Our self-assessment of adult social care in Devon

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

The self-assessment is designed to reflect on:

• our key strengths
• our key challenges
• the evidence that supports this
• what we have done, are doing, or plan to do to improve

It is arranged by the four themes and nine quality statements of the CQC framework for the assessment of local authorities.

It is supported by a data pack for each of the four themes, available internally.

It is reviewed quarterly with a major update annually in the winter of each year and informs the agenda of our Performance and Performance and Assurance Board.

This self-assessment replaces our Annual Report (or ‘local account’) and is taken through the governance of the Council in the first quarter of each calendar year.

It is complemented by our guide to adult social care in Devon which describes the place and population we serve, the services we commission and provide, and the how we work.

Introduction: Leadership

As leaders in adult social care in Devon we are committed to demonstrating the standards, the culture and the expectation placed on everything  we do. Above all our work focuses on how we support the people we work with to live in the place that they call home, with the people and things they love, in communities where we all look out for each other, doing the things that matter most to them. In progressing over the last 12 months, we have:

• reset the priorities for our Directorate to be explicit in our focus on practice quality and productivity, improving services through feedback, and maintaining financial and market sustainability, demonstrating a golden thread to the overarching priorities of the Council
• aligned our budget, and redesigned and restructured parts of the Directorate to support the delivery of our priorities
• engaged across the Council on our redesign through our ‘One Council’ approach to corporate governance
• developed and delivered a programme of on-going staff surveying, engagement and events to ensure we are visible and accessible and influenced by staff at all levels, hearing their voices and co-producing our culture, our values and our approaches to innovation
• made better use of our various sources of customer feedback to shape the things we do, including being able improve our insights from those with protected characteristics
• under the leadership of our Principal Professionals, co-produced with staff our Practice Standards and Values, working to ensure consistency of practice and continual learning which we are now building into refreshed approaches to Practice Quality Assurance and Supervision
• developed our programme of ‘Leading and Managing Efficient Workflow’ to improve the consistency, productivity and impact of our care management practice through the development of team managers
• continued our investment in the voluntary and community sector to support resilient communities in line with our promoting independence approach
• finalised our approach to procuring a case management system to be implemented across adults’ and children’s social care to support the modernisation of our services and improve productivity
• ensured that the work programme of our Health and Care Scrutiny Committee is shaped around our risks and challenges, with a range of learning and development opportunities and Masterclasses available to all Councillors
• evolved our Race Equality Improvement Programme to now focus on all protected characteristics, seeking independent feedback through of engagement networks to ensure our policy framework is free from bias and does not create inequalities of access, experience or outcome for those drawing on adult social care

In this self-assessment, we reflect on how well we are delivering on those aims, using the framework developed by the Care Quality Commission, beginning with the ‘leadership’ theme.

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.

Evidence base: Leadership

The ‘leadership’ theme covers:

• strategic planning
• learning
• improvement
• innovation
• governance
• management
• sustainability

We maintain an evidence base for the ‘leadership’ theme available to all staff on our SharePoint site.

As well as our repository of internal business intelligence tools and the evidence library that feeds our information return, we also refer to independently produced evidence such as the reports produced using LGInform.

Key points to note regarding Devon as a place and its population:

• Devon has an older population when compared to England, particularly for people aged 85 and over – however, there is significant variation at a town and neighbourhood level, for example, Sidmouth has over 60 times the proportion of people aged 85+ when compared with the new town of Cranbrook.
• The over 65 and over 85 populations are forecast to continue to grow, with the working population stable.
• While the proportion of the population that is non-White has grown from 2.5% to 3.8% over the last decade, it remains a small minority, somewhat concentrated in Exeter.
• The LGBT+ population of Devon is about 2% of the total, again concentrated in Exeter where the Census indicates 5.3% of the population so identify.
• Life expectancy and healthy life expectancy are in the top quartile of local authority areas for men and for women.
• Although Devon is not generally a deprived part of the country, 4% of the population live in the 20% most deprived wards in England; and rural isolation is also a factor, as is the unavailability of affordable housing.
• Generally, the north of the county is more deprived than the south and the city of Exeter.
• The proportion of people with life limiting disabilities in Devon is broadly stable between Census periods at 20%.

The Adult Social Care Outcomes Framework (ASCOF) demonstrates that the impact we make in people’s lives is comparatively good:

• In recent years, the majority of ASCOF indicators have been in the top two quartiles nationally.  In 2023-24, 63% of the published indicators are in the upper quartiles.
• Of particular note are overall satisfaction with services and quality of life ratings which are consistently in the top quartile. In 2023-24, service user satisfaction has improved further improving Devon’s ranking to 4/151 local authorities in England (1^st quartile). We have seen a minor decline in quality of life with ranking falling to 56/151 local authorities (2^nd quartile).
• The proportion of regulated providers in Devon rated ‘Good’ or ‘Outstanding’ is consistently higher than all comparator averages.
• Outcomes for carers are less good than people who use services, particularly their quality of life impacted by social isolation.

In their 2023 Peer Review of adult social care in Devon, the Local Government Association said:

• Devon appears to have good strategic governance arrangements in place​
• there is a clear vision for Adult Social Care in the Council with good plans – these could be better prioritised and implemented at greater pace
• there is a robust structure of external engagement groups for service user and carer engagement​
• elected members are engaged in understanding the challenges facing Adult Social Care​
• Devon Audit Partnership expressed confidence in how Integrated Adult Social Care manages risks
• there is an excellent suite of detailed data reports and intelligence in Adult Social Care
• partnerships appear to work well within governance arrangements across Devon 
• integration of local delivery is working well at an operational level.
• there is further opportunity to evidence wider partnership working with health system partners
• leadership discussions with a small core group of Place leaders may enhance the governance arrangements​

A year after the Peer Review we published an update on our Improvement Plan with almost all actions completed.

In 2023, we conducted two leadership surveys, the most recent receiving over 200 responses from across our 1,000 strong staff:

Respondents had the opportunity to comment on strengths and areas for improvement, key themes being:

• leaders being preoccupied by the financial challenge
• some change initiatives being implemented too fast and not always well
• communications not being clear and consistent enough
• leaders needing to be more visible and listen to people at the frontline more
• positive support for the openness and transparency of the survey
• the identification of some differences between localities and teams that need to be addressed
• concern that capacity is reducing but demands are increasing

Actions taken so far in response to this survey include:

• staff conferences held in March 2024 and October 2024
• a series of team visits by the leadership team scheduled to allow staff to have conversations with our senior leaders face-to-face
• a review of our Communications Strategy, beginning with a session at our Extended Leadership Team in January 2024
• monthly online catch-up sessions with Heads of Service and a monthly video message from the Director
• a single newsletter combining previous bulletins
• a commitment to a further Leadership survey and the Employer Standards Social Work Health Check in 2025 with a corporate staff survey undertaken in 2024

The Integrated Adult Social Care (IASC) workforce response to the People Survey 2024 was significantly below the Council average (34% c.f. 51%) with our larger workforce being more distributed and response rates varying by function, with those working in our in-house provision and assigned to the Devon Partnership Trust least likely to respond due to IT access issues.

Perceptions of the Council being a good place to work were poorer than the Council average as were the 55% of IASC respondents who want to remain working for the Authority for the foreseeable future. Over half of the service’s responding workforce felt valued and recognised, but there is scope for improvement, our staff being our greatest asset.

We have subsequently asked our staff ‘what makes adult social care in Devon a good place to work’ and ‘what makes people want to continue working for the service’. They suggested the following actions:

• Improve the culture of reporting and responding to bullying and harassment. There is a feeling that some independence from the Authority in this process should be explored.
• New and more career progression opportunities for social workers, and better support for new and aspiring managers currently in frontline roles.
• More time and training given to support staff to adapt to change.
• Ensure teams are resourced so that secondments and other development opportunities can be taken without reducing team capacity.
• There needs to be better management of underperformance and capability issues.
• More trust and respect are needed for the skill, knowledge and professional judgement and autonomy of staff.
• Stop the culture of overworking, need to have a better understanding of work life balance.
• HR related improvements: more timely pay award negotiations, improved maternity and paternity pay, pay equal with other sectors, Essential Car User Allowance improvements for part time staff, and a voluntary redundancy policy.

We have sought to improve by:

Increasing awareness of staff conduct and how to respond to complaints:

• Integrated Adult Social Care (IASC) Newsletter to include links to the employee code of conduct, how to report unacceptable behaviour and discrimination, and new Inside Devon page on Whistle Blowing policy and process. These will collectively also be on a single Inside Devon web page.
• IASC Leadership Team to add these links to email signatures.

Focussing more on the experience of our assigned workforce’s experience of ICT:

• New Head of Social Care for Devon Partnership Trust (DPT) and the Council will be reviewing the Assigned Workforce’s experience and challenges of ICT whilst working across two employers.

Expanding career development opportunities:

• Manager and aspiring manager learning, and development support remains a priority for the organisation with a candidate accepted onto each of the last three cohorts on the ADASS Accelerate Programme
• Developing our IASC Workforce Vision to include aspirations to ensure everyone has access to career development opportunities, including those in non-registered roles such as commissioners and contract managers

Celebrating staff experience:

• Workforce Development Team to use the positive messages about working in IASC (such as those recorded in our Big Thank You! Scheme) in our recruitment processes with more of our many positive news stories to feature in our directorate and corporate bulletins.

We are currently undertaking the 2025 Employer Standards Healthcheck to understand this feedback in more detail specific to adult social care.

We would like to highlight the following examples of good practice in ‘leadership’:

• In January 2024, The Department of Health and Social Care acknowledged the best practice of our Management Information Team in drawing insights from data to set strategy and improve outcomes.
• In December 2022, a House of Lords report recognised the work our Involvement Team are doing in co-production.
• The July 2023 Peer Review said: “You have a strong foundation for coproduction” noting the role of Carer Ambassadors and examples of co-production such as website redesign and assessment process redesign.
• In 2024, Carolyne Hague, Principal Occupational Therapist is just one of twenty two people nationally to receive a Chief Allied Health Professions Officer Gold Award for Excellence from Professor Suzanne Rastrick OBE, Chief Allied Health Professions Officer for England, commemorating 10 years in her role.
• In 2024, Robert Lewis, Approved Mental Health Professional Service Manager, has been seconded to the role as Mental Health Social Work Lead at the Government’s Department of Health and Social Care taking a lead on national policy initiatives, contribute to Mental Health Act reform, support workforce development, and help to strengthen a number of emerging national professional networks.
• Stewart Telford was shortlisted in the Adult Mental Health professional category of the Social Worker of the Year Award 2024. Stewart is an Approved Mental Health Professional currently working in Devon Partnership Trust as part of the DCC assigned workforce.
• Lucy Hunt (Team Manager Newton Abbot Community Health and Social Care Team) won the 2022 Social Worker of the Year Team Manager award.
• Social Care Assessor Jacqui Hendra, who works in the Ivybridge and Kingsbridge Community Team, was awarded a BEM for services to people with disabilities in the 2024 New Year’s Honours List.
• Having a successful candidate on each of the last three cohorts of the ADASS Accelerate leadership programme.

In June 2023, users of services and their carers (including people with learning disabilities, people from diverse ethnic backgrounds, people with autism, older people, and young people preparing for adulthood) participated in a review of Devon County Council’s access channels, helping us gain insight into what:

• gets in the way of people receiving the help they need from the Council
• would improve the customer experience in using the council’s various access channels
• practical steps the council could take to improve its engagement with customers
• would improve their experience of being communicated with by staff

Consequent improvements focussed on:

• navigation, structure and content of the website
• adding intelligent search functionality
• using simpler language, defining any unavoidable jargon and acronyms
• paying more attention to the needs of those who are digitally or otherwise excluded
• adding live chat to assist people
• providing more prompts and guidance within online forms

They particularly focussed on the County Council’s adult social care web pages, co-producing new navigation and content and reviewing the results, saying they should be:

• inclusive in language, without acronyms and with more use of appropriate pronouns
• representative in imagery
• written in plain English
• kept simple with content relevant to the end user rather than the organisation
• clear on which organisations are responsible for what and who does what in the council
• specific on how to contact appropriate teams, with an emphasis on customer service
• not assuming of any prior knowledge in describing what to expect

Through 2024/25 we have continued to seek from people who use services and their representative organisations to review and further improve our contact arrangements, focussed on our responsiveness to contacts by telephone which they told us had been variable but is now much improved. This and other feedback is also distilled into our quarterly feedback summary considered at our Performance and Assurance Board.

The Customer Relations Team handles all customer feedback received regarding Devon County Council, to ensure that complaints, comments, and compliments are dealt with appropriately, in line with legislation, policy and procedure. The aim is to promote and support early resolution.

As part of the Assurance process, the service receives reports highlighting complaints, including Ombudsman’s complaints, and compliments, which highlight recurrent themes that are used to inform practice improvement.

In 2023/24, a total of 221 complaints were received, including 24 investigated by the Local Government Ombudsman. Key themes related to communications, in particular assessments, care planning and financial assessment, and delays in service provision. We have implemented clear Practice Standards and Values Statements, which should address the identified communication issues. Eleven complaints were investigated by the Local Government Ombudsman in 2023/24 of which six were upheld either in full or part with all recommendations fully implemented to improve future service user/carer experience. No public reports were issued against the Authority in 2023/24.

We tend to under-report compliments received due to poorer recording. However, 232 were received in 2023/24, primarily by teams providing direct support to service users, fpr example, Social Care Reablement, Respite Care Centres and our Dementia Centres of Excellence. However, person centred approaches, hard work, compassion, kindness and efficiency of service were also attributed to our front-line professional teams and services. We are addressing this, for example, through our Big Thank You! where we celebrate the successes staff in living out our values with 123 instances recorded so far in 2024/25. We have linked this with national celebrations e.g. during Occupational Therapy Week and Social Work Week.

The role of Caldicott Guardian is held by the Director of Integrated Adult Social Care who holds responsibility for protecting the confidentiality of people’s health and care information. The Authority has clear policies and procedures in place in relation to the security of information. The importance of information security is supported through corporately mandated training requirements for staff to ensure they fully understand their responsibilities relating to data protection and information security. Systems are in place to maintain the security, availability, integrity and confidentiality of data, records, and data management systems. Electronic recording systems have restricted access for those working with people using services. In January 2024, the Council undertook a cyber-attack exercise which has informed further improvements in our arrangements for Emergency Planning, Preparedness and Response.

Co-production activity during 2024-25 has included:

• the Unleashing Potential Co-production Action Group co-produced top tips on what to expect from a good review which will be added to the public facing webpages
• the Community Services Co-design Group explore people’s lived experiences and gathering stories for publication on the Devon Integrated Social Care Alliance ‘Infra 360’ site using a co-designed template
• the Learning Disabilities Co-production Group recorded the script for a short film being made to encourage more people with learning disabilities to join the Learning Disability Partnership Board
• the Co-production Working Group developed and delivered a co-production workshop to the Change Management Team
• members of the Co-production Working Group attended events during national Co-production Week and fed back their findings to the Commissioning and Market Management Meeting
• a Co-production evidence diary was produced by the Co-production Working Group to tell us about Co-production activity in Devon
• questions to be asked by operational staff when phoning people about their care management experience were co-produced with people who use services

Members of our leadership team regularly attend our Joint Engagement Forum and constituent involvement groups to conduct open question and answer sessions.

Self-assessment: Leadership – governance, management, and sustainability

Quality statements:

• We have clear responsibilities, roles, systems of accountability and good governance.
• We use these to manage and deliver good quality, sustainable care, treatment and support.
• We act on the best information about risk, performance and outcomes, and we share this securely with others when appropriate.

Framework summary:

There are clear and effective governance, management and accountability arrangements at all levels within the Local Authority. These provide visibility and assurance on:

• delivery of Care Act duties
• quality and sustainability and risks to delivery
• people’s care and support experiences and outcomes

The Local Authority uses information about risks, performance, inequalities and outcomes to:

• inform its adult social strategy and plans
• allocate resources
• deliver the actions needed to improve care and support outcomes for people and local communities

There are robust arrangements for the availability, integrity and confidentiality of data, records and data management systems.

Through self-assessment, we have identified our key strengths as:

• achieving good outcomes overall, with the majority of indicators of the Adult Social Care Outcomes Framework currently in the top two quartiles of national performance, especially those associated with promoting independence
• performing particularly well in the indicators that suggest people are positive about their lives and the differences that services make to them including those regarding overall satisfaction, quality of life, and quality of services
• being stimulated by the fresh ideas and approaches brought in by the external appointments of a Chief Executive and Director of Integrated Adult Social Care, with the support of a stable and experienced senior leadership teams
• implementing a ‘One Council’ and ‘Team Devon’ approach to governance, performance management and delivery, leading to closer working with Public Health on the prevention agenda, securing stronger partnerships with District Councils on the housing agenda, and involving the wider organisation in changes to our Front Door arrangements
• embedding our Assurance framework and governance bringing together qualitative and quantitative information to learn and improve with a range of independent challenge and support linking to sub-groups that focus on practice quality, safeguarding improvement, provider quality, and service improvement
• sustaining integrated operational leadership and management over 15 years, directing co-located and co-managed frontline staff focussed on the health and care needs of their local population and working together at case level
• having stable and experienced political leadership with a Leader with experience as a Lead Member for Integrated Adult Social Care and Health who chaired our Health and Wellbeing Board and our ‘One Devon’ Integrated Care Partnership Board where they are well respected and enjoy good relationships with local partners, as well as being well connected nationally to influence MPs and government
• supporting our Health and Care Scrutiny Committee through coordinated agenda setting and report writing across the health and care system, providing regular masterclasses, and funding an independent expert advisor
• having mature and nationally recognised capabilities in the use of data, risk management, co-production, and emergency planning, preparedness and response

Through self-assessment, we have identified our key challenges as:

• addressing financial sustainability, with the governance of budget setting in recent years acknowledged as not having fully recognising the challenges of increasing demand and increasing costs, leading to in-year savings requirements
• gaining sufficient and consistent corporate focus on adult social care in a context where our children’s services have been rated less than Good by Ofsted for many years
• getting population health and wellbeing in general, and adult social care in particular, sufficiently represented in the ‘One Devon’ strategy and joint forward plan which is still mainly NHS focussed
• maintaining effective strategic partnerships with the NHS, District Councils and other statutory partners when all are experiencing financial and performance challenges and leadership changes
• progressing our vision and strategies through realistic and prioritised implementation plans in a context of financial and workforce challenges and other corporate priorities
• maintaining sufficient staff capacity and productivity to ensure we consistently respond to people in a timely and effective manner, minimising waiting times and waiting lists, checking people are ‘waiting well’, and ensuring consistent delivery of reviews
• understanding and acting on the comparatively worse outcomes we achieve for carers, including their quality of life being limited by social isolation

We have improved by:

• embedding new arrangements for the strategic governance of assurance, budget and transformation which the July 2023 Peer Review recognised as robust
• forming appropriately led and resourced groups focussed on delivering improvements in financial sustainability, practice quality, effective workflow, safeguarding, and care management
• relaunching practice quality assurance informed by values-based practice standards, applied to all those who undertake Care Act assessments and reviews including those outside the organisation such as Devon Carers and the Devon Partnership Trust
• using the insights we gain from our data analysis of trends and benchmarking to inform medium-term financial strategy and improvement prioritisation and delivery
• bolstering our use of feedback with regular reports received, reviewed and acted upon from a range of surveys, voice organisations and involvement groups

We are improving by:

• responding to the results of directorate and corporate staff surveys by sharing the results and determining actions with staff and other stakeholders with more face-to-face interactions between leaders and dispersed staff including staff conferences, extended leadership team sessions, and a programme of local team visits
• embedding changes to corporate and directorate governance with a new Corporate Performance Framework and the creation of Integrated Adult Social Care Boards for Budget, Assurance and Service Improvement
• completing our Local Government Association Adult Social Care Peer Challenge in July 2023, delivering on the consequent action plan, and preparing for a Corporate Peer Challenge in Autumn 2025
• ensuring our internal and external workforce strategies are fit for the challenges of a changing labour market with Skills for Care inviting Devon to participate in their workforce strategy development in recognition of our local focus and national contribution
• finalising the update of our Market Position Statement, making clear our commissioning intentions to providers and other stakeholders, informed by ongoing dialogue in our Provider Engagement Network and Joint Engagement Forum structures

We plan to improve by:

• finding ways of better using qualitative and quantitative information to evaluate and improve equality in access to, experience and outcome of services as we broaden our approach to listening to seldom heard groups and addressing inequalities of access, experience and outcome, building on our Race Equality Programme
• further developing our improvement programme to prioritise and schedule activity emerging from financial sustainability, strategy development, and assurance work into a prioritised and sequenced medium-term plan, including through the appointment of a new dedicated Leadership Team position
• shifting focus from annual budget planning to a five-year medium term financial plan with clear long-term targets, anticipating medium-term local government financial settlements
• taking a more corporate approach to assurance led by a new Performance and Partnerships directorate and Corporate Performance Framework
• getting more grip on escalating demand and costs in those areas where we know growth is greater than comparator authorities and is a root cause of our financial challenges
• working across the sector locally and nationally to determine and implement the government’s plans for a National Care Service, local government reorganisation and devolution

Additionally, we have responded to the recommendations of the July 2023 Peer Review regarding transformation:

There are a range of different plans across the directorate, including around savings, transformation (in different service areas), assurance, improvement work (for instance around waiting lists or practice), etc.

Bringing these plans into alignment will help not only to develop synergies and avoid duplication, but can also help to balance and manage risks and priorities, identify mitigations to key risks (where there are inter-dependencies), and where possible to identify initiatives or pilots that could be scaled up at pace, or accelerate where they are shown to work (in Devon or elsewhere).

We have improved by:

• reviewing our transformation programme to recognise changing priorities
• updating our vision and strategies to frame our transformation work
• focussing on financial sustainability, CQC assurance, and service recovery in 2023/24

We are improving by:

• prioritising practice quality, improving services in response to feedback from their users, and maintaining financial and market sustainability in 2024/25
• rescheduling our transformation programme and allocating resources accordingly
• reporting on progress in our online self-assessment that is now our Annual Report

We will improve by publishing a summary of our transformation programme and maintain it in alignment with our Improvement Plan, Medium Term Financial Strategy and the Council’s strategies and plans

Self-assessment: Leadership – learning, improvement, and innovation

Quality statements:

• We focus on continuous learning, innovation and improvement across our organisation and the local system.
• We encourage creative ways of delivering equality of experience, outcome and quality of life for people.
• We actively contribute to safe, effective practice and research.

Framework summary:

• Learning from people’s feedback about their experiences of care and support, and feedback from staff and partners is embedded throughout the local authority’s work and it informs strategy, improvement activity and decision-making at all levels. Coproduction is embedded throughout the local authority’s work.
• There is an inclusive and positive culture of continuous learning and improvement. The local authority has strong external relationships that support improvement and innovation. Staff and leaders engage with external work, including research, and embed evidence-based practice in the organisation.
• There are processes to ensure that learning happens when things go wrong, and from examples of good practice. Leaders encourage reflection and collective problem-solving.

Through self-assessment, we have identified our key strengths as:

• demonstrating our transparency and use of evidence through the online publication of a self-assessment or annual report over many years, contributed to by, and shared with, stakeholders, recently highlighted by Partners in Care and Health as good practice
• using data and the data analysis tools and reports that draw insights from it effectively, with best practice in this area recently being highlighted by Department of Health and Social Care in its ‘Care Data Matters’ report and members of the team being active in regional and national roles and groups
• informing budget setting by a comprehensive annual exercise analysing trends and benchmarking in activity, cost and spend, extending the Local Government Association ‘Use of Resources’ and ‘Better Lives’ approaches
• exemplifying how the use of data and other evidence can drive improvement e.g. from being an outlier five years ago, our safeguarding activity and performance is now broadly in line with comparator authorities
• bringing focus to and acting to improve on our most pressing priorities e.g. addressing insufficiency in the personal care market as we emerged from the pandemic through increasing rates and working as a system on recruitment and retention of care workers, including internationally
• identifying, mitigating, and managing risks in a complex environment, especially strategically but also tactically and operationally, with examples of consequent action and impact noted by the Local Government Association in our 2023 Peer Review
• using our ‘Unleashing Potential’ programme to grow and develop our own workforce with comparatively low vacancy and turnover rates for social workers and occupational therapists e.g. through apprenticeships at all levels, and with defined career pathways supported by a comprehensive learning and development programme for operational staff
• introducing a co-produced set of values that have informed the standards we use in practice quality assurance, supervision and appraisal with one chosen each month for particular focus
• involving people through a mature set of arrangements valued by both the organisation and people who use services and their carers who participate, with best practice in this area highlighted by a recent House of Lords report and by the July 2023 Peer Review
• demonstrating consistent success in regional and national awards schemes, for example, Social Worker of the Year

Through self-assessment, we have identified our key challenges as:

• having sufficient capacity to achieve our aspirations for improvement, given recent vacancy management, budget reductions, and corporate reorganisations and pressures arising from waiting lists
• combining strategic performance management and improvement with mechanisms that are effective at locality and team level, addressing known differences in practice and effectiveness, for example, in safeguarding conversion rate, assessment waiting times
• acting on the insights we gain from data analysis more consistently, for example, the Local Government Association recently identified that although we have long highlighted more working age adults with lower-level needs are supported long-term rather than enabled to be independent, we have not yet fully addressed the issue
• turning our strategic intent into delivery and impact, for example, in shifting resources from long-term support to prevention and early intervention when budgets are constrained and under immediate pressure
• making whole system improvement in a complex partnership environment, for example, working with eight district and city councils on housing, four NHS acute hospital settings in improving system flow and hospital discharge

We have improved by:

• participating in sector-led improvement, including inviting a team of peers into Devon to assess adult social care services, with several leadership colleagues participating in peer reviews elsewhere
• having many senior leaders and managers active and making a difference at regional and national levels through ADASS and other networks, sharing and learning from best practice, with consequent recognition through national award schemes and secondments
• taking a more corporate approach to governance, delivery and improvement involving colleagues from across the council in some of our challenges, including working more closely with public health on our common prevention agenda
• delivering on our Race Equality Action Plan, with progress recognised by staff through our last Leadership Survey

We are improving by:

• improving our use of qualitative information, especially distilling what we are told by stakeholders into intelligence that can be acted upon
• reinvigorating practice quality assurance and provider quality assurance post-pandemic to give senior leaders and members clear line of sight to the frontline to drive those improvement cycles
• using our revised assurance arrangements to identify, prioritise and assign actions that address evidence gaps and areas for improvement feeding into a medium term change programme
• using data and targeted training and interventions with team managers to address differences in productivity and impact, setting and achieving workflow expectations such that all localities and teams are performing at the required standard
• taking the recommendations and agreed actions of CQC assurance, Peer Challenge, Sector Led Improvement, and focussed support and challenge commissioned from LGA and IPC into our change programme
• further improving our reporting of complaints and compliments by making it more contemporary and with more focus on thematic analysis and identifying, monitoring, and evaluating actions taken
• accelerating the digitisation of providers and use of Technology Enabled Care Services in a market that is dominated by small/medium sized providers that deliver good quality but not always flexibility, with good progress so far through our local implementation of the national Digitising Social Care Programme

We plan to improve by:

• being more consistent in the understanding and use of national research and best practice generated by organisations such as SCIE, NICE and the King’s Fund and through our membership of Research in Practice for Adults
• encouraging innovation across the system, including in providers, recognising that good practice is not always easily identified, developed, and sustained in a large rural authority area
• being more outward looking in improving services where we know we achieve less than Good outcomes such as the quality of life of unpaid carers, looking to similar councils who do demonstrably better and using reports published by, for example, the Care Quality Commission, Partners in Care and Health

Additionally, we have responded to the recommendations of the July 2023 Peer Review regarding collecting and using feedback:

Developing better and more varied ways to routinely create and collect evidence of  outcomes for people will help to prepare for future assurance.

This might include the aggregated out-turn from reviews, feedback from people and communities and partners, or formal coproduction.

A clear focus on delivery of outcomes, through transformation and innovation, can also help to maintain quality and values in the service offer, with equal priority to the management of risk and financial out-turn.

We have improved by:

• completing a self-assessment for the LGA Peer Challenge involving stakeholder groups
• building into this a range of feedback including a leadership survey; staff surveys; surveys of service users and carers; stories about service users, services, and members of staff including those who have recently won awards
• updating our self-assessment according to LGA feedback and updated data

We are improving by:

• exploring additional cost-effective options for collecting and using feedback from people who use services, especially our care management
• improving our systematic use and recording of feedback from Involvement Groups through our Involvement Team

We will improve by improving reporting of compliments and comments delivered though our corporate Customer Relations Team.

Introduction: Working with people

Our care management aspires to be strength based, working with people in their homes and communities to keep them as independent as possible, doing what matters to them. This is now embedded in a ‘three conversations’ model of practice that seeks to meet people’s needs through preventative approaches and short-term interventions before any requirements for longer-term care and support.

We are committed to doing this in an integrated way, with our frontline staff co-located and co-managed with their health colleagues in local settings. For more than 15 years we have operated in joint teams with NHS provider organisations, working to primary care boundaries that mirror the natural geography and local communities across Devon and align to the footprints of our NHS partners.

These teams are connected to, and work alongside, the voluntary sector and independent care providers, promoting independence and looking to support people where possible in the community without unnecessarily drawing them into ongoing adult social care provision.

How we work with people absolutely shapes the experience and outcomes they achieve through adult social care support. We know we don’t get everything right for everyone all of the time, but we believe that being values-based in all we do, from recruitment to practice, means we can work better with people. We are constantly trying to improve, and over the last 12 months we have:

• further embedded our approach to Promoting Independence, recently refreshing our vision and strategy, and using our ‘three conversations’ model to ensure there is a focus on strengths and the people themselves
• co-produced an updated website to include more self-help tools and changed our Front Door arrangements so that people get expert information and advice on first contact, including for self-funders and those without eligible needs
• reshaped our Reaching for Independence Team to ensure their interventions are designed to prevent, delay and reduce and are even more effective with more reach
• delivered a staff wide Care Act training programme to ensure legal literacy and leadership on key elements including eligibility decisions and the wellbeing principle
• ensured we are focussed on the need to reduce waiting times and waiting lists, particularly for assessment and review, with demonstrable progress made in improving our productivity
• launched our Practice Values and Standards to support the right culture across everything we do and how we do it as the foundation of our approach to practice quality assurance
• worked more strategically across the council including with Public Health in how we are redesigning a ‘One Council’ approach to prevention
• maintained our commitment to investing in the VCSE this year through a number of grants and also through the continued partnership with Devon Carers

Keri has spent her career working across health and adult social care in Devon. Several members of Keri’s team work in integrated roles overseeing community-based health and care services on a locality basis with professional backgrounds including nursing, social work and occupational therapy; they also provide our professional leadership.

Evidence base: working with people

The ‘working with people’ theme covers:

• assessing needs
• planning and reviewing care
• arrangements for direct payments and charging
• supporting people to live healthier lives
• prevention
• wellbeing
• information and advice
• understanding and removing inequalities in care and support
• people’s experiences and outcomes from care

We maintain an evidence base for the ‘working with people’ theme available to all staff on our SharePoint site.

As well as our repository of internal business intelligence tools and  the evidence library that feeds our information return, we also refer to independently produced evidence such as the reports produced using LGInform.

Key points to note regarding determinants of health and wellbeing in Devon:

• Hospital admissions related to alcohol use are significantly greater than the England average.
• Hospital admissions related to incidents of violence are significantly fewer than the England average.
• The proportion of adults who are physically active is significantly better than the England average.
• Diagnosis rates for diabetes and dementia are worse than the England average.

Key points to note regarding people who receive adult social care services in Devon:

• We serve significantly more people aged 18-64 relative to our population than is typical, especially people with learning disabilities.
• We serve significantly fewer people aged 65+ relative to our population than is typical.
• Care home fees and those for community-based services are rising more rapidly than is typical elsewhere and are now above comparator averages.
• A recent rise in the use of pathways into care homes on discharge from hospital is of concern, with the proportion of older people having their needs met by care homes rather than at home now greater than the national average.
• The significant improvement in the sufficiency of the personal care market in Devon and the consequent freeing up of our social care reablement capacity offers an opportunity to support more people leaving hospital at home.
• Our use of self-directed support in general and direct payments in particular is consistently above the national average.

Key points to note regarding prevention and early intervention:

• In recent years, surveys indicate people in Devon find it easier to access information and advice than is typical elsewhere. However, adverse impacts of changes to our social care Front Door and cessation of Pinpoint, our community directory had an adverse impact on both service users and carers in 2023-24. We used this intelligence alongside ‘mystery shopper’ activity to identify and implement changes to our Front Door arrangements which have improved people’s experience with positive recent feedback.
• Although ASCOF indicators suggest the reach and effectiveness of short-term services to support people from being discharged from hospital requires improvement, where services are operated by NHS not all data is captured, and the proportion of recipients not then requiring longer term support is in the top quartile nationally.
• We are concerned that data indicates the number of people in receipt of equipment has been in decline since 2019 and this is a focus for investigation and improvement including through the recent retendering of our Community Equipment Service.
• 19% of people who receive adult care services have some form of Technology Enabled Care Services, up from 17% the previous year, with expenditure stable, although with the potential to increase further.    

Key points to note regarding the performance of our care management services:

• Around 60% of people receive an assessment of their needs within 28 days, below our aspiration of 65% in 2024-25 and 70% in 2025-26, allowing that people with complex needs sometimes require more time.
• We perform much better regarding our aspiration that at least 90% of people receive the services in their support plan within 28 days following assessment, although performance over the latter part of 2024 has fallen below target due to a data quality issue which we are currently looking to address.
• Around 47% of people receive an annual review in Devon, although these are prioritised according to need.  We have a targeted review programme in place, which is resulting in gradual performance improvement as we increase the number of planned reviews undertaken. 
• Although improving as a consequence of recent activity to monitor and improve productivity, our waiting lists for needs assessment, financial assessment and DoLS assessment are too long, and people aren’t typically reviewed frequently enough; we monitor and manage associated risks to ensure people are waiting safely and well and are improving the consistency of this approach through our Leading and Managing Effective Workflow (LMEW) programme.

Key points to note regarding our support to carers:

• On 16 February 2025 there were 92 carers waiting for an assessment, with a median wait of 9 days and a current maximum of 19 days
• 535 Professionals have undertaken Carer Awareness Training in Q3, which is an 89% increase from Q2.
• 86% of Primary Care Networks have increased the number of carers identified and recorded on clinical systems. 95% have increased the number of referrals to Devon Carers.
• Promotional activity included a Carers Awareness talk delivered at the Devon Memory Cafe Consortium with representatives of over 50 memory cafes in attendance.  
• We delivered 3 in-person and 2 virtual training sessions to Integrated Adult Social Care Staff, focussing on how to identify unpaid carers and the impact of caring with 91% of participants indicating they were now more confident in doing so.
• Contract changes, a new telephone system and a changed privacy policy has had some impact on service delivery which are escalated for awareness but being managed.

Our contract with Devon Carers which is in its 7^th year with a mature relationship governed through quarterly meetings with commissioners and overseen by our Carers Partnership Steering Group; these points are summarised from report for Quarter 3 of 2024/25.)

Key points to note regarding the performance of our support to people with mental health needs during 2023-24:

• 75% of people with mental health needs receiving adult social care services in Devon were extremely or very satisfied, higher than our overall average of 72%, which itself is 4/152 in the country.
• They are less likely than is typical of people served in Devon to feel safe, but more likely to report having adequate or better social contact; their quality of life is second only to people with learning disabilities.
• Devon was supporting 940 people aged 18-64 with mental health needs at year-end, significantly above the peer group average.
• Relative expenditure on this group is typical to the region but higher than our peer Group and England generated more by activity than cost.
• ​Devon was supporting 400 people aged 65+ with mental health needs at year-end, somewhat above the peer group average but below regional and national comparators.
• Relative expenditure on this group is typical to England, below the region and significantly above our Peer Group, again generated more by activity than cost.

For most working aged adults and some older people with mental health needs, Care Act assessment, review and support planning are delivered through a s75 Partnership Agreement with Devon Partnership Trust (DPT).

Governance and assurance of the s75 Adult Mental Health Partnership Agreement is provided by a Partnership Board chaired by the Head of Social Care and comprising key colleagues from the Trust and Local Authority, including finance and performance professionals.

The Trust was subject to a cyber-attack during 2022-2023 and as part of recovery is implementing a new IT system and processes.  Data is currently limited and incomplete, which has meant that implementation of the new Performance Framework agreed in September 2023 has been slower than planned.

We are working with data and intelligence colleagues in the Trust to develop and implement new core datasets to improve performance assurance going forward

Key points to note from our July 2023 Peer Review independent audit of 23 cases:

• 48% were scored above 75% and 65% above 50% by independent assessors using the Local Government Association methodology.
• Practice by Social Care Assessors was often rated more highly than that by Social Workers, perhaps reflecting complexity and other pressures.
• Practice relating to people’s mental health needs was rated the lowest.
• Actions were taken relating to three individual cases, one urgently.
• The process was used as a baseline and springboard for the relaunch of our own Practice Quality Assurance system.  
• Strengths identified:
  • Evidence of including the service users and/or their advocate.
  • Being able to follow people’s journeys.
  • Examples of positive impact on wellbeing.
  • Positive links with Reaching for Independence Team.
  • Person centred with relevant goals identified.
  • Strengths and aspirations noted and considered.
  • Good use of Direct Payment support hours.
• Areas for improvement:
  • Technology enabled care could be considered more.
  • Some of the goals could be more clearly defined – not SMART.
  • Inconsistent recording of Care Act outcomes.
  • Information sharing between partners.
  • Outcomes could have been met through non-commissioned support.
  • Examples of poor practice regarding consent to share information; protected characteristics; variable practice standards in terms of Mental Capacity Act; safeguarding decisions.
• In response, we have:
  • increased the capacity of our Practice Leadership Team
  • co-produced and launched our practice values and standards
  • aligned these to a new Practice Quality Assurance Framework
  • increased the volume of cases reviewed monthly
  • improved mechanisms to identify and disseminate feedback and learning
  • rolled out refresher training on the Care Act

Using this as an opportunity to relaunch our own approach to Practice Quality Assurance (PQA), we have redeveloped our PQA framework to align to our co-produced practice standards, with a Practice Quality Review (PQR) event in December 2024 enabling 165 audits to be completed in one day.

During 2024:

• 428 Practice Quality Reviews for Care Act Assessments were submitted, our target being 50 per month.
• The average score for Care Act Assessments was 78.6%, a static trend over the year.
• Variation between locality was from 67.5% in Western to 81.0% in Southern.
• Scores among staff assigned to the Devon Partnership Trust averaged 75.0%.

By 14 February 2025, 79 PQRs had been completed for Care Act Assessments with an average score of 84.0%.

We have now launched a PQR process for Section 42 Enquiries with 50 PQRs being completed in 2024 with 62% demonstrating Good or Outstanding practice.

Our Practice Leadership Team take learning from PQRs to inform our learning and development programme and communications to staff regarding practice improvement.

Key points to note regarding our own workforce:

• Turnover rate is currently 8.7% and increasing marginally, but higher for Occupational Therapists than other groups.
• Sickness absence rates rose during the pandemic and are still showing a linear upward trend with seasonal variations.  The proportion absent for psychological reasons has now fallen back to pre-pandemic levels.
• Staff headcount is reducing, in part due to vacancy management and service restructures, especially in non-frontline roles including temporary positions created during the pandemic.
• The use of agency staff in adult social care in Devon remains low, typically under 40 mainly covering long-term absence.
• Our workforce is ethnically similar to the wider population in Devon but almost 83% female with 56% being 50 or over presenting future recruitment and retention challenges. 

Key points to note regarding equality of access to, experience and outcome of adult social care services in Devon:

• The inequalities gap in Devon is 15 years for life expectancy and 14 years for healthy life expectancy, meaning people in the lowest income decile are four times as likely to have a long-term condition than those in the top decile.
• Older men are significantly less likely to access adult social care services than older women, even considering life expectancy differences.
• Ethnic minority and LGBT communities in Devon are comparatively small, diverse, and distributed (although disproportionately concentrated in Exeter) making it challenging to use data analyses.
• Qualitative work indicates older members of the LGBT community are often socially isolated and people of Asian heritage are less likely to access services than others while the experience of recent migrants is variable.

Key points to note regarding comparative waiting lists based on ADASS Spring Survey 2024 data:

• Based on data from 145/153 local authorities, there is an overall reduction nationally in the number of people waiting for assessment, care and support and a review of their assessed needs.
• We continue to work to improve the experiences of people waiting for assessment in Devon and have seen a reduction in average waiting times.  However, our waiting lists per 100,000 population (18 and over) remain above the national average although now improving regarding long waiters. ​
• Following assessment, we aspire to have 90% of services identified in Care and Support Plans in place within 28 days: a target we consistently exceed.  We perform better than the national average regarding service delivery waiting times​.
• Whilst we have a targeted review programme in place to reduce the number of outstanding planned reviews, we remain above the national average for overdue reviews. ​
• We are following up our data return by improving data quality, especially ensuring that ‘long waiters’ are indeed waiting.
• Our ‘Leading and Managing Effective Workflow’ initiative is seeking to improve consistency of practice as well as productivity, with rollout team by team scheduled to be completed by Spring 2025, and evidence of improvements in waiting lists and waiting times in teams where it has been implemented.

We would like to highlight the following examples of good practice in ‘working with people’:

• The July 2023 Peer Challenge said: “Staff are incredibly enthusiastic, committed, and supportive of the Directorate and its work.”
• Community Health and Social Care Teams in Devon were shortlisted at the Local Government Chronicle Awards 2023 in the large team of the year category.
• At the Social Worker of the Year Awards 2022 , Lucy Hunt won the gold award in the Team Leader of the Year category for her work in safeguarding people with physical and learning disabilities.
• Also at the Social Worker of the Year Awards 2022, Tom Wood won the silver award in the Team Leader of the Year category for his work in services to people with mental health needs, the most recent in several such awards given to our social worker staff in recent years.
• In 2023, social worker Ana Barbosa, winner in the diversity and equality category at the West Country Women Awards for her leadership in the Council’s anti-racism initiatives.
• The July 2023 Peer Review highlighted the PATH model for reviewing under-65s as promoting the person’s goals and aspirations.
• Our Reaching for Independence service works with adults and young people from the age of 17 in transition to increase their confidence for and skills in independent living e.g. brewing company in Ivybridge is using Innovative Technology to enable people in Devon with Learning Disabilities and Autism to gain and maintain skills essential for independent living and Employment.

In May 2023, four people with learning disabilities and three carers (including two people of Egyptian heritage) involved in our co-production working group reflected on their experience of assessment and review including ease of contact, waiting time, understanding of the process, accessibility of paperwork, the relevance of goal setting, and their level of participation in the process. The issues they raised included:

• Lack of involvement of practitioners with experience of people with learning disabilities e.g. in hospital discharge.
• Changes in personnel through the process, meaning relationships had to be remade, stories retold.
• The need to request Easy Read materials rather than have them provided proactively.
• Difficulties in reaching named workers by telephone during the process and consequent delays.
• Difficulties in getting face-to-face appointments, despite online interactions being problematic.
• Positive examples of promoting independence such as through registering for independent housing and universal credit.
• The time limit on the Reaching for Independence service which was otherwise considered very effective.
• Initial over-ambition in goal setting which was adjusted to be more realistic through the process.
• Lack of an annual review following moving into a new setting.

As a result of this feedback, actions taken included:

• A report to the group responsible for practice quality assurance and improvement to inform guidance and training.
• Easy Read documents and forms reviewed with service users, revised and relaunched to staff with training from a learning disability specialist.
• Permission to share case details with staff involved to enable them to learn from specific feedback.

Building on this, Hikmat Devon conducted a short review of service user involvement with the Adult Social Care Assessment process. The initial investigation was undertaken with six service users who answered questions provided by the Devon County Council Review team interviews were conducted by Hikmat staff who speak the language of the service users or carers involved, which included people of Chinese, Bangladeshi, Syrian, Filipino, Syrian and Egyptian heritages. Their feedback included:

• The assessment and review processes are difficult to understand.
• Solutions appropriate at the time of assessment can become less so as needs escalate.
• Choice is sometimes respected, but not consistently so.
• Needs specific to ethnicity, culture or religion are not always asked about or considered.
• Communication was sometimes unclear or ignored communications needs.
• Carers feel isolated, often lacking the support of networks of family and friends. 

These findings have informed our Anti-Racism Action Plan and follow-up work has been commissioned on a quarterly basis to ensure monitoring of progress is informed by qualitative studies.

We are now commissioning an independent review of our policies from the perspective of people with protected characteristics and/or who live in isolated rural or deprived communities to test whether they present any barriers to equality of access, experience and outcome.

We have been working with Devon Communities Together to identify areas within our policy framework that might contain any negative bias against those living in rural and extremely rural areas and differing levels of deprivation. The purpose of this has been to remove any policy approach that may cause or contribute to an inequality of access, outcome and experience of adult social care for those living in rural areas. Similar work also took place with Hikmat exploring the same challenge in relation to ethnicity and religion. Feedback was across the following themes:

• Equality of contact – ensure equality of IASC staff resource.
• Equality of access – ensure equality of access to services.
• Equality of choice – ensure equality of choice of services.
• Equality of funding – ensure equality in the value of Personal Budgets ‘rural premium’.
• Equality of understanding – ensure care management processes account for how rurality can impact and shape needs, and meeting them.
• Opportunities – enhanced roles for VSCE including as ‘Rural Community Connectors’

A number of considerations and actions have come out of this work across policy, commissioning and delivery, including ensuring as staff guidance is reviewed it is done so additional through this lens.

Devon Communities Together (DCT) has shared its input and learning into this work locally and national including with:

• Defra (through DCT/ ACRE Q2 Report 2024)
• Action for Communities in Rural England National Rural Proofing Network
• Torbay, Plymouth & Devon VCSE Assembly Executive
• Devon County Council Children’s Service (Family Hub Strategy) Leads
• Devon Drug & Alcohol Strategic Partnership Programme Lead on the current Barriers to Accessing Substance Misuse Treatment Services in Rural and Coastal areas. –
• Devon County Council Local Transport Plan 4 Health Impact assessment Group
• VCSE Assembly Virtual Wards Consortium
• National VCSE ICS Alliance Network

DCT’s rural proofing team have offered to work in partnership around the further development and implementation of the considerations identified in the broad areas of policy development, service delivery and commissioning processes and procedures to meet our collective objective of ensuring that services users living in rural communities in Devon are not disadvantaged and have equity of access to adult social care services going forward.

We have been exploring the opportunities to further work with the VCSE including:

• Rural Community Connectors: An expanded role for the VCSE in signposting and connecting rural communities to prevention/promoting independence/ IASC support.
• Work better in partnership with Anchor Institutions e.g. on housing, digital and connectivity, learning and skills. Incorporating IASC policy links
• Use Local Care Partnerships and the VSCE engagement in these as an opportunity, e.g. aligning social prescribing across the system.
• Do we know the gaps in service provision, and where? VCSE organisations could support a response e.g. to support hospital discharge, befriending, transport, advocacy.
• Collaborate with the VCSE Assembly Digital Inclusion Group to promote the newly developed Devon Digital Skills Framework to carers.
• Draw on community assets, such as village halls, and organisations to support rural and remote communities.
• Assess equality of access to activities for children and young people
• To support the identification of unmet needs and hidden deprivation

Feedback activity on ‘working with people’ noted on our quarterly feedback summary during 2024-25 includes:

• One to one phone call interviews with 9 people who consented to share their experiences of adult social care.
• Plymouth & Devon Racial Equality Council sought insight from people receiving adult social care at their community listening event.
• Members and voice organisations at our Joint Engagement Forum shared and discussed experiences of our changed Front Door arrangements.
• DIVAS (women with learning disabilities and/or autism who have survived domestic abuse or sexual violence) gave a presentation on knowing when and how to ask for help to report abuse.
• People with different communication needs have emphasised the importance of maintaining multiple contact channels e.g. autistic people often prefer online messaging whereas those with learning disabilities often don’t have the skills or IT access to make use of them.
• Voice Groups have sometimes highlighted lack of responsiveness in services including Assessment, Financial Assessment and Financial Assessment, concerns passed onto managers for investigation and reply.
• Living Options Devon informed us that people from ethnically diverse communities under asylum status find accessing ASC support challenging.
• An online survey sent to 100 people waiting for an assessment who have given their email address as a means of contact to check whether they were ‘waiting well’ with the majority responding reporting changes in their physical and/or mental health helping us to refine our approach to maintaining contact.
• Focus groups were held to help us to further improve our Front Door arrangements and productivity through workflow with recognition of recent improvements.
• Parents of transition-aged young people told us that processes were well planned and person-centred with professionals providing key information to make the transition as positive as possible.
• Hikmat Devon CIC fed back that translated material sent to people who do not have English as their first language isn’t always accurate leading to a meeting to listen, learn and improve including making the Language Line link more prominent and to ensure that communication needs are checked at every contact.
• Age UK reported people were finding financial assessments difficult to understand leading to a meeting with the Client Financial Services Manager to discuss their user-friendliness.
• Recent positive feedback on care management has included:
  • Once the social worker became involved in our lives it has felt like the lights were turned on.
  • Our social worker and occupational therapist are amazing at offering the support I need.
  • Generally, the help given me has been very good and I have no reason to complain. Devon County Council are, in my opinion, offering all the right services. I write this as a 92 year old.

Self-assessment: Working with people – assessing and reviewing needs

Quality statement:

• We maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

I statements:

• I have care and support that is co-ordinated, and everyone works well together and with me.
• I have care and support that enables me to live as I want to, seeing me as a unique person with skills, strengths and goals.

Framework summary:

• People with care and support needs, including unpaid carers, those who fund or arrange their own care and communities have the best possible wellbeing outcomes. This is because:
  • their care and support needs are assessed in a timely and consistent way
  • assessments and care and support plans are co-produced, up-to-date and regularly reviewed
  • support is co-ordinated across different agencies and services
  • decisions and outcomes are transparent.
• People’s care and support reflects their right to choose, builds on their strengths and assets, and reflects what they want to achieve and how they wish to live their lives.

Through self-assessment, we have identified our key strengths as:

• having passionate staff committed to making a difference, remarked upon by the July 2023 Peer Review.
• using co-production to improve our information and advice, Front Door, and assessment processes and supporting resources including in their continuing monitoring and review.
• seeking and acting on feedback from representative users of services, their carers, and their voice organisations to fine tune these arrangements to make sure they are responsive as well as effective.
• maintaining our commitment to co-located and co-managed integrated health and care teams embedded in communities through organisational and personnel changes over 15 years.
• showing generally positive trends and comparative performance in the indicators that form the Adult Social Care Outcomes Framework, especially regarding service user overall satisfaction, quality of life, and promoting independence.
• transforming our approach to person-led reviews to increase their quality and frequency with a programme of reviews targeting those who may benefit most from approaches which promote their independence.
• using enabling services such as Reaching for Independence (a service that attracts more compliments than any other) to have a positive impact on people’s lives where they are received.
• increasing choice and control through the use of self-directed support where it makes the most difference, while improving market sufficiency to ensure people have availability and wherever possible a choice of services within the constraints of rural areas.
• using quantitative information to understand and improve performance, with tools available to inform leaders, managers and staff at every level strategically, tactically, and operationally.
• using triage and dynamic risk assessment to focus our limited staff capacity on those with most pressing need and/or at greatest risk.

Through self-assessment, we have identified our key challenges as:

• addressing the waiting lists through our Leading and Managing Effective Workflow Programme in and waiting times for assessment, review, and DoLS assessments which we recognise as improving but not yet as rapidly as we would aspire to.
• working with Client Finance Services to deliver their improvement plan to reduce waiting lists and waiting times for financial assessments to enable people to plan their finances in an informed and timely way.
• securing the capacity and focus to procure and implement a new care management system and using its facilities to enable the improvements in practice and outcome that will justify the investment.
• making sure that our first response is preventative wherever possible, consistently promoting independence through our ‘three conversations’ model of practice.
• responding to people in crisis with short-term care and support consistently and effectively, targeted to maximise independence before assessing and meeting any long-term needs.
• being consistent in our home first approach, making sure that the right care to the right people at the right time avoids care home placements that are not the right place for the person, including those discharged from hospital when too many people have been going into short-term care home placements that are then extended.
• improving how we support unpaid carers by recognising the detrimental impacts of social isolation and how they can be addressed in practice including through respite and replacement care.

We have improved by:

• improving our Front Door arrangements by changing from a three to two-tier operating model to reduce hand-offs and ensure people speak to those with the right expertise sooner, using co-production and regular feedback including ‘mystery shopper’ exercises to check and change.
• redeveloping our website and online tools to give people better information, advice and signposting, co-producing the content with people who use it.
• launching our Practice Values and Standards to support the right culture, featuring one each month in staff communications.

We are improving by:

• moving towards delivering on the target to complete assessment within 28 days for 65% of people.
• improving our practice in direct payments to make sure it is consistently promoted to those for whom it might be the best option, informing those who hold them how to use them best by using e-learning.
• creating more capacity for targeted short-term interventions that promote independence by continuing to improve sufficiency in the personal care market, avoiding those services being diverted in contingency.
• encouraging and increasing the use of our self-help and self-assessment tools to enable people to meet their own needs wherever possible and to initiate formal assessment where necessary.
• extracting learning from Practice Quality Audit to assess individual and collective quality, understand strengths, and target individual and collective areas for improvement and secure a greater consistency of practice from a widely dispersed staff group.
• using feedback and mystery shopper exercises to understand people’s experiences of our Front Door arrangements and fine tune the approach and capacity deployed to ensure their responsiveness, with a significant reduction in the number of calls abandoned.
• improving people’s understanding of the Care Act by delivering a training programme to ensure legal literacy and leadership on key elements including eligibility decisions and the wellbeing principle.

We plan to improve by:

• using compliments and complaints more systematically to identify best practice and where we need to improve, for example, in consistently applying our promoting independence and supporting policies.
• using supervision to individually identify best practice and where we need to improve, for example, in embedding the wellbeing principle.
• having better information about contacts at our Front Door, the support given, and the impact and outcome of that support to maximise the value of Client Level Data.

Additionally, we have responded to the recommendations of the July 2023 Peer Review regarding practice quality assurance:

Alongside this a renewed approach to regular case file audit, and other processes for peer learning at a practice level, should underpin a refreshed approach to quality assurance, wider practice and approach and efficacy, and safeguarding practice.

This can also be used as a means to embed practice change, and to bring challenge to frontline teams in line with these changes, in particular relating to outcomes, savings and independence.

We have improved by:

• undertaking a case audit of 23 cases for the LGA Peer Challenge, communicated and acted on that learning
• establishing a Practice Quality Assurance Group to govern practice quality assurance and improvement
• developing our Practice Quality Assurance Framework, including practice standards, case audit, and practice improvement
• relaunching our practice quality review tool to support individuals across our teams to peer review practice standards and share learning
• improving the capacity of our practice leadership and increasing the number of cases reviewed each month

We are improving by:

• increasing the volume of Practice Quality Reviews undertaken, with over 160 completed in a single day in November 2024
• ensuring learning is shared, including though our Performance and Assurance Board, Self-Assessment and regional networks
• seeking independent moderation through regional partners with an agreement reached through our SW ADASS ‘buddy group’

We will improve by:

• recognising that timeliness of response is an important aspect of practice quality from the person’s perspective

Self-assessment: Working with people – supporting people to live healthier lives

Quality statement:

• We support people to manage their health and wellbeing so they can maximise their independence, choice and control.
• We support them to live healthier lives and where possible, reduce future needs for care and support.

I statements:

• I can get information and advice about my health, care and support and how I can be as well as possible – physically, mentally and emotionally.
• I am supported to plan ahead for important changes in my life that I can anticipate.

Framework summary:

• The Local Authority works with people, partners and the local community to promote independence and support people to prevent, reduce or delay the need for care and support. It does this by providing or arranging provision of services, facilities, resources and other measures.
• The Local Authority takes steps to identify people with needs for care and support that are not being met.
• People in the area have access to the information and advice they need to make informed decisions about how to meet their care and or support needs.

Through self-assessment, we have identified our key strengths as:

• having a population with life expectancy and healthy life expectancy in the top quartile and significantly above the national average
• giving access to intermediate care and reablement services delivered in partnership with the NHS that have positive impacts on people’s lives including avoiding admissions and readmissions to hospital and in not requiring further ongoing support, albeit not always with the reach that we would like
• making available preventative services that adapt people’s homes and provide equipment to improve their ability to live independently, including the use of Apps such as AutonoMe.
• having a consistently higher than average proportion of people learning disabilities in employment and living in appropriate accommodation, maximising their life chances including social opportunities
• responding to the pandemic with a whole system approach to preventing outbreaks and supporting settings where they occurred, limiting fatalities in care homes to among the lowest in the country, and maintaining this approach in our winter planning.
• promoting the take-up of vaccinations, with uptake among care staff and in care settings among the highest in the country
• having our Leader of the Council and Lead Member for Integrated Adult Social Care and Health active in the wider partnership including the Health and Wellbeing Board, Integrated Care Partnership Board, and Torbay and Devon Safeguarding Adults Partnership Board to ensure preventative and strengths-based approaches are written though organisational, partnership and system strategies and delivery plans
• working closely with the Director of Public Health and his team on informing and implementing their recent annual reports on ‘Prevention’ and ‘Healthy Ageing’

Through self-assessment, we have identified our key challenges as:

• after several years of improvement, responding to a decline in the indicators in the Adult Social Care Outcomes Framework that measure access to information about services for both people who use services and their carers
• delivering on a strategy that emphasises the promotion of wellbeing and independence through prevention and short-term targeted intervention in a period of financial challenge
• ensuring we capture data about the delivery of all of our short-term and intermediate care services provided across health and care services in Devon to better assess and represent their reach and impact
• developing our approach to prevention into an updated strategy, especially regarding how we develop and extend key services such as social care reablement, reaching for independence, and technology enabled care services
• working with Public Health to ensure that preventative approaches are targeted on preventing, delaying, and reducing needs for adult social care and central to ‘One Devon’ and Council strategies and plans
• capitalising on improved partnerships with district and city councils to deliver increased housing with support capacity and capability
• addressing how we support working age adults, especially those with lower-level needs who are more likely to receive ongoing support in Devon than elsewhere
• refocussing a Public Health system that was mainly focussed on local outbreak management for over two years to addressing the wider determinants of health by encouraging healthier behaviours
• making more progress in driving up the uptake of and modernising our Technology Enabled Care Services and other aspects of our Digital Care programme
• capitalising on the potential of Artificial Intelligence to provide bespoke information and advice and assist in assessment, review and support planning

We have improved by:

• making prevention and healthy ageing the themes of the Director of Public Health’s last two annual reports, ensuring discussion and action at the most senior levels of the Council
• building on the Team Devon approaches to outbreak management to address other wider determinants of health and wellbeing including those related to housing, with new Extra Care Housing schemes in the pipeline

We are improving by:

• using the joint expertise across public health and adult social care to develop a view of evidence-based high impact interventions and initiating audits to check existing arrangements against their potential
• securing a stronger commitment to prevention in the update to the council’s strategic plan, linking it to both promoting wellbeing and managing the demand for statutory services such as adult social care
• seeing more join-up between the approaches of adult social care and other parts of the Council such as public health in the use of data through a corporate review of business intelligence

We plan to improve by:

• working more closely within the council and across the system to fulfil the priorities and ambitions of our ‘One Devon’ strategy and plan to achieve its ambition of there being equal chances for everyone in Devon to lead long, happy, and healthy lives
• extending our review of governance into partnership working including our memoranda of understanding, s75 agreements, governance of Better Care Fund, and Local Care Partnerships
• improving how we evidence and evaluate the impact of partnership working and initiatives jointly funded through the Better Care Fund or otherwise at system or Local Care Partnership level
• improving how we evidence and evaluate the impact of preventative services such as Technology Enabled Care Services and home adaptation
• improving how we evidence and evaluate the impact of short-term interventions we commission, building on our approach to monitoring the impact of those we provide, and seeking to optimise these capacities and maximise their impacts

Self-assessment: Working with people – equity in experience and outcomes

Quality statements:

• We actively seek out and listen to information about people who are most likely to experience inequality in experience or outcomes.
• We tailor the care, support and treatment in response to this.

I statement:

• I have care and support that enables me to live as I want to, seeing me as a unique person with skills, strengths and goals.

Framework summary:

• Understanding and addressing barriers to care and support
• Understanding and addressing inequalities in experience and outcomes
• Ensuring care and support meets the diverse needs of communities
• Ensuring people are encouraged to give feedback, which is acted on and used to drive improvements
• Meeting legal requirements relating to equality and human rights. This includes:
  • avoiding discrimination
  • having regard to the needs of people with different protected equality characteristics
  • making reasonable adjustments to support equity in experience and outcomes.

Through self-assessment, we have identified our key strengths as:

• having a well-developed and embedded approach to involving people with lived experience in our work strategically and in the commissioning and developing services
• involving people with particular disabilities and conditions through their own groups (for example, autistic people, people with learning disabilities) and those with protected characteristics through our Equalities Reference Group and representative user-led organisations
• supporting decision makers with impact assessments that encourage all involved to consider people with the range of protected characteristics, including through accessible consultations
• commissioning a Race Equalities Audit and responding to its findings by developing and beginning to deliver a resulting action plan demonstrating increased commitment to anti-racism in initiatives such as international recruitment
• working with partners such as Hikmat and Intercom to understand the lived experience of people from ethnic minority groups and trans people with adult social care needs
• publishing a directory of services for ethnically diverse communities
• Embedding the Equality Act 2010 within our commissioning practices including in impact assessments, tenders, and contracts

Through self-assessment, we have identified our key challenges as:

• fulfilling the commitments that followed from our Race Equality Audit involving raising staff awareness, encouraging staff commitment, and addressing inequalities in our employment practice
• broadening that corporate approach to be more externally focussed on those we serve and to consider other groups with needs associated with their protected characteristics (or other factors such as their rurality or economic circumstance) who may also experience disadvantage
• devising more effective ways of listening to seldom heard groups, identifying potential unmet need, and providing culturally appropriate services when in places like Devon it is often dispersed in rural areas

We have improved by:

• commissioning and responding to a Race Equality Audit with a corporate commitment to an Equalities Commission and Race Equality Action Plan
• ensuring equity is incorporated in impact assessments, where the distributed and varied nature of people from ethnic minorities and LGBT communities sometimes means their particular needs are not always considered
• supporting and challenging leaders to consider their attitudes to race and other protected characteristics through a mentoring programme and management training programme

We are improving by:

• broadening our Race Audit Action Plan seeking to use qualitative and quantitative information to demonstrate whether people from ethnic minorities achieve equality of access to, experience of, and outcomes from the services we deliver and commission
• continuing to ensure staff are challenged to consider their attitudes to race and other protected characteristics through a monitored learning and development programme
• seeking, creating, and triangulating Practice Quality Assurance data with insights from people with lived experience to inform, co-produce, and improve the quality of our operational practice
• working with our voice organisations through our engagement contract to commission specific pieces of work that seek to listen, understand and respond to those who are seldom heard or who have needs that aren’t met or responded to appropriately
• including being an unpaid carer as a key characteristic to consider in impact assessment and any evaluation of equity of access, experience and outcome

We plan to improve by:

• considering a co-production group of people with protected characteristics to support and challenge our commissioning and service development building on the council’s commitment to an Equality Commission
• ensuring our analysis of complaints addresses potential inequalities by being more mindful of the protected characteristics of complainants and including that in reporting
• exploring differential take-up of services and inequalities in access, outcome, and experience with relevant communities, for example, regarding safeguarding

Introduction: Providing support

As commissioners we are at the heart of shaping how DCC provides adult social care support, and the starting point for our work is understanding our neighbourhoods and communities, including the way their characteristics and aspirations evolve.

We draw upon various intelligence, working in partnership to understand this and to shape the things we do, to develop solutions that people want to receive where they want to access them. In progressing our work, over the last 12 months we have:

• continued to develop the Provider Engagement Network, and working with groups such as the Devon Care Homes Collaborative and Devon Integrated Social Care Alliance ensuring that a culture of positive and equal partnership working happens
• refreshed some of our provider support policies and approaches, reshaping parts of our Commissioning Team structures supporting these approaches and our broader market shaping, market sufficiency and safeguarding duties
• begun to define the work programme of the reconstituted theme by completing the update of our Market Position Statement, building on our programmes of work focused on modernising services provided in the Community and in Care Homes
• seen the quality of our independent care market assessed by the Care Quality Commission continue to be better than is typical regionally and nationally
• renewed our commitment to investment in the voluntary and community sector, leading to services provided by the community for the community in the community, building resilience through preventative approaches, including supporting people to leave hospital in a timely and lasting way
• undertaken the re-tendering of our Community Equipment Service, looking for opportunities to achieve better outcomes, including with an increased focus on Technology Enabled Care Services
• maintained the strength of our health partnership, despite changes in structure and leadership in recent years, ensuring a synergy across our key strategies and approaches including through our formal Partnership Agreements and s75 Agreement with NHS providers and our joint governance of the Better Care Fund
• continued our partnerships with our District and City partners, particularly on housing, exploring how collectively we can ensure people have the opportunities to access to the most appropriate housing

Solveig Wright – Deputy Director of Integrated Adult Social Care (Commissioning)

Solveig leads the adult social care commissioning team, with responsibility for the strategic commissioning of services to meet the social care needs of people in Devon; working with the market of adult social care providers to ensure its quality, sufficiency, diversity and affordability; managing countywide arrangements that meet the needs of carers, people with mental health needs, and those who require advocacy; determining and implementing change programmes and projects; and leading on performance, policy and involvement.

Evidence base: Providing support

The ‘providing support’ theme covers: 

• market shaping 
• commissioning 
• workforce capacity and capability 
• integration 
• partnership working

We maintain an evidence base for the ‘providing support’ theme available to all staff on our SharePoint site.  

As well as our repository of internal business intelligence tools and the evidence library that feeds our information return, we also refer to independently produced evidence such as the reports produced using LGInform.  

Key points to note regarding care providers and provision in Devon: 

• Care Providers in Devon are dominated by small and medium sized enterprises, with care homes typically having a lower number of beds than elsewhere, and community-based services being mainly locally based and operated.  
• This can mean providers carry greater overheads, with fee levels typically at the regional and higher than and rising more rapidly than the national average.  
• The absence of larger national providers and larger settings of greater than 60 beds can be a constraint in innovation to meet changing needs.   
• This includes the capacity and capability to deliver services such as respite care to people with more complex needs or to develop modern housing with support solutions.
• The quality of care providers is rated better than all comparator averages with 84.6% of care homes and 70.1% of community-based services regulated by the Care Quality Commission being Good or Outstanding. There is currently only one provider in Devon rated Inadequate.  
• This is reflected in the ASCOF overall satisfaction and quality of life indicators which are consistently in the top quartile. In 2023-24, service user satisfaction has improved further improving Devon’s ranking to 4/151 local authorities in England (1^st quartile). We have seen a minor decline in quality of life with ranking falling to 56/151 local authorities (2^nd quartile).
• Approximately 40% of care home residents and 42% of recipients of community-based services in Devon are self-funded according to the Provider Information Return. 
• Care users of all ages express top quartile levels of satisfaction with the services they receive. 
• While there are generally sufficient residential and nursing care home beds across the county, there are times when it is difficult to identify a suitable care home for someone to live in at short notice that both meets their needs and is in proximity to their family and friends. 
• Care home occupancy has increased since the pandemic and is now around 87%, similar to the regional and national averages.  
• Capacity in the personal care market has been a cause for concern but high fee levels, international recruitment and attracting new providers in the market has reduced insufficiency from over 6,000 hours per week to under 800 in two years.  
• The most recent Capacity Tracker data shows 1.5% of domiciliary care packages were ended or returned by providers as of 19 December 2024. This is an increase on the 2023 position.
• 2 care homes closed during 2023/24, but capacity has been off-set through new homes and expansions during the same period.  Small care homes in rural areas are particularly vulnerable to closure as their viability often depends upon their being owner operated.
• During 2024/25, 12 providers handed back contracts, predominantly due to financial viability issues.
• We have seen a significant improvement of 5% in the proportion of people feeling they have a choice of services. Looking at our 2023/24 survey data, 67.6% of respondents felt that they had sufficient choice over care and support services, which is an improvement against 2022/23 outcomes (63.4%) taking us above the 2023/24 national average (66.2%).
• In 2023/24, we have seen an increase in the proportion of people reporting that they feel they have control over their daily life which remains above the national and regional averages for all cohorts.   
• There is now only one safety measure in the national framework, which does not take account of the impact of services on perceptions of safety and can be influenced by wider societal issues, both local and national. Devon’s performance has declined in 2023/24 remaining below the national and regional comparator ranking 99/151 local authorities in England (3^rd quartile).

Key points to note regarding out of area placements in Devon: 

• The use of out of area placements increased significantly in 2021, the second year of the pandemic
• This seems to have been mainly associated with hospital discharge, including the commissioning of block beds for short term residential placements such as pathway 2 through discharge to assess. 
• There are currently 524 placements part or wholly funded by DCC outside the area. 
• Over half are in Plymouth and Torbay, and over a third elsewhere in the SW region​. 
• Over three-quarters are known to be in settings rated Good or Better​. 
• Three-quarters are wholly DCC funded, a quarter have an element of NHS funding.​ 
• Around half of OOA placements have dementia and two-thirds have a disability​. 
• Over a quarter have a learning disability and a further 12% a mental health condition​. 
• Over two-thirds are older people, under a third under the age of 65​. 
• Regardless of setting, approximately half of people in OOA placements have not had a formal review in the last 12 months​, although none are in inadequate settings. 
• We are looking at our OOA placements to better understand and quantify what proportion are made through the choice of the person and their family, and what proportion are due to local insufficiency, including of provision for people with complex needs.
• The south-west region is currently developing a regional placement protocol for people with learning disabilities.

Key points to note regarding the external (non council) adult social care workforce in Devon: 

• In line with national trends, the sector’s workforce is predominantly female, white, British and aged between 25 and 54; 30% of workers being aged over 55 and ​only 9% under 25 is a cause for concern. 
• More are on permanent contracts and fewer on zero-hour contracts than the national average; qualification levels are improving and above the national average.  
• High turnover (27%) and vacancy (7%) rates but with notable improvements in 2024. Absence rates are static at 5 days (4.8 days in the last year), below regional and national levels.  
• Much of the high turnover rate in Devon, especially in community-based services, is movement between employers in the sector rather than out of it, with around 50% within the sector.  
• Internal recruitment has led to increases in workforce capacity with the proportion of the workforce that is non-British is less than the national and regional averages but growing due to international recruitment.

A representative sample of comments from people who use services in the most recent survey or in recent forums include: 

• My Care and Support Services on the whole have been excellent. They are polite, helpful good listener’s, observant and responsive to my needs. They are also hardworking. 
• My care and Support Services help me to keep in touch with family and friends, to have a good social life and attend places of worship which I enjoy. 
• Very pleased with all care. Staff and are all kind and willing to help if I need it. 
• The way we are supported in our house makes us feel like a family as we have lived together for so long. I’ve learned how to cook and have the right support to be independent. 
• We have just gone through COVID, managing with very little or no support and we are exhausted. 
• I am a younger person in a home for older people because Devon didn’t have any residential care homes for younger people  
• New support helps so much. Great help with appointments. 
• I really appreciate the help I receive from my carers which means I get out and about and do plenty of exercise.  
• My mother feels safe, comfortable and has no worries. The care staff do all they can to help keep her happy and to feel and secure as her dementia progresses.  
• There are people coming and going doing different things. It’s hard to feel safe when you don’t know who staff are. 

When Healthwatch and Age UK consulted with users of adult social care services in the autumn of 2022, they reported: 

• Lack of personal care capacity is a major issue (This has since improved).
• Not knowing where to find support is a problem (Our website has since been co-produced).
• Home visits and face to face meetings with professionals make a difference.  
• Access to transport services is a barrier, especially in rural areas.  
• Devon Carers, Care Ambassadors, and peer support are all valued highly.  
• More and accessible respite care is needed (This is a focus of our ‘Caring Well in Devon’ strategy). 

We would like to highlight the following examples of good practice in ‘providing support’: 

• In June 2022, the Learning Disability Respite Team came second and were highly commended for its work in the small team of the year category of the Local Government Chronicle Awards.  
• Westbank Neighbourhood Friends in Exeter won the 2021 Queen’s Award for Voluntary Services for its work during the pandemic to help to keep vulnerable or frail adults out of hospital, or to have shorter hospital stays.  
• In March 2021 Devon scooped a prestigious care award at the Health Service Journal Awards for a service designed to support unpaid carers, and highlighted as an example of integrated working by NHSE.  
• The July 2023 Peer Review highlighted our well-established quality assurance and improvement offer to providers and said, “care providers were consistent in describing your excellent pandemic engagement response.” 
• The July 2023 Peer Review acknowledged we have “made significant improvements in addressing previously high levels of unmet need.” 
• Southern Healthcare won five national awards at two ceremonies in London and Leicester. Teams from the group’s care homes in Exeter, Seaton, Dawlish attended the National Care Awards at Excel London and the Caring UK Awards, where it won the employer award. The Director of Nursing and Compliance was presented with an award for outstanding contribution to social care after she developed an advanced diploma in social care nursing. 
• The group also reached the finals of the Caring UK Awards in two other categories. Sefton Hall in Dawlish was a finalist for both dementia care team of the year’ and ‘care home of the year (south)’. A member of the care team at The Old Rectory in Exeter, was a finalist for care employee of the year. 
• Dr Len Lofts the former CEO and now Patron of The Northam Care Trust, which supports people with learning and physical disabilities and complex health needs in North Devon received an MBE in 2024. Their services include supported living and enabling services, residential lodges and community outreach day opportunities. They also offer support to help reconnect isolated people within the community.

During 2023, a collaborative commissioning approach was taken to the review of community-based services, including personal care, personal assistants, day services and enabling services. People with lived experience of these forms of care and support have been involved throughout the process:

• A survey on what works well and could be better currently.
• A co-design group that steered how the design process worked.
• People who use services and their carers working alongside commissioners and providers.
• Co-production training to ensure all involved could work together meaningfully.
• Regular meetings continuing into 2024 taking an iterative approach to co-production.

Feedback activity on ‘providing support’ noted on our quarterly feedback summary during 2024/25 includes:

• Our Learning Disability Friendship Group facilitated by Devon People First have had experience sharing sessions on Personal Independence Payments, participating in Reviews, and our Reaching for Independence service. 
• The Dimensions for Autism network have hosted discussions on disclosure, rights and reasonable adjustments at work.
• In surveys of Social Care Reablement users, some recipients have expressed concerns that changes in visit times and personnel create uncertainty and anxiety.
• Recent positive feedback on service provision has included:
  • I really appreciate the help I receive from my carers. I have a memory impairment and cognitive difficulties (due to a brain injury) but I am physically very active. The support provided by my carer means I can get out and about and do plenty of exercise.
  • The care I got from Crediton Care which is sourced through DCC is completely central to my life. Without this support I wouldn’t be able to stay in my own home.
  • Despite not attaining my final goal of remaining independent in my home, this was not due to the lack of great support, wonderful encouragement and care from your great Social Care Reablement team.

Self-assessment: Providing support – care provision, integration, and continuity

Quality statement:

• We understand the diverse health and care needs of people and our local communities, so care is joined-up, flexible and supports choice and continuity.

I statement:

• I have care and support that is co-ordinated, and everyone works well together and with me.

Framework summary:

• The local authority understands the care and support needs of people and communities. There is a good variety of care providers, provision is resilient and there is sufficient capacity to meet demand now and in future.
• Local people have access to a diverse range of safe, effective, high-quality support options to meet their care and support needs. This includes unpaid carers and those who fund or arrange their own care. Services are sustainable, affordable and provide continuity for people.

Through self-assessment, we have identified our key strengths as:

• basing our commissioning strategies and plans in evidence, including our Joint Strategic Needs Assessment and bespoke needs and market analysis
• enjoying a high quality market of independent and voluntary sector providers, with a greater proportion of those in both residential/nursing and personal care sectors in Devon being rated Good or Outstanding by the Care Quality Commission than the national and regional averages, with particular strengths in being safe, caring and well led
• having 19/26 in 2021/22, 14/26 in 2022/23, and 14/22 (so far published) in the top two quartiles of the indicators in the Adult Social Care Outcomes Framework (ASCOF), with service user overall satisfaction and quality of life being consistently high
• generally getting services in place in good timescales once an assessment or review has been completed, although those processes often take too long
• strengthening relationships with providers during the Coronavirus pandemic, with communication and engagement based on mutual respect, approaches now embedded in our Provider Engagement Network
• demonstrating effective partnership, with adult social care providers and health and care support organisations working well together to address shared challenges e.g. on international recruitment and the digitisation of providers
• paying providers higher than average fees to recognise the rural premium of delivering services, stabilise their finances and encourage workforce recruitment and retention through higher wages.
• offering a well-regarded provider quality assurance and improvement offer and a wide range of free training to provider staff, including giving access to resources designed to improve their physical and emotional wellbeing
• working together to improve recruitment and retention, for example, through ‘Proud to Care’ and ‘One Devon’, contributing to the national Skills for Care workforce strategy
• maintaining market sufficiency and stability, making progress since the pandemic, for example, a system wide approach to international recruitment helping to reduce insufficiency in the personal care market by 90%
• embedding the Equality Act 2010 within our commissioning practices including in impact assessments, tenders, and contracts

Through self-assessment, we have identified our key challenges as:

• finalising and promoting the update of our Market Position statement, building on the work of our Market Sustainability Plan and Adult Social Care Needs Analysis
• ensuring we maintain strategic focus on the external as well as internal adult social care workforce, with responsibility transferring to our People and Culture directorate
• giving more consideration to the needs of self-funders, recognising our Care Act duties extend to ensuring they can secure a range of services that are affordable and of high quality
• maintaining the significant progress made in sustaining market and workforce sufficiency, particularly in the personal care market in some rural areas, and in complex dementia support in residential settings
• developing our contracts and contractual frameworks to give more clarity on expectations regarding service delivery and cost and improve discipline in price control
• undertaking timely reviews of individuals on a scheduled basis to pick-up on changing needs of the individual or otherwise unidentified quality issues or risks informing our provider contract and quality monitoring
• monitoring out-of-area placements consistently as effectively as those in-county, ensuring quality assurance of providers and the review of high-risk services and individuals
• profiling risk across all types of providers with subsequent management to mitigate against and minimise provider failure, which is currently infrequent in Devon
• supporting providers to embrace change and innovate, for example, in digital and Technology Enabled Care Services, especially the small and medium sized providers that dominate the Devon market
• improving the wellbeing of staff across the sector in recovering from the pandemic with absence and turnover levels still indicating burnout, although improving year on year and being good compared with other areas
• being reliant on international recruitment to boost the adult social care workforce, in common with the national picture highlighted by Skills for Care
• securing more options in specialist provision such as for the homeless, those with mental health needs, and unknown vulnerable adults
• having a care market dominated by smaller organisations and settings, which although being correlated with better CQC ratings, are also more likely to experience challenges to their financial sustainability and deliver services less adaptable to changing needs

We have improved by:

• improving access to and analysis of data on out of area placements to inform quality assurance and review arrangements are in place that ensure people’s needs are being met in settings where we have the same expectations of providers as we would if they were in Devon, including through our Specialist Placements Team
• updating our carers’ strategy delivery plan to focus on improving social contact and working with Devon Carers to improve the outcomes we achieve for carers within the limits of our resources
• continuing our initiatives to improve the recruitment and retention of frontline care staff, evaluating approaches to understand which make most difference, and focussing on those, for example, in improving staff health and wellbeing to reduce absence
• supporting safer recruitment, in particular when recruiting internationally, to bring people with the right values and aspirations into the care sector in Devon, and work to reward them better

We are improving by:

• updating our Market Position Statement and delivering on our Market Sustainability Plan through a clear set of commissioning intentions and plans aligned to our vision and strategies.
• encouraging providers to reshape their business models to meet those commissioning intentions underwritten by the changing care and support needs of the population we serve.
• making better use of Capacity Tracker, building on it becoming a statutory provider return to ensure provider information is complete and contemporary, and using it to track monitor capacity and workforce.
• extending the approaches we have developed to manage and quality assure regulated providers into the unregulated sector.
• maximising operational staff capacity and productivity to undertake more reviews, gathering and using intelligence on provider quality, including out-of-area placements.

We plan to improve by:

• improving how we evaluate the effectiveness of some of our support and challenge to providers such as interventions by the Quality and Contract Monitoring Team
• capturing the impacts of investments and initiatives such as the Better Care Fund (BCF), community catalysts, and Technology Enabled Care Services
• seeking feedback from providers in a more structured way that enables us to target and drive improvement
• obtaining better evidence to demonstrate whether people of all backgrounds are experiencing equal access to and outcomes from services and having their particular needs met in a culturally appropriate way
• developing our approach to the use of provider information, bringing data from multiple sources into our data warehouse to assess and respond to emerging risk

Self-assessment: Providing support – partnerships and communities

Quality statement: 

• We understand our duty to collaborate and work in partnership, so our services work seamlessly for people.  
• We share information and learning with partners and collaborate for improvement. 

Framework summary: 

• The Local Authority works actively towards integrating care and support services with services provided by partner agencies. This achieves better outcomes for people who need care and support and unpaid carers and helps to reduce inequalities. 
• Partnership working helps to ensure that care and support meets the diverse needs of individual people and communities. People experience a seamless care and support journey, and their support is co-ordinated across different agencies and services. 

Through self-assessment, we have identified our key strengths as: 

• understanding the diverse health and care needs of our populations and communities in commissioning through needs analysis and operationally through multi-agency teams embedded in communities
• having operational arrangements that are flexible, joined-up with the NHS, support choice and promote independence including through short-term interventions such as reablement, intermediate care, and end-of-life care
• developing locality provider forums which are now embedded in all localities and bring together health and care commissioners and operational managers with independent and voluntary sector providers  
• working with the voluntary sector to support and facilitate new approaches, for example, dementia memory cafes which are self-sufficient with a small grant to the consortium which supports their safe running  
• sharing learning and collaborating on system and service improvement, for example, hospital discharge initiatives such as the Devon Carers Hospital Service and the provision of 1:1 agency staff to get people with complex needs home quickly while their longer-term needs are assessed, and solutions and their funding agreed  
• supporting personal assistants and micro-providers, including social enterprise opportunities
• building strong relationships within the Council to secure their support in meeting adult social care priorities, for example, with the Public Health and Communities directorate in preventing and managing outbreaks in care homes, with Economy and Enterprise in promoting health and care as the largest sector and employer in the local economy
• working closely with district and city councils to ensure that housing with support is developed and care needs are considered in mainstream housing and social housing developments

Through self-assessment, we have identified our key challenges as: 

• understanding the needs of self-funders, supporting them to make decision and ensure market sufficient to meet needs
• ensuring equitable access, such as, developing the market in less well provided for areas to increase provision where there are gaps in service provision, especially in rural areas where the population is dispersed  
• maintaining system flow, especially during winter and other periods of high demand on hospital services 
• commissioning services and agreeing fee levels within constrained budgets which are under pressure through rising demand, increasing costs, insufficient supply, cost of living pressures, and falling council income
• supporting unpaid carers to meet their own needs and enable them to maintain their caring role without detrimental impact on their health and wellbeing  
• being active within housing planning and development to encourage affordable and incentivised housing to support workforce expansion
• sustaining the good relationships we have enjoyed across the Integrated Care System through changes in leadership and challenges with continuing to deliver good outcomes when under financial pressure to deliver on the One Devon five-year forward plan
• taking local best practice often growing from local expertise and enthusiasm and spreading it across the county

We have improved by: 

• using Capacity Tracker data and ONS research to improve our understanding of demand from self-funders and how the adult social care market is meeting it
• working with district councils to better understand the take-up of social housing and housing with support by people with current or potential adult social care needs
• working with carers and their ambassadors through our Carers Partnership Steering Group to improve their outcomes, given surveys indicate they are often less satisfied, have a lower quality of life, and feel more socially isolated than the people they care for
• restructuring our commissioning team to ensure we can respond to both the strategic challenges of market development and the immediate realities of contract monitoring and quality improvement 

We are improving by: 

• targeting market development on services (for example, care homes specialising in dementia support) and geographies (for example, personal care in the South Hams) where there is lack of provision.
• working across the partnership to improve how we minimise and respond to individual crises and larger-scale incidents through more proactive ‘business as usual’ approaches. 
• working with NHS trusts to improve our understanding of the journeys of people through the health and care system and inform the planning, delivery, implementation and evaluation of system-level change, for example, through joined-up Client Level Data and pathways analysis.  
• making better use of research and best practice to inform our commissioning strategies and plans. 
• participating fully in corporate approaches to reduce spend that does not add value, for example, on agency staff or on functions that do not deliver our statutory duties. 
• working more closely with other local authorities in the system, region and beyond to cooperate in shared challenges and successes, for example, in specialist commissioning. 
• building on ‘Team Devon’ of local authorities in Devon and the housing forums we have established to deliver on our shared aspirations to improve housing options for people with care and support needs and of key workers e.g. through planning powers, the use of Section 106 funding and public sector land assets. 
• Improving our commissioning of community mental health services including undertaking and acting on a joint review of the functions we delegate through our s75 agreement with the Devon Partnership Trust.  

We plan to improve by: 

• extending co-production from examples of good practice into our default approach to service commissioning, service development, and improvement supported by a clear policy
• ensuring a stronger voice in the local health and care system responses to the forthcoming 10-year plans for health and care to ensure the Council’s adult social care priorities and plans are fully reflected

Additionally, we are responding to the recommendations of the July 2023 Peer Review regarding co-production: 

Building on existing work on coproduction will help to engage with wider communities, and to develop services (at both individual and macro-levels) that best meet their needs.

It will allow staff and system leaders to learn from those who have lived experience of using adult social care and other public services, and to develop an offer in line with what works best for local people.

It can help to build capital with those who will continue to rely on local services in the coming years, and whose support will be needed when making difficult decisions, or managing significant transformation in how services are offered. 

We have improved by: 

• collating our current use of co-production to show good practice and its benefits where it exists
• having conversations within and beyond the Council as to how to better coordinate our work with the voluntary and community sector

We are improving by: 

• publicising the opportunities of our Co-production Working Group and Commissioning Involvement Group
• reflecting on the areas of activity where more co-productive approaches have most potential to improve outcomes

We will improve by: 

• formalising our co-production offer and approach through a clear policy
• ensuring opportunities for co-production are considered at the outset of any new project or initiative 
• reviewing our policy towards the remuneration of people taking part in co-production 
• considering the representation of people with lived experience in our governance

Introduction: Ensuring safety

As professional leads, we work as a team to assure and improve the quality of practice, and develop our workforce, including in safeguarding, believing that everyone has a right to live free from abuse and neglect, and promoting the principle that safeguarding is everyone’s responsibility. In progressing our work, over the last 12 months we have:

• established a Safeguarding Governance Group, working to monitor and improve the safeguarding practice in adult social care, including through good use of data
• sustained regular reporting on safeguarding practice and learning into the Performance and Assurance Board, with professional leads also regularly meeting the Director with a focus on our safeguarding practice
• developed, implemented and started to embed our new approach to Practice Quality Assurance, including on safeguarding practice to embed the right standards and rigour
• restructured how we deliver our operational safeguarding duties, bringing together a number of teams into a single county-wide team which is more consistent in practice, improving productivity and reducing waiting times
• embarked on work to develop our processes and policies to record, respond to and learn from serious incidents
• focussed on the progression and completion of safeguarding adult reviews, providing assurance and improvement and learning through the Torbay and Devon Safeguarding Adults Partnership
• been tested in our Emergency Planning, Preparedness and Response arrangements including through major power outages in North Devon, and an outbreak of Cryptosporidium impacting the water supply in South Devon

Tina Ramage: Principal Social Worker – Operations, Integrated Adult Social Care

Carolyne Hague: Principal Occupational Therapist, Integrated Adult Social Care

Helena Riggs: Principal Social Worker for Safeguarding – Commissioning, Integrated Adult Social Care (not in photo)

Kayleigh Bradford: Head of Social Care, Mental Health (not in photo)

Evidence base: Ensuring safety

The ‘ensuring safety’ theme covers:

• Section 42 safeguarding enquiries
• reviews
• safe systems
• continuity of care

We maintain an evidence base for the ‘ensuring safety’ theme available to all staff on our SharePoint site.

As well as our repository of internal business intelligence tools and  the evidence library that feeds our information return, we also refer to independently produced evidence such as the reports produced using LGInform.

Key points to note regarding Adult Safeguarding activity:

• Recorded safeguarding activity has increased significantly, with concerns raised doubling in four years, but flattening more latterly. Activity levels are now below both the England and Peer Group averages.
• S42(2) enquiries continue to reduce with the rate per 100,00 population (18 and over) significantly below England and has dropped further compared to our new Peer Authorities.
• Consequently, the conversion rate of concerns to enquires continues to reduce and is significantly below comparators. This may also indicate lack of understanding of thresholds, but also improved triage with more concerns resolved in other ways
• Only 64% of people lacking mental capacity were recorded as receiving independent support through the safeguarding process, well below the national and comparator averages.
• More concerns relate to neglect or abuse in people’s own homes and less in care settings, and usually relating to someone known to the individual and psychological rather than physical abuse, perhaps reflecting that more providers are rated as Good or Outstanding in Devon than is typical elsewhere, including on the safety judgement.
• The characteristics of people who are the subjects of safeguarding concern regarding their gender, ethnicity and primary support reason are broadly in line with the population and/or comparator authorities.

Key points to note regarding Adult Safeguarding outcomes:

• We are broadly in line with comparators at removing or reducing risk as a result of the safeguarding process and whether people achieve the outcomes they were hoping to.
• In 2023/24, over 90% of people or their representative were asked about their desired outcomes from the safeguarding enquiry process with over 83% positively expressing these. In over 95% of enquiries these were met either in full or part. We are seeing consistency in practice with improving performance in meeting outcomes expressed in full or part.
• The ASCOF perception of safeguarding survey indicators, now no longer takes account of the impact of services on perceptions of safety and has declined but remains 3^rd quartile in 2023/24; previous focus groups on why people feel unsafe focussed on factors in their community.
• There is no discrete measure of carers’ perceptions of safety, but analysing free text commentary from the Carers Survey 2023/24, we know that carers do report concerns for their personal safety because of the person they care for, for example, dementia and alcohol related issues are noted.

Key points to note regarding Safeguarding Adults Reviews (SARs):

• The Torbay and Devon Safeguarding Adults Board received thirteen SAR Referrals in 2022/23 from seven different partner organisations and decided that three met the Care Act criteria for a review to be undertaken.
• In 2022/23 the Torbay and Devon Safeguarding Adults Partnership completed 3 SARs, two of which were published on the TDSAP website. Regarding the third, a decision was made by the TDSAP Board, not to publish due to the sensitive nature of its content.
• In 2023/24 the Torbay and Devon Safeguarding Adults Partnership published 5 safeguarding adult reviews (SARs) plus a further Multi Agency systems review following five homicides in 2018-19 was also published. During 2024-25, two more SARs plus a thematic SAR focussed on mental health and suicide were also on its website.
• Themes from recent SARs referrals have included mental health, self-neglect, substance misuse, and acts of omission.
• With all SAR reviews, the identified learning and SAR recommendations are progressed and embedded into operational practice.

Key points to note regarding Deprivation of Liberty Safeguards (DoLS) activity and outcomes:

• DoLS applications received and completed are both on a rising trend, increasing by 22.9% and 26.7% respectively in 2023/24.
• Approximately 57% of all DoLS applications now come from hospitals.
• DoLS applications completed relative to population are among the highest in our comparator group.
• Applications not completed at the end of 2023/24 totalled 3,240: up 2.7%.
• Investment to increase capacity and improve productivity has been necessary to meet rising demand.

Key points to note regarding young people in transition to adult social care services:

• 98% of young people in transition have an assessment completed or open by 17 years old, an increase of 40% in three years.
• 28.6% have a completed a ‘Your Care and Support Plan’ six weeks before turning 18.
• This means that 59% of young people do not have a ‘Your Care and Support Plan’ either completed or in process six weeks before turning 18.​

Key points of recent complaints reports include:

• The number of complaints investigated is relatively stable at between 40 and 60 a quarter.
• The majority of complaints regard care management in the Eastern locality, although that also serves the largest population.
• The issues attracting the most complaints in the last year are regarding communication issues and delays in providing services.
• Responses to complaints could be timelier, with around 60% within agreed timescales, which is an improvement on the previous year.
• In 2023/24, 94 out of 208 complaints (45%) were upheld either partially or fully.
• However, there has been a recent increase in the number escalated to the Local Government Social Care Ombudsman (LGSCO), indicating more dissatisfaction with responses, although a significantly lower proportion (55%) of those have been upheld.
• Recent focus on learning has been on those instances where the LGSCO has upheld complaints with consequences for the council.
• We tend to under report the number of compliments received by the service. In 2023/24, 232 compliments were received primarily focussed on our in-house provider services. Examples highlighting specific teams and their commendable performance include:
  • The Social Care Reablement (SCR) teams stood out for their exceptional support and care, particularly noted for aiding recovery post-hospitalisation and assisting service users in regaining independence, highlighted for their knowledgeable and supportive approach.
  • Residential Respite services like Greenfields and New Treetops within the Adult Provision teams were praised for their commitment and support.
  • Woodland Vale, a Dementia Care Home, received compliments for their attentive care, kindness, and professionalism.
  • Services like Care Direct and CHSC Exeter were recognised for their compassionate and efficient service.
  • The Autism and ADHD Service and Care Direct were acknowledged for their outstanding support.
  • Dementia Care Homes and Reaching for Independence teams were recognised for enabling service users to regain confidence and independence.
  • The Specialist Placement Team within the Integrated Adult Social Care received compliments for their hard work and patient-centred care.

We would like to highlight the following examples of good practice in ‘ensuring safety’:

• In commenting on our Torbay and Devon Safeguarding Adults Partnership Board arrangements, the July 2023 Peer Review said, “relationships between partners are reported to be strong at board level,” and “the Chair proactively works to maintain and strengthen the role of the board which appears to be fulfilling the statutory duties.”
• Regarding mitigating and manging provider risk, the July 2023 Peer Review said, “There is positive work to support providers to manage risk and improvement.”
• Regarding the supervision and improvement of safeguarding practice, the July 2023 Peer Review said, “use of your Practice Quality Review tool in safeguarding supervision practice, supported by a new Supervision Policy.”
• The July 2023 Peer Review said, “the Preparing for Adulthood Team is a positive development in supporting young people and their carers in a timely manner.”

The Safeguarding Adults Community Reference Group brings together people with lived experience of Safeguarding and Voluntary, Community and Social Enterprise (VCSE) organisations representing people with protected characteristics across Devon and Torbay. The purpose of the Group is to ensure that people with lived experience and their carers remain central to the work of the Partnership Board.

The Group aims to raise awareness of Safeguarding across the VCSE sector and the general public. CRG members provide feedback on the developments and priorities of the Board as well as gathering intelligence and raising issues on behalf of people with lived experience of Safeguarding.

In 2022/23 this included focused task and finish groups, on-line and telephone surveys and varied user led dialogue, exploring the subject of hidden harm, the importance of professional curiosity, and the impact of data on the understanding of how to support harder to reach and protected characteristic groups.

In November 2023, the Group co-produced a series of bulletins during Safeguarding Adults Raising Awareness Week covering:

• What is Safeguarding?
• Who might abuse adults?
• Hidden harm and curiosity
• Financial abuse and scams
• Modern slavery and exploitation
• Healthy relationships: tricky friends, forced marriages and bullying

Self-assessment: Ensuring safety – safe systems, pathways, and transitions

Quality statements:

• We work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured.
• We ensure continuity of care, including when people move between different services.

I statements:

• When I move between services, settings or areas, there is a plan for what happens next and who will do what, and all the practical arrangements are in place.
• I feel safe and am supported to understand and manage any risks.

Framework summary:

• Safety is a priority for everyone. There is a strong awareness of the risks to people across their care journeys. The approach to identifying and managing these risks is proactive and effective. The effectiveness of these processes is monitored and managed to keep people safe.
• Care and support is planned and organised with people, together with partners, and communities in ways that improve their safety across their care journeys and ensures continuity in care. This includes referrals, admissions and discharge, and where people are moving between services.
• The views of people who use services, partners and staff are listened to and considered.
• Policies and processes about safety are aligned with other key partners who are involved in people’s care journey to enable shared learning and drive improvement.

Through self-assessment, we have identified our key strengths as:

• supporting care providers in maintaining business continuity, with minimal rates of market exits and contract hand backs, and our 24/7 agency staffing support during the pandemic commended as a national exemplar
• having effective multi-agency and adult social care specific winter plans, governance and escalation arrangements, including out of hours
• monitoring provider risk, enabling proactive interventions where risks are emerging to avoid reactive scenarios relating to provider failure
• managing care home closures where they do occur, with a recent letter from the sister of an elderly woman with learning disabilities writing to us to thank our staff for finding what turned out to be a superior alternative in a short timescale when a provider terminated her contract for the place she had called home for 40 years
• responding to emergencies effectively, our arrangements having been tested during and since the pandemic, for example, by:
  • a major unexploded bomb being found on the boundary of a care home
  • the increasing incidence of major storms leaving many care settings and service users without power
  • a fire in a care home in South Molton requiring the re-accommodation of all residents
  • the contamination of the water supply in South Devon by Cryptosporidium 
• maintaining effective links between the on-call manager, the emergency duty service, NHS and council on-call arrangements, and national agencies such as UKHSA, all tested daily though the pandemic and subsequently during periods of industrial action and other incidents

Through self-assessment, we have identified our key challenges as:

• working corporately and in partnership to improve SEND services to children and young people and children’s social care services, both subject to Ofsted inspection, including for young people in transition to adult social care
• using our integrated operational arrangements to avoid funding disputes relating to hospital discharge, Continuing Healthcare (CHC), Section 117 aftercare (S117), and Funded Nursing Care (FNC) when council and NHS budgets are under pressure
• responding to hospital discharge pressures by making decisions that don’t always mean people receive the right support for them at that time, including the use of short-term residential placements that become long-term in bed-based care that leads to deconditioning
• monitoring services where people move in and out of area where quality assurance and case review arrangements can be less secure than those accommodated within the county

We have improved by:

• implementing our revised provider failure policy to give clarity to all stakeholders and consistency for providers
• working across the council and partnership to continually improve our approach to emergency planning, preparedness and response, learning from each incident and preparing for emerging risks such as cyber-attack

We are improving by:

• embedding the identified learning from the themes of Safeguarding Adults Reviews (including mental health, coercive control, cuckooing, and neglect including self-neglect) in a large rural and organisationally complex area
• fulfilling the promise of our corporate Disaster and Emergency Management System (DEMS) programme learning from recent emergency incidents to further improve our preparedness and response
• working across the council to develop a new approach to humanitarian assistance including the provision of rest centres and key workers
• further developing our Preparing for Adulthood service to achieve safe transitions between children’s and adult social care
• improving our monitoring of, and operational practice towards, out-of-area placements such that we ensure mutual quality assurance arrangements and regular review to keep people safe
• improving the commissioning and monitoring of our services to people with mental health needs with staff assigned and responsibilities discharged through a s75 agreement with Devon Partnership Trust
• working across the health and care system on improvements to urgent and emergency care, contributing to both hospital admissions avoidance and hospital discharge

We plan to improve by:

• being more systematic in our learning from serious incidents
• improving how we triangulate data on process and outcome with feedback from people and qualitative data from practice quality audit and other mechanisms that seek to assess and improve practice quality
• using the potential richness of complaints information to understand and address themes highlighting where we are deficient which we know is often at transitions into and between services
• working to better join up support to unpaid carers and the people they care for when these assessments and services are delivered by different organisations

Self-assessment: Ensuring safety – safeguarding

Quality statements:

• We work with people to understand what being safe means to them as well as with our partners on the best way to achieve this.
• We concentrate on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.
• We make sure we share concerns quickly and appropriately.

I statement:

• I feel safe and am supported to understand and manage any risks.

Framework summary:

• There are effective systems, processes and practices to make sure people are protected from abuse and neglect.
• Section 42 safeguarding enquiries are carried out sensitively and without delay, keeping the wishes and best interests of the person concerned at the centre. People can participate in the safeguarding process as much as they want to. 
• There is a clear understanding of the key safeguarding risks and issues in the area and a clear, resourced strategic plan to address them.
• Lessons are learned when people have experienced serious abuse or neglect, and action is taken to remove future risks and drive best practice
• People are supported to understand safeguarding, what being safe means to them, and how to raise concerns when they don’t feel safe, or they have concerns about the safety of other people.
• People are supported to make choices that balance risks with positive choice and control in their lives.
• People are supported to understand their rights, including their human rights, rights under the Mental Capacity Act 2005 and their rights under the Equality Act 2010.

Through self-assessment, we have identified our key strengths as:

• having effective Safeguarding Adults Partnership and Board arrangements across Devon and Torbay, with joint working between the Boards for adults and children, and a range of sub-groups focussed on the priorities of the business plan
• working with a Community Reference Group and other feedback arrangements to ensure we learn from people’s lived experience and take a co-productive approach to improvement
• using a range of quantitative and qualitative data such as Making Safeguarding Personal and statutory surveys to inform priorities, with examples of resulting improvements
• commissioning safeguarding training jointly, aligned to the partnership competency framework defining appropriate training based on role within the organisation and across the partnership, for example, 3-tier domestic abuse training package delivered by a partnership of three of Devon’s specialist third sector domestic abuse organisations with a focus on hidden harm
• developing overarching safeguarding practice guidance in partnership, including specific guidance on:
  • when to raise a safeguarding concern
  • safeguarding for organisations that undertake the management of medicines
  • the relationship between falls prevention and safeguarding
• embedding the National Friends Against Scams e-Learning initiative as part of our Level 1 Safeguarding Adult training offer for practitioners to address the noted increase in such scams during the pandemic
• using data analysis to inform and deliver improvement, including through an annual deep dive into published data yielding insights that led to action and improvement, with rates of concern and enquiry now similar to comparators, as are the outcomes achieved under Making Safeguarding Personal
• maintaining the comparatively high quality of regulated services in Devon, with a greater proportion being rated Good or Outstanding by the Care Quality Commission than is typical regionally or nationally and in particular with regard to assessments of their safety
• maintaining sound multi-agency policy, guidance, process, and training with a new policy in place to address serious incidents
• taking a partnership approach to whole service safeguarding incorporating and continuously learning from provider feedback

Through self-assessment, we have identified our key challenges as:

• ensuring leaders from across the council and its partners are well sighted on and committed to addressing adult safeguarding challenges and improving practice when child protection has greater prominence
• reinvigorating our approach to the quality assurance of safeguarding practice to inform our improvement activity, building on our relaunch of Practice Quality Assurance across care management
• embedding our reorganisation of safeguarding arrangements in the council, with a more centralised approach designed to deliver greater consistency of practice, better management of risk, and more responsive resolution of concerns
• ensuring consistent uptake of safeguarding training, including through improved monitoring of learning and development individually and in aggregate
• exploring our comparatively low conversion rate of concerns into enquiries and differential activity between localities by understanding whether they are driven solely by differences in population, services, and risk or result from inconsistent application of the Section 42(1) legal criteria

We have improved by:

• improving our internal safeguarding operational guidance by building on the published partnership guidance
• using our Safeguarding Governance Group to determine and deliver improvements to safeguarding arrangements and performance within the Council

We are improving by:

• building on the use of our Community Reference Group of people with lived experience of safeguarding processes by ensuring those with protected characteristics who may not achieve equality of access, experience or outcomes are represented
• continuing the work of our Safeguarding Governance Group and ensuring that through reinvigorating Practice Quality Assurance it is informed by qualitative as well as quantitative information
• focussing on the strategic priorities determined by our Torbay and Devon Safeguarding Adults Partnership Board such 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

We plan to improve by:

• further developing our assurance of safeguarding practice through a review of tools, take-up and reporting with consequent improvement planning and delivery
• undertaking a Rapid Improvement Process within our safeguarding practice focussed on waiting list management, risk assessment and triaging, allocation of concerns and enquiries, and recording requirements
• focussing on waiting list management, risk assessment, triaging, and work allocation

Summary: What we are proud of and concerned about

We can be proud of our:

• performance in the Adult Social Care Outcomes Framework, with 14 of the 22 indicators relating to 2023-24 so far published ranking in the top two quartiles, and generally improving trends, with aspects where we perform less well informing our priorities for improvement
• overall satisfaction ratings for service users being among the best in the country, ranking 4/152, with key indicators relating to ‘promoting independence’ such as control over daily life, quality of life, and minimising the use of care home placements also being high ranking
• provider quality ratings in Devon consistently exceeding the national, regional and comparator authority averages with a greater proportion of community-based services and care homes in Devon rated Good or Outstanding by the Care Quality Commission than is typical elsewhere
• staff and providers being nominated for and winning many national and regional awards in recent years, including Gold and Silver Awards in the National Social Worker of the Year in 2023, a Chief Allied Health Professionals Gold Award for Excellence in 2024, and several national citations of good practice
• working with providers and their recruitment to secure sufficiency of regulated personal care when in the aftermath of the pandemic we were unable to source up to 6,000 hours each week, now reduced to consistently around 800 hours per week, with contingencies in place to keep people safe
• proven record in mitigating and responding to risks and emergencies, including avoiding and managing provider failure, responding well to multiple major incidents in recent years, and having sound out of hours arrangements
• open and honest approach to involving stakeholders in the production of an annual self-assessment which we have consistently taken through Scrutiny and Cabinet and published as an annual report, with governance through a Performance and Assurance Board that invites external challenge and support

We are concerned about:

• minimising waiting times for assessments and reviews, for financial assessment, and for DoLS assessments with our own capacity constrained, demand increasing, and people’s circumstances changing more frequently, although triage and allocation is risk based with contingencies in place to keep people safe
• managing hospital discharge and system flow, with delays sometimes due to lack of capacity in community-based health and care services leading to an over-reliance on bed-based intermediate care, which can mean people don’t get the right support at the right place at the right time to optimise their recovery
• sustaining and supporting staff wellbeing and resilience, particularly during periods of change, and when there are increased demands on capacity, whilst maintaining our comparatively low vacancy and turnover rates and low use of agency staff
• ensuring the consistency and responsiveness of safeguarding practice through a changed operating model, such that decision-making and thresholds are comparable across localities, and learning from Safeguarding Adults Reviews and other Serious Incidents is embedded in practice
• working across the council and its partners to address the social isolation of carers, with its impact on their wellbeing highlighted in recent surveys as being of particular concern, especially in rural areas, despite survey data indicating higher than average access to carers’ breaks
• managing demand, with the cost-of-living crisis impacting on people who use our services, their carers and people who might become vulnerable, and activity levels of people aged 18-64 higher in Devon than elsewhere, with particular pressures through transition from children’s services
• managing costs, with wage and utility price pressures threatening the viability of our providers, and fee levels rising more rapidly than is typical, especially for services to older people, both residential and community based, when council budgets are not rising in line with inflation in the care market

The challenges ahead include:

• living up to the vision that people should be supported to live their best possible life in the place they call home, with the people and things they love, in communities where people look out for each other, doing what matters to them to be independent, informed, secure, and connected   
• realising that vision by delivering on our ‘Promoting Independence’ policy framework and ‘Living Well’, ‘Ageing Well’, and ‘Caring Well’ strategies including maintaining people at home and not in hospital or a care home wherever possible
• improving our productivity, including through implementing a new care management system, and reviewing and redesigning our operating model to deploy our capacity and capability more effectively and reduce waiting lists and waiting times
• maintaining financial sustainability when our budget, while increasing remains under pressure from rising demand, increasing costs, insufficient supply, cost of living pressures, and falling council income with these constraints likely to continue for the foreseeable future
• supporting flow through the health and care system, especially during winter when we are facing outbreaks of infectious diseases while meeting pent-up demand for NHS services, continuing to improve our approaches to transitions between services, local authorities and providers when risks of failure can be at their greatest
• recruiting, retaining, and developing sufficient staff in the council and across the sector to deliver on our statutory duties and maintain sufficient, diverse, and high-quality services including working with providers to innovate new services 
• strengthening our governance in line with a corporate review and building on the changes we have made to the governance of assurance and change in adult social care, while responding to changes in government policy and the prospect of local government reorganisation and devolution 

If you want more information on the content of this self-assessment or have any questions please contact adultsc.adultcarereform-mailbox@devon.gov.uk.