.

These operational arrangements have matured over time, improved by advancements in technology and developments in good practice, and are supported by:

• Memoranda of Understanding with our partner NHS Trusts covering management and staffing arrangements with annual strategic agreements covering budget and performance targets.
• A contract with Devon Carers giving information and advice to and assessing the needs of unpaid carers.
• A Section 75 agreement with Devon Partnership Trust assigning the staff and budget necessary to meet our statutory responsibilities towards people with Mental Health needs.
• Our contract with Devon Advocacy Services which provides independent advocacy relating to the Care Act, Mental Capacity Act, Mental Health Act, and Complaints.

Regarding the latter, the Council and Devon Partnership Trust (DPT) have an established Section 75 partnership agreement for the delivery of social care for people in receipt of Adult Mental Health Services. It has been in place since 2011-12, predating the Care Act 2014. 

The agreement means that adult mental health social care is delivered alongside adult secondary mental health services, and the 24 hour Approved Mental Health Professional (AMHP) function, and ensures a fully integrated service. This is achieved by assigning council social care workers into Devon Partnership Trust, who manage both the assessment and the commissioning function within the NHS Trust.

The section 75 agreement applies to people both open to DPT Mental Health services and who appear to need social care services using eligibility criteria defined by the Care Act.

Governance is through a monthly Partnership Board, chaired by the Head of Social Care, Mental Health, a jointly funded post hosted by DPT. The KPIs in the partnership agreement are monitored and reviewed there, including financial performance and quality assurance. Following a joint-funded expert review of the arrangement in 2023-24, the partnership agreement has been fully refreshed and updated for 2025-26, underpinned by a development plan to ensure continuous improvement.

Our approach to working with people is based on a partnership through conversation that is based on people’s strengths, acknowledging the networks of support within their family and community. Where appropriate, we sign post people to our online self-help tool which directs people to advice specific to their needs and is a gateway to online Self-Assessment where appropriate. We are currently tendering for a new care management system which we anticipate will improve operational efficiency and our capability to interact with people online.

Within our operational services, we have a range of specialist staff and/or functions that:

• assess and review people’s needs and arrange any necessary short or longer-term care and support
• support and advise unpaid carers through our arrangement with Devon Carers
• promote and advice on options for independent living
• conduct financial assessments, delivered through colleagues in Client Finance Services
• receive and prioritise safeguarding concerns and arrange consequent enquiries
• provide Occupational Therapy support
• undertake Deprivation of Liberty Safeguards assessments under the Mental Capacity Act
• provide out of hours cover including through Approved Mental Health Professionals
• support young people transitioning to adult services
• provide support to people with sensory impairments
• provide support to autistic people and people with ADHD
• provide support to people with a range of disabilities and long-term conditions embedded in our Community Health and Social Care Teams with a dedicated countywide review team
• provide support to people with complex needs placed outside Devon
• support people with mental health needs via staff embedded in Community Mental Health Teams through our Section 75 agreement with Devon Partnership Trust
• facilitate discharge for people going home from hospital
• deliver short-term services to promote people’s independence such as Social Care Reablement and Reaching for Independence

In 2024 we established and launched our Practice Standards and Values to provide a collective understanding of the expectations we have of each other and when working with the people of Devon.

Our co-produced Practice Standards and Values provide a framework for our interactions with the people we serve, ourselves, and our partners, ensuring we are always strengths-based in our approach, that we have the right conversations with people to understand the things that are important to them, and can empower them to live the lives they want to live.

These values were coproduced as part of our Unleashing Potential programme, which focussed on the recruitment and retention of, career pathways and learning and development for our frontline staff, including the assurance and improvement of their practice. This programme led to positive outcomes such as significant reduction in vacancy rate and turnover of our registered occupational therapists and social workers.

We have also developed Practice Quality Reviews, a process in which staff take an objective and reflective look at practice to support learning and improvement, by holding ourselves to our Practice Standards and Values. As well as the internal moderation of PQRs to assess accuracy and draw out and share learning, we are starting to develop external scrutiny across our local authority buddy group for mutual peer support, challenge and learning.

We know in Devon that waiting lists for Care Act needs assessments have been too long, and reviews have not happened frequently enough. Leading and Managing Effective Workflows (LMEW) is the programme in Devon that has been developed to address this and improve care management productivity.

A small number of teams piloted the approach. Activity rates per worker increased and now meet expectations for those teams, successfully reducing the number of people waiting for assessment and the length of time they wait. Teams are also increasing the number of reviews completed.

Work has also focussed on ensuring that staff are clear on how they can ensure our data is as clean and accurate as possible so we can understand where we need to focus our improvement activity. 

The staggered training programme means that all teams are due to start the new arrangements by the end of Q1 in 2025/26 meaning that we can then expect to see further progress. We are also engaging with service user representative groups to focus on how we support people to ‘wait well’, including information or advice about access to community resources and resources like the Independent Living Centre for community equipment.

Our approach to safeguarding

Safeguarding adults at risk by protecting their rights to live in safety, free from abuse and neglect is a core statutory duty that runs through everything we do in adult social care in Devon. Our governance of safeguarding incorporates our role in system governance via the Torbay and Devon Safeguarding Adults Partnership Board and our arrangements for organisational governance via our Safeguarding Governance Group.

The Torbay and Devon Safeguarding Adults Partnership covers two local authority areas, facilitating strong partner representation with an independent chair; it publishes its annual report and business plan laying out its achievements, concerns and priorities to address them.

In the Board’s Strategic Business Plan for 2021-24 it reiterates the principles of safeguarding (empowerment, prevention, proportionality, protection, partnership and accountability) and outlines the strategic priorities it has agreed, informed by local evidence and national guidance, and what will be done to deliver on them:

• Embed the learning from Safeguarding Adult Reviews (SARs) into organisational practice.
• Improve outcomes for people with needs for care and support by finding the right solution for them.
• Work with partners to better understand and reduce the risk of ‘Hidden Harm’.
• Improving Involvement and Engagement with people in receipt of safeguarding services.

In its Strategic Business Plan, and using a range of qualitative and quantitative information, the Board has determined its priorities for 2025-27 as:

• Seek assurance from partners in relation to practice improvements in key risk areas.
• Seek assurance from partners that learning from Safeguarding Adults Reviews is embedded into practice.
• Improve awareness, engagement and inclusion.

The Board monitors and ensures delivery by:

• The TDSAP Business Activity Plan monitors and reviews the development, progression and delivery of the actions that support these Strategic Priorities.
• The Operational Delivery Group holds the Business Activity Plan and reports on progress to each TDSAP Board meeting.
• We will regularly monitor and assess the safeguarding data and performance to inform future thinking and direction of travel.
• A yearly Annual Report is produced that describes the activity in relation to each priority.

The Torbay and Devon Safeguarding Adults Partnership Annual Report for 2023-24 is introduced by the Independent Chair and outlines the membership, purpose and structure of the Partnership before summarising safeguarding activity and an analysis of the demographics and locations of people subject to concerns, the types of risks involved, and the outcomes achieved in removing or reducing those risks.

The Annual Report also summarises Safeguarding Adult Review (SAR) activity for the year in which eight referrals were received from six different partner organisations on a range of themes including mental health, self-neglect, substance misuse and acts of omission or neglect. Six Safeguarding Adult Reviews were completed in the year and published on the website.

The Annual Report lists some key achievements of Devon County Council regarding safeguarding, including:

• Centralising three locality based safeguarding hubs into a single point of contact to improve consistency and timeliness of response
• Developing a range of practice support guidance and tools around working with people who self-neglect in response to learning from SARs
• Introducing safeguarding practice standards and a supporting Practice Quality Review framework and tools
• Via Public Health, supporting the Real time Surveillance System for suspected suicides and the Themed Adult Safeguarding Review into Mental Health, also involving Alcohol Treatment Services (Together)
• Public Health have also championed the need to review deaths of the homeless population, often as a result of deaths of despair, and are working with Colleagues across Torbay and Plymouth to host a conference exploring the links between suicide and Domestic Violence and Abuse.

Combining resources enables us to provide a well-resourced offer regarding learning and development, policy and guidance, and information and advice as well as topic specific content on health and wellbeing, exploitation and abuse. It has an important role in raising public awareness through advertising, media and clarity of guidance on reporting concerns.

The Board uses its website to raise the awareness of adult safeguarding among the public as well as professionals, and conducts awareness raising campaigns such as that during Safeguarding Adults Awareness Week.

The Board has agreed the following as a position statement with regard to assessment by the Care Quality Commission:

• There are robust Safeguarding Adults Board arrangements in place with a joint Torbay and Devon Safeguarding Adult Partnership (TDSAP). 
• This provides assurance to both Torbay Council and Devon County Council’s Directors of Adult Social Services that there are robust and safe mechanisms in place to ensure the safety and wellbeing of the respective Local Authorities.
• The Partnership’s website provides all the information in relation to the Board and its work and priorities. The Chairs of the Childrens Safeguarding Board and Adults Safeguarding Board meet and discuss shared areas of work, for example transitions. 
• The Community Reference Group (CRG) was established as a user led group and together with members of the voluntary and community sector, it has had direct input into the TDSAP Board.
• A review of the purpose and effectiveness of the CRG has recently taken place. This review focussed on how effective we are at securing the voice of people, so that their voice is clearly heard across all areas of work.
• The review highlighted the need to better engage in a ‘co-production focussed’ way, by working in partnership with people, service users and third sector representatives to raise awareness, improve understanding and shape effectiveness of specific elements relating to the safeguarding of adults.
• The new approach to working in co-production is inclusive of a wide range of communities, to ensure that the voice of people with lived experience to safeguarding is heard. 
• Regular feedback has been received from the CRG, which is directly provided to the TDSAP, and any recommendations have been taken through the Operational Delivery Group. This feedback mechanism continues with the new co-production approach.
• The feedback processes allow for feedback from any appropriate advocate.

The Safeguarding Governance Group within the Council is chaired by the Deputy Director Integrated Adult Social Care Operations and reports to the Performance and Assurance Board chaired by the Director of Adult Social Services. Its membership includes our professional and practice leads and representatives of our frontline managers and staff and relevant support staff such as those providing and analysing quantitative and qualitative information. It also includes managers responsible for quality assurance of in-house and external provision.

A typical agenda includes:

• Feedback from local and national learning from Safeguarding Adult Reviews, Serious Care Reviews and Domestic Homicide Reviews.
• Highlight reports from initiatives in practice improvement.
• Updates from operational teams on practice issues to inform learning, development and guidance.
• Analysis of relevant data and feedback.

This Group oversees our operational Safeguarding arrangements:

• A Safeguarding Hub with countywide oversight to ensure consistency of decision-making.
• Triage of concerns and prioritisation of enquiries by a responsible manager.
• Response by frontline practitioners in integrated teams.

Our performance in 2023-24 is summarised in the infographic below, noting:

• Five years ago, Devon was an outlier regarding the low volume of Concerns and Enquiries; work on raising awareness and improving practice across the system has brought us broadly in line with comparators.
• Nevertheless, while the rate of Concerns continues to increase, plateauing more recently, we continue to benchmark below the England average.
• Section 42 Enquiries have fallen in 2023-24 along with the conversion rate (19%,) which is significantly below the England average (31%), which has also fallen in 2023-24.
• The main area of risk remains in a person’s ‘own home’ (65%) with the alleged perpetrator ‘known’ to the individual (73%) and relate to physical abuse and neglect and acts of omission.
• Risk is identified and action taken in 58% of S42 enquiries, which is below comparators; risk remained in 5% of Section 42 Enquiries, which is below comparators.
• Where people lacked mental capacity, 64% were supported by advocates, friends of family, significantly below comparators.
• 86% of people expressed desired Making Safeguarding Personal outcomes, which were met in full or part following 94% of Section 42 Enquiries.

Our approach to commissioning

Adult social care commissioning involves a continuous cycle of assessing population needs, planning, designing and procuring services, implementing them, and monitoring their effectiveness. This ensures that services are high-quality, responsive, and tailored to people’s evolving needs.

Meeting the needs of an aged and ageing population requires a strong commitment to a strengths-based approach that promotes the independence of people in their communities.

The quality of life and overall satisfaction of people who use the Council’s services continues to be high, although the biennial survey of unpaid carers raises some concerns that we need to address, especially in relation to replacement care.

Although the population of older people has continued to grow, the Council spends more of its budget on people aged 18-64 than those aged over 65. This reflects success in promoting the independence of older people and their circles of support.

However, the Council now anticipates further demands as more people develop needs that require adult social care support, particularly due to the prevalence of dementia among those aged over 85.

People with physical and learning disabilities, sensory needs, or autism (or both) are living longer with more complex needs. Peaks in demand typically occur following the transition to adulthood and in middle age due to the ageing of their carers. In recent years, the Council has been successful in ensuring more younger adults are supported in their own or their family’s home, but less so at finding solutions that promote their independence and self-reliance.

Having updated the vision for ‘promoting independence’ and strategies for ‘Living Well’, ‘Ageing Well’, and ‘Caring Well in Devon’, the Council reviewed its Market Position Statement in early 2025 to take into account these changing circumstances and the context of recovering from the pandemic and enduring the cost-of-living crisis. However, the Council aims to refresh the whole MPS for Summer 2025 and work is underway.

The solutions commissioned in the future will be characterised by:

• Collaboration: Engaging providers in whole system redesign and innovation. 
• Prevention: Promoting well-being and independence throughout life. 
• Integration and Partnership: Across the health and care system and with independent sector providers and the community and voluntary sectors. 
• Outcomes and Personalised Services: Focusing on ‘what matters’ to the individual. 
• Innovation: Transforming services to respond to changing models of care that support people in their own homes wherever possible. 
• Use of Technology: Maximising the potential of the digital revolution for service users, carers, businesses, and systems. 
• Workforce Development: Recruiting locally and internationally into rewarding careers across the health and care system that will retain and develop people with the right attributes and values. 

In March 2023, Devon County published its Market Sustainability Plan which highlighted:  

• A predominantly rural population with a significant number of older adults. The population is growing, but the working age population is in decline whilst an already aged population is still ageing rapidly.   
• The employment rate is above the national average, but with lower-than-average wages and higher than average housing and living costs, and a competitive labour market in lower paid sectors including retail, tourism, and social care.  
• Workforce challenges include an ageing workforce, difficulties in recruitment and retention, exacerbated by competition from other sectors.  International recruitment has had a beneficial effect, but uncertainty remains following the changes to visa regulations. 
• These factors mean more pressure on demand for adult social care and more constraints on the workforce necessary to deliver it. There is high turnover within the sector, but more than 60% involves people moving between employers.   
• Continue to promote direct payments where they achieve better outcomes for people, further developing the market of personal assistants and micro-providers.

Our Market Position Statement offers a thorough summary of the market with our data tool kept up-to-date to allow analysis of the latest information and our commissioning analysis and intentions laid out by sector: care homes, extra care housing, community services, individual purchasing, supported living, Carers (unpaid) and technology enabled care services. 

The Market Position Statement includes our commissioning intentions in the care home market:  

• Our intention remains to support as many people at home as is possible, with care homes catering for people with increasingly complex needs, avoiding out of area placements unless that is the person’s preference.   
• Hospital Discharge (D2A) has had an impact on placement activity, and data indicates that short term placements are becoming long term. There is a required improvement for reablement and rehabilitation services which could be delivered either by statutory servicer or the independent sector, this is being reviewed as part of our Hospital Discharge Transformation steering group, 
•  Implement a new Older Persons fee model in June 2025 (market engagement is currently live), this includes a new contract. Phase 2 of this project is to work with health and independent sector providers to consider a new model for complex care. This will focus on the fragility in our nursing sector.
• In 2026 a new fee model and contract will be launched for care homes who predominately support working age adults.  This model will be co-designed with stakeholders but focus on sustainability, less restrictive practice and ensuring all services are promoting independence.

We are also reconsidering our commissioning intentions in the community-based sector:  

• Interim market interventions to consolidate recent capacity growth in the personal care sector to ensure it is financially sustainable and can maintain sufficient workforce. This will ensure we seek growth of volume through strategic partnerships.
• This is informed through a review of community services which has delivered its stage 1 report, with a final report proposing new models of commissioning and delivery.  
• This is complemented by an updated needs analysis, considering changes in needs, means, and preferences of people during and since the pandemic.   

• Leading to a co-designed and co-produced model of service delivery that will maximise reablement and recovery and take a step change in our use of Technology Enabled Care and Support services to promote people’s independence.   
• Addressing the challenge of multiple models for unregulated care and incorporating learning from significant changes to markets during COVID.

Working with partners to improve our Accommodation with Care offer: 

We are working with city and district councils to take a Team Devon approach to improving housing with support options including Supported Living, Extra Care Housing, and Shared Lives Schemes that enable people of all ages to live in appropriate accommodation, with the right care and support where it is required, in the community.

This Team Devon approach has recently seen the County and all district and city councils as well as our neighbours in Plymouth and Torbay collaborate in a Housing Commission chaired by Lord Richard Best. Partners have agreed to waive Council Tax for all care leavers and to give them priority access to housing.

A recent restructure of the commissioning function has enabled us to realign to the changing priorities of the Council and within Adult Social Care to maintain a diverse, high quality, sufficient and affordable adult social care provider market; work in partnership on co-producing more innovative solutions to meet people’s needs; and deliver on our vision, strategies and resulting Market Position Statement and its commissioning intentions: 

• A Strategic Commissioning Team focussed on market development. 
• A Quality and Contract Management Team focussed on market management. 
• An Assurance Team focussed on how we use qualitative and quantitative information to improve our services and their outcomes.  
• A strengthening of our corporate People and Culture function to focus on our internal and external workforce. 
• A bringing together of change management and business support capacity into a corporate Transformation Team able to be deployed to the changing priorities of the Council.

The team work closely with operational colleagues, Public Health and the corporate functions responsible for change management, business support, information technology, workforce development, legal, finance, and procurement.

In particular, our commissioning activity is only made possible by close joint working with our corporate procurement and contracting function including through a new ‘One Council’ Commissioning Board. Our Devon County Council Procurement Strategy 2021-26 clearly lays out the approach we take, including to:

• Support organisational objectives such as the Climate Emergency.
• Prioritise local economic development.
• Promote social value.
• Enable digital transformation.
• Manage the delivery of contracts.
• Realise benefits and achieving value for money.
• Work in partnership, including where we procure jointly.

Underlying our commissioning activity is a rich evidence base including:

• Our Joint Strategic Needs Analysis (JSNA) with supporting online tools.
• Our Public Health Intelligence and Smarter Devon teams who offer intelligence, regular webinars, and expertise in approaches such as Population Health Management.
• Our nationally well regarded Adult Social Care Management Information Team and its wide range of PowerBI and other tools and analyses accessible through a SharePoint site and Report Finder.
• Our own Adult Social Care needs analysis tools developed to complement the JSNA.
• Our use of national data and tools such as those available on LG Inform.
• Our analysis and application of key national publications of data and insights such as those by the Care Quality Commission, Social Care Institute for Excellence, Research in Practice for Adults, and Skills for Care.
• Our tools and annual presentations that make best use of comparative nationally published data through returns such as SALT, ASC-FR and ASCOF.
• Our regional and national involvement in Association of Directors of Adult Social Services and the Local Government Association including engagement with their Use of Resources analysis.

In partnership with our market of social care providers

For most people most of the time, their experience of adult social care is through the services delivered to them by the many independent and voluntary sector providers in Devon, ranging from individual personal assistants to national organisations.

While the local authority has a duty to ensure a sufficient, diverse, affordable and high-quality market, and to assess the needs of people and arrange and fund services for those without the means to do so themselves, everyday delivery is mainly through this diverse market of providers with few care and support services remaining in-house.  

We work with adult social care providers in Devon through the Provider Engagement Network featuring a wide range of engagement mechanisms such as market sector focussed meetings, task and finish groups to work on defined projects and via regular newsletters, webinars. The Council regularly reviews these mechanisms to ensure they are effective and meaningful; this review is undertaken by engaging with our providers.

Our Strategic Commissioning and Market Development Team focus on strategic commissioning: 

• Assessing future demand for services and the market capacity and capability to meet that demand.  
• Developing commissioning strategies based on that analysis focussed on sufficiency, quality, affordability, and choice. 
• Developing business cases and options appraisals to secure services that deliver on those commissioning intentions, including working with providers on innovations including through technology.  
• Designing services and developing service specifications and contract monitoring requirements.  
• Agreeing the approach to procurement through tenders and contracts. 
• Continually assessing and acting on strategic market and workforce risks.  
• Leading on market engagement and provider communication.  
• Management of countywide contracts including those relating to equipment and carers.  
• Evaluating the outcomes achieved through strategic commissioning of services and other solutions.  

Key products of our strategic commissioning include the Market Position Statement and Market Sufficiency Statement.

Our Quality and Contract Management Team focus on contract management and quality assurance and improvement: 

• Service Monitoring and Support, ensuring effective service delivery through regular reviews and interventions aimed at continuous market improvement. 
• Contract Management, maintaining strong provider relationships, upholding provider contract terms, and ensuring services meet quality/contract standards. 
• Financial Oversight, monitoring the financial aspects of contracts addressing discrepancies, and upholding service standards. 
• Quality Assurance, ongoing monitoring of service quality against benchmarks, proactive risk management, and driving performance improvements. 
• Supporting providers, offering guidance to providers facing challenges and assisting with smooth introduction of newly contracted services. 

The approach aims to be supportive while reserving the right to suspend activity where services are judged to be Inadequate or there are serious safeguarding concerns. 

Devon County Council works with its voluntary, community and social enterprise sector through umbrella organisations including: 

• The Devon VCSE Assembly, part of a UK network of VCSE alliances seeking to strengthen the voice of the sector and share good practice, working across the area of the Devon Integrated Care Partnership Board and complemented by local networks. 
• Devon Communities Together, the Community Council of Devon, whose vision is to inspire and support rural communities in devon to be dynamic and sustainable places to live and work.  
• The Devon Mental Health Alliance, a partnership between six organisations dedicated to providing support for people experiencing challenges with their mental health whose goal is to improve access to services and identify new opportunities to support people across all of Devon’s communities. 
• Healthwatch Devon, the independent consumer champion for health and social care in the area of the Devon Integrated Care Partnership Board, linking in with voice organisations across the sector.  
• Local VCSE consortia that provide key services to us such as the Devon Advocacy Consortium and Devon Disability Voice within the Devon Engagement Service all coordinated by Living Options Devon.  

In Integrated Adult Social Care, we work with our colleagues within the Communities function of our Public Health directorate to ensure our work with the VCSE sector is coordinated with best use made of available grant funding.  

Recent discussions between the Council and the Assembly have determined a number of priorities for joint work related to adult social care: 

• Adult Social Care ‘front door’ redesign. 
• Improved hospital discharge planning and co-ordination. 
• Waiting Well for Social Care Waiting Lists. 
• Workforce Planning and Organizational Development. 
• Building Community Resilience. 

They also highlighted several recent examples of good practice: 

• Digital Inclusion Group and Local Transport Plan 4 consultation in partnership with the VCSE Assembly. 
• Devon Domestic Abuse Alliance in partnership with Co-Lab Exeter. 
• Rural Proofing in partnership with Devon Communities Together. 
• North Devon Inclusive Community Framework building resilience and educating for people with complex needs in partnership with Devon Voluntary Action. 

Developing the social care workforce

There are over 28,000 filled posts in the adult social care sector in Devon, all but a few hundred of them in the independent and voluntary sector.

Without an adequate, committed, experienced and well qualified workforce, the adult social care sector cannot deliver sufficient, diverse, and high-quality services to meet the needs of our population, whether they fund their own care or are supported by the local authority or NHS.

Working with our Provider Engagement Network and countywide bodies such as the Devon Care Homes Collaborative and Devon Integrated Social Care Alliance we have developed a comprehensive workforce development offer including:

• Our Proud to Care recruitment service and its network of ambassadors for care work.
• Career pathway initiatives such as trialling trainee Nursing Associates and the apprenticeship levy sharing schemes.
• A learning and development offer across the range of roles including eLearning and in-person training.
• A range of wellbeing support, discount and benefit schemes.

In 2022 we held an Appreciative Inquiry into adult social care and its workforce challenges bringing together national and local system leaders with care workers, care providers and people who use their services. Out of this event and a visit from colleagues in the Department of Health and Social Care we launched a prospectus for change for the ‘One Devon’ health and care system, aspiring to develop our collective workforce into one that is sufficient, caring, confident and collaborative. 

Since then, we have been working together to:

• Agree five principles relating to workforce that can be embedded across the whole system: system working, stability, learning and education, enhancing technology, and sustainability.
• Address future thinking with Health Education England (HEE) and the staff college to develop future scenarios that reflect what the system and workforce could look like in 2035.
• Maximise the value of Proud to Care, our recruitment service for health and care in Devon.
• Undertake joint overseas recruitment, pooling resources and requirements with our NHS partners and independent sector providers.

We have also focussed on developing our own workforce through our ‘Unleashing Potential’ Programme and an ongoing recruitment campaign, by:

• Benchmarking salary and other employee benefits across the region
• Reviewing our career pathways across the health and care system
• Promoting our existing staff benefits including opportunities for secondments, career breaks, flexible retirement, and unpaid leave.
• Developing Social Work and Occupational Therapy Apprenticeship posts as part of career pathways
• Using a range of media, social media, and other opportunities to promote opportunities to work in adult social care in Devon County Council.

We seek to learn from staff who choose to leave their roles in the organisation and recent analysis of exit interviews within the department indicate:

• The main reasons for leaving are career progression, family reasons, relocation, or caring responsibilities.
• A minority do so in search of a better work-life balance or working environment.
• Only 5% had not enjoyed their role working for the council, and were not valued, and only 10% reported not having received sufficient supervision, while all agreed they had enjoyed supportive colleagues.
• 78% thought their workload was manageable.
• A significant minority thought they had insufficient opportunities for career progression and/or inadequate remuneration.
• When asked what might have made a difference to their leaving, the most common suggestions were improved career opportunities and salary; other options such as career breaks, secondment opportunities, or more flexible working were only cited by a minority.

Our ‘Unleashing Potential’ Programme also included initiatives to:

• Scope, grow, and invest in our internal workforce to maintain capacity and develop capability and better define career pathways for progression including for Occupational Therapists.
• Build on our apprenticeship and traineeship schemes; there are currently 6 Social Work apprentices, 9 Occupational Therapist apprentices, and 14 Social Work trainees doing degrees or diplomas.
• Share best practice and celebrate the successes of our workforce, including through award schemes.
• Ensure we have the right knowledge and skills through a learning and development programme focussed on the frontline.
• In particular, improve our disability practice to build on people’s strengths and promote their independence, from transition through adulthood.
• Improve the quality and consistency of professional supervision and appraisal.
• Reinvigorate and make better use of practice quality assurance.
• Review and update practice policy and process guidance.
• Better use innovative technology, such as the full range of Technology Enabled Care Services.
• Define and promote the core values applying to our operational and commissioning practice.

In particular, focus on equality, diversity and inclusion and our Race Audit Action Plan

Listening to those we work for

Devon County Council is committed to enabling people who receive our support to have their say in the planning, commissioning, and provision of services, whenever possible. We have a number of different ways of engaging with people who use services and carers and the wider public, so we learn from their experience of adult social care, including.

• The Joint Engagement Forum: a quarterly gathering of people who use services, carers, and relevant organisational representatives.
• The Learning Disability Partnership Board: of people with learning disabilities, carers, relevant providers and health and social care managers.
• The Autism Involvement Group: a specialist forum for autistic people, those with ADHD and related conditions and their carers.
• Our Co-Production Groups which include people with lived experience of receiving social care services and equality issues.
• Carer Ambassadors recruited by Devon Carers to actively represent the views of carers, a number of whom sit on the Carers Partnership Steering Group.
• Mental Health engagement: services are delivered and jointly commissioned by Devon Partnership NHS Trust who have developed the LEAP programme.
• Older people’s engagement: set up to deliver all forms of engagement opportunities with our partners Age UK Devon.

We also commission services that further facilitate the involvement of people with lived experience in making their voices heard:

• Living Options Devon coordinate a network of organisations who help us engage with people through statutory consultations and more informal listening events and surveys.
• The Equality Reference Group is made up of people from organisations representing each characteristic protected by the Equality Act (2010) and helps us undertake Impact Assessments.
• Healthwatch Devon is the statutory health and social care consumer voice organisation for the Devon County Council area, and receive their reports at our Health and Care Scrutiny Committee and our Health and Wellbeing Board.
• Our corporate Customer Relations service that facilitates formal complaints and other feedback.

We are going beyond listening to actively collaborating with people in our Co-Production Working Group whose aim is to develop the council’s approach to participative involvement in commissioning, planning, designing, and evaluating services.

Like other local authorities we participate in statutory surveys of the people who receive adult social care services, annually for service users, and every other year for carers, enabling us to listen to the views of hundreds of people locally on the services they receive and the impact of their lives, and to compare their experiences with those who live elsewhere. We have been incorporating these insights into our annual report for many years, are now using them in our Self-Assessment, and share and discuss them widely with stakeholders to better understand what factors informed people’s responses.

We have improved how we capture and make use of the feedback from people who use our services, their unpaid carers, and other stakeholders – recording key comments from our various involvement groups, categorising them by the themes and quality statements used by the Care Quality Commission and replicated in our Assurance Framework, and providing quarterly summaries our Performance and Assurance Board as well as continuing to contact relevant service managers direct.

We have a well-defined and advertised process for making formal complaints about adult social care in Devon, in particular relating to our own services and also encourage comments and compliments we can learn from. Our annual and quarterly reports are published online to encourage transparency. However, we recognise that we need to improve the timeliness and quality of reporting of customer feedback to focus more on learning from them and actions taken as a result and have raised this with our corporate customer relations team as an area for improvement. 

Listening to those we work with

During the pandemic, with many staff working from home, we undertook six staff surveys focussed on their wellbeing, informing how we ensured colleagues could:

• Stay connected through more regular supervision by managers and team socials and check-ins.
• Maintain a healthy work-life balance by taking regular breaks and leave.
• Work differently using new technology such as Microsoft Teams and SharePoint.
• Learn from specialised training and support such as learning that promotes individual and team resilience.
• Adopt a hybrid working style that recognised the benefits of being with colleagues and working from home.
• Benefit from new office facilities redesigned to facilitate different ways of working such as Lucombe House.

As we moved into the recovery period, the focus of our staff surveys has shifted to meeting the new challenges we are facing including the cost-of-living crisis, with council income falling and demand for its services rising.

In the two internal staff surveys we conducted in 2023, which had 600 respondents, pleasing outcomes included:

• 86% of people said they have pride in working for DCC​.
• 83% said their manager was approachable and they have regular supervision​.
• 87% feel they have good peer support​.
• 71% of people are happy with the office building and equipment in their work environment.
• 88% of people are happy that they have a suitable working space at home. 

Outcomes inviting more concern included:

• 46% are concerned about the impact of the DCC budget situation on their role.
• 50% of occupational therapists who responded had access to profession specific supervision.
• 57% of people said they have annual appraisals that are relevant to their role​
• 10% of people have witnessed or experienced ​racism at work.
• 10% of people do not feel safe at work​.

Actions taken as a consequence included:

• Further promotion of our anti-racism guidance, with training for managers.
• Further promotion of our lone working policy, with support to managers to implement.
• A refresh of our staff wellbeing resources.
• The provision free of financial advice and support.
• A new supervision policy with action monitoring and dedicated time for continuing professional development.

We complete the Local Government Association Social Worker employer standards health check biennially, a process led by our Principal Social Worker, and last completed in 2022.  

For the 159 staff without professional registration who responded, ‘Good’ outcomes included:

• 88% Physical health
• 87% Relationships with colleagues
• 86% Fulfilment and pride in their work.

No outcomes for staff without professional qualification were poor. Those with ‘room for improvement’ included:

• 62% Role autonomy and control.
• 69% Review and improvement.
• 69% Mental health.

For the 46 occupational therapists who responded, ‘Good’ outcomes included:

• 82% Safe workloads and case allocation.
• 78% Professional registration.
• 76% Wellbeing.

No outcomes for occupational therapists were poor. Those with ‘room for improvement’ included:

• 56% Continuing professional development.
• 63% Supervision.
• 64% Effective workforce planning systems.

For the 88 social workers who responded, ‘Good’ outcomes included:

• 81% Safe workloads and case allocation.
• 78% Strategic partnerships.
• 78% Effective workforce planning systems.
• 77% Wellbeing
• 75% Strong and clear social work framework.

No outcomes for social workers were poor. Those with ‘room for improvement’ were:

• 63% Continuing professional development.
• 72% Supervision.

For the 12 mental health registered social workers who responded, ‘Good’ outcomes included:

• 91% Safe workloads and case allocation.
• 91% Strong and clear social work framework.
• 85% Strategic partnerships.

No outcomes for mental health registered social workers were poor. That with ‘room for improvement’ was:

• 74% Continuing professional development.

These outcomes informed our Unleashing Potential programme which focussed on recruitment, retention and continuing professional development.

We are currently undertaking the 2025 Employer Standards Healthcheck to check whether these results have changed in the intervening period, understand why, and take any necessary action.

The initial areas of focus of our Chief Executive and her leadership team following staff engagement in 2023 were:

• People First, redefining our workforce strategy on themes of voice, belonging, wellbeing, learning, recruitment and reward.
• Performance and Governance, ensuring we make the right decisions in the right way, in a one council approach with clarity of roles and responsibilities and a focus on improving outcomes and performance within the limits of a sustainable budget.
• Leadership and Direction, updating our strategic plan to ensure our priorities are responsive to changing circumstances.

Our new Director of Adult Social Services has initiated a Leadership Survey which has now gone through two iterations. We discussed learning and action taken from the survey in a staff conference in March 2024 and updated on progress at a second event in October 2024.

Our leadership team has committed to visit every team during 2024 to give staff an opportunity to meet with the Director in person, complementing our online Head of Service catch-up sessions that attract wide attendance.

Listening to staff, we have revised our staff communications strategy to rationalise the number of channels and focus on key messages to avoid overload.

Although we seek to have conversations with frontline staff regularly and encourage similar openness and two-way communication between managers and staff across the organisation (including through our Staff Reference Group for frontline staff and Social Care Leadership Group for frontline managers) we know that things don’t go right in all services and places all of the time and regularly remind staff they are able to raise concerns formally through our whistle blowing and unacceptable behaviour policies and grievance process if they feel they have not or would not be listened to with leaders including the relevant links in their email signatures.

Improving equality of access, experience and outcome

One area where we know we haven’t always done as well as we aspire to is in challenging inequality and celebrating diversity. In 2021, Devon County Council commissioned a Race Equality audit and received some difficult messages, including:

• Denial that racism is an issue, despite feedback from people who experience it on a regular basis.
• The excuses of their being small numbers in Devon and a lack of data limiting insight when people are reporting incidents in their work and in their communities.
• White fragility in leadership, with the vast majority of senior managers being from White British backgrounds, leading to lack of credible leadership and role models.
• An unwelcoming culture for Black and Asian people in particular, including in care work.

Equality, Diversity and Inclusion are now recognised as priorities for the organisation as illustrated by our most recent leadership survey, with a particular focus on the racism experienced by our staff, by staff of the organisations we commission services from, and in our communities. We are now broadening the programme to be more outward focussed and take into account the full range of protected characteristics as well as inequalities of deprivation and rurality.

This commitment to address race inequality in our employment practice through a corporate and directorate programme has also reinvigorated our mechanisms for addressing inequalities more widely:

• An Equality Commission drawing on our Staff Diversity Network and Equality Reference Group.
• A clear Equality Policy making real our commitment to the Devon Joint Declaration for Equality.
• A statement of Equality objectives with an accompanying action plan, extending into frontline services.
• Comprehensive guidance on equalities issues for leaders, managers and staff with mandatory equalities training across the organisation.
• Ensuring Impact Assessments are undertaken to inform key Council decisions about service change.
• Work across the Council such as our Gypsy and Traveller Liaison Service, our Homes for Ukraine Scheme, our work addressing domestic violence and abuse, and our Safer Devon Partnership.

Through focussed activity in events such as Race Equality Week we endeavour to raise awareness among staff and the general public, in 2025 with daily events including those focussed on intersectionality, recognising privilege, and using inclusive language.

We use quantitative and qualitative information to highlight groups who may have unmet need or not enjoy equality of access, experience and outcome:

• The 2021 Census and its population profiling tools.
• Our joint strategic needs assessment and attendant analysis tools.
• Needs assessments informing specific commissioning strategies and impact assessments.
• Data relating to our care management and safeguarding activity and our provision of services.

Our involvement structures and engagement contracts give us opportunities to listen to people with protected characteristics, including through groups represented on our Equality Reference Group and other more local or community specific organisations:

• Racial equality: Plymouth and Devon Racial Equality Council.
• Racial equality: Hikmat Devon.
• LGBT+: Intercom Trust (Lesbian, Gay, Bisexual and Trans people).
• Disability: Living Options Devon/Fusion Partnership (Disabled people and carers).
• Gender equality: Fawcett Devon.
• Older person’s: Age UK Devon
• Young people: Young Devon.
• Religion and belief: Devon Faith and Belief Forum.

We endeavour to ensure all key information for the public is in a format that meets accessibility standards, including this Guide and Self-Assessment. We provide a range of telephone interpreter services, British Sign Language arrangements, and key information of people with learning disabilities in Easy Read formats

Managing change

We take the following approach in managing change:

• Working corporately and across directorates on priorities for strategic change, feeding into our Medium Term Financial Strategy and Plan.
• Chairing of our Service Improvement Group, Performance and Assurance Board and Budget Governance Group by our Chief Officer to ensure she is sighted on and directing change and assurance activity.
• Using the Service Improvement Group (formerly our Transformation Board) to ensure leadership oversight and direction of all directorate change projects.
• Reviewing the change programme and its governance every 6 months to align to service priorities and maximise use of resources.
• Allocating a Senior Responsible Owner to each Project to ensure ownership and accountability by a member of our Joint Strategic Leadership Group.
• Using involvement and engagement opportunities with people who use our services in their carers to inform and where appropriate help shape and deliver change.
• Using formal Programme and Project Management proportionate to the complexity and priority of the initiative, allocating appropriate staff to manage change, most of whom are now employed in our corporate Transformation and Business Support teams.
• Using a departmental ‘plan on a page’ and concise highlight reporting as accessible means of monitoring progress, including corporately.
• Including quarterly monitoring of these priorities in our Corporate Performance Framework with reports going to our Corporate Leadership Team and Cabinet quarterly.
• Making all programme and project documentation available through our use of facilities such as Teams, OneNote, and SharePoint outlined in our Programme Management Office Standards handbook.
• Considering issues and risks arising through maintaining registers that also inform our departmental and corporate Risk Registers.
• Consulting on changes that affect people’s lives and undertaking impact assessments to inform decision making.
• Working with Devon Audit Partnership to give an independent view.
• Investing in a new role of Deputy Director for Quality, Performance and Redesign to have oversight of the improvement programme.

Our change programme itself changes as our priorities change but to illustrate the assurance and exception handling groups, plus the broad work areas see the chart below:

With change management and governance now in place, we are now developing our approach by:

• Using our updated ‘Promoting Independence’ vision and ‘Living Well’, ‘Ageing Well’ and ‘Caring Well’ strategies to frame our change priorities.
• Bringing together changes required by financial sustainability, government reform, and operational recovery from the pandemic into one programme, including those articulated in our strategies.
• Taking a more systematic approach to improvement identification, prioritisation, planning and delivery drawing on learning from our Peer Challenge and our Self-Assessment process and revised Performance and Assurance Board arrangements.
• Scheduling our programme plan into future years aligned to our Medium Term Financial Strategy, in recognition that we currently don’t have the capacity to deliver everything we would like to.
• Using our Extended Leadership Team to determine priorities and the phasing of the programmes and projects that will deliver them.
• Better aligning our adult social care priorities and our corporate and ‘One Devon’ system strategies and plans by ensuring that the voice of adult social care is prominent in both.

Our current work plan is shifting focus from securing financial sustainability to service improvement under the priority headings of ‘enabling and effective working’, ‘delivering best value’ and ‘improving our practice’, while freeing the capacity necessary to deliver on corporate priorities such as local government reorganisation and devolution, ensuring that any new contractual commitments or staffing restructures are aligned to that timetable.

Ensuring financial sustainability

With Devon County Council spending close to half of its net budget on adult social care and with demand rising due to population change and the pandemic and costs rising more rapidly than income, the whole council is focussed on using its resources effectively, prioritising its statutory responsibilities, especially those to more vulnerable people.

Our budget pages include an archive of the budgets and outturns of previous years and the budget book for the current year.

Our budget book for 2025-26 provides a detailed exposition and analysis of our financial situation:

• The detail of the Integrated Adult Social Care Budget on p.54-55.
• The breakdown of our operational budgets on p.56-58.
• The breakdown of our commissioning budgets on p.60-61.
• Backward and forward looking analysis of our Medium Term Financial Strategy on p.108-110.
• Our approach to securing financial sustainability on p.111-113.
• A commentary on the factors driving expenditure on adult social care on p.114-118.
• Analysis of financial risk relating to adult social care on p.187-195.

Despite that level of investment, significant budget savings have been required since 2022, with a cross-organisational financial sustainability programme identifying options, the majority falling to Integrated Adult Social Care as the highest spending service.

Despite a proposed budget increase of 8.2% for adult social care in 2025-26 in the context of an overall increase in the Council’s budget of 5.2%, we are facing further savings requirements which we intend to address by improved market management and service redesign. Pressures are driven by demographic change influencing demand and care market inflation impacted by changes to the national living wage, national insurance, and utility cost increases.

In Integrated Adult Social Care, we are determined to use our limited resources to best effect by setting and managing our budget in accordance with our ‘promoting independence’ vision and accompanying strategies by:

• Providing information and advice so that people can help themselves and be supported in their communities.
• Using intelligence to identify those at most risk of crisis or escalation, having contingencies in place should that occur.
• Using equipment and technology to keep people in their own homes.
• Managing demand through approaches to preventing, reducing, and delaying the need for ongoing support.
• Ensuring equality of access and provision for people of equivalent need.
• Using strengths-based assessment and review to promote independence.
• Holding Practice Quality Forums for oversight and authorisation, supporting equality of provision and strengths-based approaches.
• Reabling and enabling through short term support.
• Supporting people in the best setting for them at the time, usually at home.
• Ensuring direct payments are being used for their intended purpose.
• Charging people appropriately and recouping that income effectively.
• Developing the care market to meet complex and changing needs in Devon wherever possible.
• Getting best value from the providers we commission from.
• Collaborating with partners and providers to make the cost of care affordable.
• Ensuring all discretionary expenditure is making a difference.
• Using benchmarking to assure ourselves we are making the best use of resources.
• Using joint funding across health and care fairly to ensure people are receiving optimum support.

Our approach to assurance and improvement

The Health and Care Act (2022) gave the Care Quality Commission (CQC) new regulatory powers to undertake independent assessment of local authorities’ delivery of regulated care functions set out in Part 1 of the Care Act (2014).

The assessment framework draws on the new CQC approach that defines a set of quality statements that are arranged under topic areas and describe what good care looks like. The framework aims to:

• set out clearly what people should expect a good service or system to look like
• put people’s experiences of care at the heart of judgements
• ensure that gathering and responding to feedback is central to the expectations of those assessed

This assessment framework has been grouped into four key themes, each with several quality statements:

• How local authorities work with people – assessing needs, care planning and review, direct payments, charging, supporting people to live healthier lives, prevention, wellbeing, information and advice, equity in access and outcome.
• How local authorities provide support – market shaping, commissioning, workforce capacity and capability, integration and partnership working, supporting carers in their role.
• How local authorities ensure safety – safeguarding enquiries, reviews, Safeguarding Adults Board, safe systems, pathways, transitions, and continuity of care.
• How local authorities lead the care system – culture, strategic planning, learning, improvement, innovation, governance, management, and sustainability.

With this programme of CQC assessment beginning in 2023, Devon County Council could be asked to provide information including a Self-Assessment and facilitate an inspection visit at any time, and received its notification on 10 February 2025, with the first judgements on how local authorities are meeting their statutory duties published for pilot authorities in the autumn and all 152 scheduled to be assessed within a 2-year baselining period through to December 2025.

Each year in Devon we have maintained the discipline of writing and sharing an annual report which is our assessment of how we are performing. For the 2022 annual report, we extended the range of evidence we use to represent the lived experience of the people we serve to include:

• Some key facts about the population of Devon and the people we serve.
• The money we spend on those services, activity levels and their cost.
• The outcomes we achieve, including those defined by the government in the adult social care outcomes framework which we can benchmark against other local authorities.
• What people say about their lives and the difference services make to them, through structured and statistically sampled surveys, at the various involvement groups we facilitate, and through the organisations that give them a voice such as Healthwatch. 
• How our operational services perform in meeting our statutory responsibilities to assess and review people’s needs and arrange services to meet them.
• In particular, how well we fulfil our safeguarding duties compared with other councils, with analysis of who and what concerns are about, and their resolution. 
• The quality, sufficiency, and affordability of our market of independent and voluntary sector providers of adult social care services.
• The recruitment, retention, demographics and continuing professional development of our internal and external workforce.
• What we learn from complaints, audits, and other formal feedback.

We have since included this and other information in our ‘Guide to adult social care in Devon’ and ‘Self-Assessment of adult social care in Devon’ which we review quarterly and update annually at the turn of the year, taking the products through the governance of the council and publishing them in the public domain as our Annual Report. 

We are revising our Assurance Framework to better align to our updated Vision and Strategies, using the wider evidence base considered by our Performance and Assurance Board , and aligned to the structure of the CQC assessment framework. This has been accompanied by changes to our Assurance Governance to give all stakeholders a clearer and more complete view of how we are doing.

A Performance and Assurance Board is now well established and coordinates assurance governance relating to Adult Social Care in Devon County Council by overseeing our gaining insights and determining improvements from:

• our use of performance and outcomes data recognised as examples of best practice by DHSC and LGA
• reinvigorating our approach to practice quality assurance and provider quality assurance
• distilling, listening, and responding to all forms of stakeholder feedback
• identifying, managing, and mitigating risk strategically, tactically, and operationally
• learning from independently facilitated audit, complaints, and other feedback

The Board oversees and complements existing performance management and quality improvement arrangements where the operational detail of assessing and improving performance and quality is undertaken. It enjoys challenge and support from councillor and independent participants including from the Devon Audit Partnership and Healthwatch Devon.

A number of sub-groups report to it, including those responsible for Practice Quality Assurance:

Our Self-Assessment was informed by the use of the LGA Self-Assessment Toolkit, with a lead and team drawn from across the organisation assigned to each theme. Findings were then tested with a wide range of stakeholders including representative staff, other colleagues in and members of the Council, selected partners and providers, and representative users of services and their carers.

Our approach to risk management

We assess strategic risks on a quarterly basis using a matrix that scores impact or severity and likelihood or probability before and after agreed mitigating actions according to a standard methodology.

The higher scoring risks assessed within our commissioning and operational leadership teams are escalated to Assurance Board, and the highest to our Corporate Strategic Leadership Group and reported to our Audit Committee.

The highest rated risks in adult social care following mitigating actions include:

• Having sufficient budgetary resources to meet statutory duties where there is rising demand e.g., in meeting Care Act eligible needs, undertaking Deprivation of Liberty Standards assessments.
• Working effectively in partnership across the health and care system given recent changes in leadership and financial sustainability pressures.
• Safeguarding adults at risk with care and support needs when concerns raised have tripled over five years.
• Meeting our Care Act market sufficiency duty in the residential (especially for people with more complex needs) and community (especially in more isolated rural areas) sectors given workforce pressures.
• Maintaining Social Care Reablement capacity and capability to promote recovery and rehabilitation given competing demands on the service. 
• Lacking practice quality assurance data from over and since the pandemic period limiting our insight into the quality of operational practice including safeguarding.

We contribute to reporting to Audit Committee regarding risk management, internal and external audit programmes, and the statement of accounts.

Our audit plan for 2024-25 includes completed audits on:

• Attraction, recruitment and retention of Registered Professionals (limited assurance)
• Prevention Practice in Technology Enabled Care Services (limited assurance)
• Service consultation and impact assessment (substantial assurance)
• Adult Social Care front door improvements (limited assurance)

The following audits are ongoing and expect to report at year end:

• Care Management System replacement project
• Assurance and performance management arrangements for adult social care

Other audits underway but not expected to report before year end include:

• Transitions to adulthood
• Practice quality assurance framework
• Safeguarding improvement
• Targeted review programme
• Budget and savings delivery

Our audit programme is agreed each year informed by our priorities and risk register and reports to our Performance and Assurance Board, to Corporate Strategic Leadership Team, and to Audit Committee. We are currently finalising the programme for 2025-26

In Devon we take a partnership approach to Emergency Planning Preparedness and Response covering:

• Preparation and planning, with business continuity plans on record for each adult social care service and setting we operate, and tools we use to prioritise the services we deliver and the people receiving them. 
• Business continuity advice to providers in the independent and voluntary sector through our Provider Engagement Network, with regular items in our newsletter and a warning system for extremes of hot and cold weather.
• Emergency response arrangements for how we respond to major incidents in and out of hours and how we recover them and rebuild community resilience. 

Our arrangements were well tested during the pandemic with Strategic/Tactical/Operational command structures deployed to effectively respond to an often fast changing situation:

• Strategic through a ‘Team Devon’ Local Outbreak Management Board linked to the Local Resilience Forum and making key decisions including on communications messages to be delivered to staff and public from across the partnership.
• Tactical through a whole council Incident Management Team with key representation from across the organisation analysing data, responding to changing government guidance, deploying financial and other resources including government grants, and ensuring focus was evidence-based and guided by risk.
• Operational with a dedicated Incident Management Team in Adult Social Care working in concert with Public Health colleagues locally, regionally and nationally within a cellular structure, with senior managers leading on aspects such as PPE provision, vaccination, and care home response.

During and since this period, our arrangements have also been tested by incidents including:

• A one-ton unexploded bomb being discovered on the boundary of a care home leading to an exclusion zone and evacuation of properties within a 500m radius with residents and other vulnerable people being reaccommodated.
• Storm Eunice meaning up to 20% of properties in the county were without power, some for up to a week, with a multi-agency response ensuring the most vulnerable continued to have their needs met including through emergency supply and accommodation.
• An outbreak of cryptosporidiosis in South Devon, meaning thousands of properties in Torbay and South Hams were without tap water for an extended period, with local authorities working with South West Water to ensure supply to all including the most vulnerable.

Learning from the pandemic and these incidents is currently informing a corporate review and improvement programme including training for involved managers and staff on topics such as legal advice and logging, and exercising, in conjunction with NHS and other partners.

Emerging and heightened risks we are preparing for include cyber-attack and extreme heat waves.

Our adult social care out of hours arrangements include:

• An emergency duty service with Approved Mental Health Practitioner capacity and capability
• An on-call senior manager duty rota covering overnight, weekends and bank holidays, bolstered by a deputy in peak periods, and supported by an information pack updated weekly.
• WhatsApp groups to mobilise support during an emergency.

Complementary on-call arrangements within the Emergency Planning Team, the Public Health Team and the Corporate Leadership Team.