Our self-assessment of adult social care in Devon 2025

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 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:

• Worked with the new council to ensure that adult social care is central to our shared vision, values, and strategy through member induction and ongoing engagement, with supporting people to live independently and with dignity recognised as a priority.
• Reset the priorities for our directorate to be explicit in our focus on reducing waiting times, finding local solutions that promote independence, consistently delivering best practice, and working within our budget — demonstrating a golden thread to the overarching priorities of the Council.
• Aligned our budget, and redesigned and restructured parts of the Directorate, investing in and recruiting new leaders to support the delivery of our priorities.
• Engaged across the Council on our redesign through our ‘One Council’ approach to corporate governance and staff development, embedding a reflective and ambitious culture.
• Developed and delivered a programme of ongoing staff surveying, engagement and events to ensure we are visible, accessible, and influenced by staff at all levels—hearing their voices and co-producing our culture, values, and approaches to innovation.
• Made better use of customer feedback to shape our work, including improving insights from those with protected characteristics.
• Co-produced our Practice Standards and Values under the leadership of our Principal Professionals, working to ensure consistency of practice and continual learning — now being built 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 care management practice through the development of team managers and frontline staff, with sustained impact on service timeliness.
• Continued our investment in the voluntary and community sector to support resilient communities in line with our promoting independence approach.
• Finalised procurement of a case management system, now being implemented across adults’ and children’s social care to modernise services, improve productivity, and facilitate better joint working.
• Ensured the Health and Care Scrutiny Committee’s work programme 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 focus on all protected characteristics, seeking independent feedback through 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 South West workforce group, Policy Lead for the Fair Pay Agreement and chairing the National Commissioning Network. In the Executive Leadership Group she is Sponsor for Learning in the People Strategy and People Lead for Local Government Reorganisation

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 more variable, particularly their quality of life impacted by social isolation due to rurality, but their overall satisfaction with social services has consistently been in the top third of local authority areas since the pandemic.

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

• Devon has 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.

A corporate wide People Strategy was launched in September 2023, with the aim of providing a framework to embed a positive culture with a key focus on the quality of our relationships across the workforce, ensuring that the workforce had the right skills, attitudes and behaviours.  It’s Action Plan was structured around 6 key themes:

• Voice: To create an effective ongoing dialogue between leaders and the wider workforce, to engage, listen to and gain clarity about what is important to them.
• Recruitment: To attract and retain an agile and flexible workforce with the knowledge, experience, and behaviours to make Devon the Best Place to live and work, to achieve our organisational priorities.
• Belonging: To have an inclusive culture that celebrates diversity, where everyone can feel safe, well and able to be themselves.
• Wellbeing: To provide a safe, stable and sustainable working environment with wellbeing at the heart of everything we do.
• Learning: To be an organisation that learns and is committed to developing its workforce through a variety of opportunities.
• Reward: To offer a reward package that is flexible, equitable, and transparent to provide benefits to our workforce, by connecting them to what they value.

Some key actions taken in relation to this and in response to recent Integrated Adult Social Care staff surveys include:

• 11 council events for managers with over 700 attendees to be clear about expectations, develop resilience and people management skills, and give feedback about the People Survey to gain insight from managers about next steps to improve workforce culture
• Directorate staff conferences held in March 2024 and October 2024 and planned for September 2025
• 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 the Employer Standards Social Work Health Check in 2025 following directorate staff surveys in 2023 and a corporate staff survey in 2024

The Integrated Adult Social Care (IASC) workforce response to the People Survey 2024 was 34%. This response rate had increased significantly from 2022 which was 16%.  The majority of the IASC workforce is distributed and the response rates varied by function. We received less responses from those in our in-house provision and assigned to the Devon Partnership Trust, feedback suggesting that the latter being due to IT access issues.   

45% of respondents described their feelings about work as either good or very good and 55% of respondents want to remain working for Devon County Council for the foreseeable future.   63% of respondents feel valued and recognised at work and 96% experienced kindness in their team.

We explored this further at a staff conference asking 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’,  feedback included that we have:

• A culture that is open to change and new ideas
• Supportive colleagues, which makes people feel heard and valued and feeling they can influence change
• People who feel connected and safe, they can work flexibly and with autonomy
• A real sense of being able to contribute and improve people’s lives in the communities that staff live in and belong to
• Good flexibility and hybrid working opportunities and terms and conditions of employment
• Highly valued career development opportunities such as secondments and supervising students
• Ways of recognising colleagues
• Supportive senior managers and leaders who contribute to a positive work environment
• The opportunity to make a difference to people’s lives is a significant motivation
• Opportunities to learn, grow, and gain more responsibilities
• Feeling that we are all on a journey of continuous improvement

What staff said about the positive impact of the staff conference

“New connections means I have a name and a face for future discussions. The workshops helped me understand more areas of IASC and see the wider picture of adult social care. The (staff) survey discussions made me feel heard and positive about the future at DCC.”

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 workplace issues 
• Provide more career progression opportunities for social workers, with better support for new and aspiring managers currently in frontline roles
• Give more time and training 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
• Support managers to address underperformance and capability issues more effectively
• Consistently recognise the skill, knowledge and professional judgement and autonomy of staff
• Have a better understanding of work life balance
• Improve HR related processes e.g. pay equal with other sectors, and a voluntary redundancy policy in any areas where staff numbers are being reduced

We have sought to improve by:

• Increasing awareness of staff conduct and how to respond to complaints:
  • Integrated Adult Social Care (IASC) Newsletter now includes 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 are now collectively on a single Inside Devon web page.
  • Members of IASC Leadership Team have added these links to email signatures.
• Focussing more on the experience of our assigned workforce’s experience of ICT:
  • New Head of Social Work for Devon Partnership Trust (DPT) and the Council (joint role) is reviewing the assigned workforce’s experience and challenges of ICT whilst working across two employers. 
  • Early actions include supplying them with Council laptops and giving them all full access to the Care Management system.
• Expanding career development opportunities:

• Manager and aspiring manager learning and development support remains a priority for the organisation with a DCC candidate accepted onto each of the last three cohorts on the ADASS Accelerate Programme.
• Further learning and development opportunities are available through the Leadership Development Programmes launching autumn 2025.
• 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.
• Commissioning Academy programme of training modules, launching with a full day event in September 2025.
• Council wide workforce planning programme launching in autumn 2025.
• 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.

Danu Crawley, Newly Qualified Social Worker, Autism and ADHD Team

“My ASYE year has been transformational — powerful training, real peer support, and the trust to make a difference. I’ve built strong foundations to grow as a reflective, insightful practitioner, and I know I’ve already helped change lives.”

We have undertaken the 2025 Employer Standards Healthcheck to understand this feedback in more detail specific to adult social care and are discussing the results and how we collectively act on them at a staff conference in September.

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

• 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.
• Carolyne has since been awarded the MBE for services to occupational therapy in adult social care for her work as Chair of the Principal OT Network, supporting the development and delivery of the first OT degree apprenticeship.

Carolyne Hague MBE , Principal Occupational Therapist

“This award gives me and every occupational therapist a louder voice and influence to have even more impact locally, regionally and nationally. That means so much more to me than the personal recognition.”

• 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 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.
• 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.

Jacqui Hendra BEM, Social Care Assessor, Ivybridge and Kingsbridge Community Team, for services to people with disabilities.

“I’m honoured to be recognised, and it was such a big surprise. I really had no idea I had even been nominated! I’m dedicated to supporting adults with disabilities to live their very best life.”

• Successfully securing a candidate on each of the last three cohorts of the ADASS Accelerate leadership programme.
• 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 December 2022, a House of Lords report recognised the work our Involvement Team are doing in co-production.
• Lucy Hunt (Team Manager Newton Abbot Community Health and Social Care Team) won the 2022 Social Worker of the Year Team Manager award.

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
• What would improve the customer experience in using the council’s various access channels
• What practical steps the council could take to improve its engagement with customers
• What 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
• Provide 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 any prior knowledge in describing what to expect

Through 2024 and 2025 we have continued to seek the views of people who use services and their representative organisations to guide the further improvement of 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 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 from approximately 20,000 people we dealt with that year, 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 6 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. 

232 compliments were received and recorded in 2023/24, primarily by teams providing direct support to service users, e.g. 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 e.g. 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.

Our draft report for 2024/25 has recently been reviewed and will be published shortly. Provisional headlines include:

• 174 complaints were investigated by Devon County Council with levels consistent over the last four years.
• 40 of these were partially or fully upheld, mainly regarding the quality or consistency of care provision, maintaining timely communications, and the timeliness of response
• 21 complaints were investigated by the Local Government Social Care Ombudsman with the Council being at fault in 10 instances
• 222 compliments were recorded as having been received, the most numerous being for our Social Care Reablement Service

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.  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 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.

In June 2025, the Community Services Co-production Group hosted a relaunch event to explore key themes such as strengths-based working, the role of the VCSE sector, carers and replacement care, and mental health support. Feedback from this event is being used to shape the next steps in the commissioning process

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 Adult Social Care Outcomes Framework indicators currently in the top two quartiles nationally — especially those linked to promoting independence.
• Performing particularly well in indicators that reflect people’s positivity about their lives and the impact of services, including overall satisfaction, quality of life, and quality of services.
• Being stimulated by fresh ideas and approaches brought in through external appointments of a Chief Executive, Director of Adult Social Services, Deputy Director of Operations, and a new political administration — supported by an experienced senior leadership team.
• Implementing a ‘One Council’ and ‘Team Devon’ approach to governance, performance management, and delivery — leading to closer collaboration with Public Health on prevention, stronger partnerships with District Councils on housing, and wider organisational involvement in changes to our ‘front door’ arrangements.
• Involving members of the new council in cross-party working, reviewing governance arrangements to make political working more inclusive, with a clear line of sight and golden thread to the impact of services on people’s lives in their communities.
• Embedding our corporate and directorate performance framework and governance, bringing together qualitative and quantitative data to support learning and improvement — linked to sub-groups focused on practice quality, safeguarding, provider quality, and service improvement.
• Sustaining integrated operational leadership and management over 17 years, directing co-located and co-managed frontline staff focused on the health and care needs of their local populations and working together at case level.
• Having a well-coordinated and robust scrutiny committee, with a joined-up focus across adult social care, public health, and the NHS—supported by an Independent Special Adviser to help the Health and Adult Care Scrutiny Committee focus on the right areas and ask the right questions.
• Having mature and nationally recognised capabilities in data use, risk management, co-production, and emergency planning, preparedness, and response.

“Integrated Adult Social Care, Public Health and the Integrated Care Board provide a single update report to each scrutiny which moves towards creating a shared view of the system. Its open nature as a report promotes responsibility and collaboration towards shared outcomes.”

Peter Hay CBE, Independent Special Adviser to the Health and Adult Social Care Committee and former president of the Association of Directors for Adult Social Care

Through Self-Assessment, we have identified our key challenges as:

• Working with members of the new Council, including those in key roles, to harness their ideas and energy to catalyse further improvement through a culture of cross-party working.
• Addressing financial sustainability, building on our experience of identifying and delivering efficiencies without adversely affecting how we meet our Care Act duties.
• Maintaining effective strategic partnerships with the NHS, District Councils, and other statutory partners amid national and local financial pressures, performance challenges, and leadership changes.
• Progressing our vision and strategies through realistic and prioritised implementation plans, despite constrained finances.
• Maintaining sufficient staff capacity, productivity and connectivity to consistently respond to people in a timely and effective way—minimising waiting times and lists, ensuring people are ‘waiting well’, and delivering reviews consistently.
• Understanding and responding to carers who report that their quality of life is limited by social isolation, particularly in rural and coastal communities.

We have improved by:

• Embedding arrangements for strategic governance of assurance, budget, and improvement—recognised as robust in the July 2023 Peer Review.
• Forming appropriately led and resourced groups focused on delivering improvements in financial sustainability, practice quality, effective workflow, safeguarding, and care management.
• Increasing the volume and impact of practice quality reviews, informed by values-based practice standards and applied to all those undertaking Care Act assessments and reviews—including external partners such as Devon Carers and the Devon Partnership Trust.
• Using insights from data analysis of trends and benchmarking to inform our medium-term financial strategy and prioritise improvement 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 findings and agreeing actions with staff and stakeholders — focusing on being more approachable and engaging, with greater emphasis on face-to-face interaction through staff conferences, extended leadership sessions, local team visits, and regular webinars and online catch-ups.
• Further embedding changes to corporate and directorate governance, with our new council strategy supported by a Corporate Performance Framework and continued use of Integrated Adult Social Care Boards for Budget, Performance, and Improvement.
• Completing our Local Government Association Adult Social Care Peer Challenge in July 2023, delivering on the resulting action plan, and preparing for a Corporate Peer Challenge in Spring 2026.
• Ensuring our internal and external workforce strategies are fit for a changing labour market, with Skills for Care inviting Devon to contribute to national workforce strategy development in recognition of our local innovation and leadership.
• Refreshing our Market Position Statement, clearly setting out our commissioning intentions for providers and stakeholders — shaped by ongoing dialogue through our Provider Engagement Network and Joint Engagement Forum.
• Ensuring a strong adult social care presence in the Council’s submission on Local Government Reorganisation and Devolution — working with other councils in the County Council Network and Newton Impact to better understand need and spending patterns.

We plan to improve by:

• Finding better ways to use qualitative and quantitative information to evaluate and improve equality of access, experience, and outcomes — broadening our approach to listening to seldom-heard groups and addressing inequalities, building on our Race Equality Programme and other targeted initiatives.
• Further developing our improvement programme, prioritising and scheduling activity emerging from financial sustainability, strategy development, and assurance work into a sequenced medium-term plan — supported by a new Directorate Leadership Group post focused on this agenda.
• Shifting focus from annual budget planning to a five-year medium-term financial plan with clear long-term targets, anticipating future local government financial settlements.
• Taking a more corporate approach to assurance, led by the new Performance and Partnerships Directorate and supported by the Corporate Performance Framework aligned to the Council’s Strategic Plan.
• Getting more grip on escalating demand and costs, particularly in areas where growth exceeds that of comparator authorities and is a root cause of financial pressure — building on our track record of delivering savings while maintaining and improving service quality.
• Working across the sector locally and nationally to determine and implement the government’s plans for a National Care Service.

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, and improvement work (for instance around waiting lists or practice).

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, recognising changing priorities through a cyclical process of reflection and review—updating our Directorate’s business plan within a corporate framework.
• Updating our vision and strategies to provide a clear framework for transformation.
• Focusing on financial sustainability, CQC assurance, and service recovery as key priorities for 2023/24.

We are improving by:

• Prioritising practice quality, improving services in response to user feedback, and maintaining financial and market sustainability in 2024/25 and reducing waiting times, finding local solutions that promote independence and consistently delivering best practice in 2025/26.
• Rescheduling our transformation programme, and allocating resources accordingly to reflect changing priorities.
• Reporting on progress through our online Self-Assessment, which now serves as our Annual Report.

We will improve by:

• Publishing a summary of our transformation programme, and maintaining alignment with our Improvement Plan, Medium Term Financial Strategy, and the Council’s new strategy and plans — delivered through corporate governance.

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 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, and recently highlighted by Partners in Care and Health as good practice.
• Using data and analytical tools effectively, with best practice in this area recently recognised by the Department of Health and Social Care in its Care Data Matters report, and with team members active in regional and national roles and groups.
• Informing budget setting through a comprehensive annual exercise, analysing trends and benchmarking in activity, cost, and spend — extending the Local Government Association’s Use of Resources and Better Lives approaches.
• Exemplifying how data and evidence drive improvement, with safeguarding performance moving from outlier status five years ago to now being broadly in line with comparator authorities.
• Bringing focus to and acting on pressing priorities, such as addressing insufficiency in the personal care market post-pandemic — through increased rates and system-wide efforts on recruitment and retention, including international recruitment.
• Identifying, mitigating, and managing risks in a complex environment, strategically, tactically, and operationally — with examples of impact noted by the Local Government Association in our 2023 Peer Review.
• Using our ‘Unleashing Potential’ programme to grow and develop our workforce, maintaining comparatively low vacancy and turnover rates for social workers and occupational therapists — supported by apprenticeships at all levels and defined career pathways.
• Introducing a co-produced set of values, which inform our standards for practice quality assurance, supervision, and appraisal — with one value chosen each month for particular focus.
• Involving people through mature co-production arrangements, valued by both the organisation and those who use services and their carers — with best practice highlighted by a recent House of Lords report and the July 2023 Peer Review.
• Demonstrating consistent success in regional and national awards schemes, including recognition in Social Worker of the Year.

Through Self-Assessment, we have identified our key challenges as:

• Having sufficient capacity to deliver our improvement aspirations, given recent vacancy management, budget reductions, 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, such as safeguarding conversion rates and assessment waiting times.
• Acting more consistently on insights from data analysis, for example, the Local Government Association recently noted that while we have long identified the issue of working-age adults with lower-level needs receiving long-term support rather than being enabled to live independently, we have not yet fully addressed it. Recent focused review work has reduced activity levels, with more people moving away from long-term support. We are now working to understand how these changes are improving independence.
• Turning strategic intent into delivery and impact, particularly in shifting resources from long-term support to prevention and early intervention — despite constrained and pressured budgets.
• Making whole-system improvements in a complex partnership environment, such as working with eight district and city councils on housing, and four NHS acute hospital settings to improve system flow and hospital discharge.
• Maintaining focus on improvement while the Council undergoes Local Government Reorganisation and the Integrated Care Board experiences significant restructuring.

We have improved by:

• Participating in sector-led improvement, including inviting a team of peers into Devon to assess adult social care services — while several leadership colleagues have contributed to peer reviews elsewhere and taken part in ADASS leadership development programmes.
• Having senior leaders and managers active at regional and national levels, making a difference through ADASS and other networks — sharing and learning from best practice, with recognition through national award schemes and secondments.
• Taking a more corporate approach to governance, delivery and improvement, involving colleagues from across the council in tackling shared challenges — including closer collaboration with Public Health on our common prevention agenda.
• Delivering on our Race Equality Action Plan, with progress positively recognised by staff in our most recent Leadership Survey.

We are improving by:

• Improving our use of qualitative information, especially by distilling stakeholder feedback into actionable intelligence.
• Reinvigorating practice and provider quality assurance, to give senior leaders and members a clear line of sight to the frontline and drive continuous improvement cycles.
• Using performance management and 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 with team managers to address differences in productivity and impact — setting and achieving workflow expectations so that all localities and teams perform to the required standard.
• Taking forward recommendations and agreed actions from CQC assurance, Peer Challenge, Sector-Led Improvement, and commissioned support from the LGA and IPC into our change programme.
• Further improving our reporting of complaints and compliments, making it more contemporary and focused on thematic analysis — identifying, monitoring, and evaluating actions taken.
• Accelerating the digitisation of providers and use of Technology Enabled Care Services, in a market dominated by small and medium-sized providers — building on strong progress through our local implementation of the national Digitising Social Care programme.
• Working with children’s services on improvements to support young people with Special Educational Needs and Disabilities, reduce the number Not in Education, Employment or Training (NEET), and improve transitions from children’s to adult social care.

We plan to improve by:

• Being more consistent in the understanding and use of national research and best practice, drawing on resources from SCIE, NICE, the King’s Fund, and our membership of Research in Practice for Adults.
• Encouraging innovation across the system, including among providers — recognising that good practice can be difficult to identify, develop, and sustain in a large rural authority area.
• Being more outward-looking in improving services, particularly where outcomes are less than Good—such as the quality of life for unpaid carers — by learning from similar councils that perform better and using reports from organisations like the Care Quality Commission and 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 and CQC assessment, involving a range of stakeholder groups.
• Building in a wide range of feedback, including a leadership survey, staff surveys, surveys of service users and carers, and stories about service users, services, and staff — including recent award winners.
• Updating the format and content of our Self-Assessment, in response to LGA feedback and updated data.

We are improving by:

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

We will improve by:

• Improving the reporting of compliments and comments, delivered through our corporate Customer Relations Team to be more analytical of themes and action focussed.

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 over 17 years we have operated in joint teams with NHS provider organisations, working in local neighbourhoods, 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 and connect 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, refreshing our vision and strategy, and using our three conversations model to focus on strengths and the person themselves.
• Co-produced an updated website, adding more self-help tools and changing our front door arrangements so people receive expert information and advice at first contact—including self-funders and those without eligible needs.
• Reshaped our Reaching for Independence Team, ensuring interventions are designed to prevent, delay, and reduce need, with greater effectiveness and reach.
• Further embedded good practice around legal literacy and leadership, through collaborative Learning Together events.
• Focused on reducing waiting times and managing risks for those waiting, particularly for assessment and review—with demonstrable progress in improving productivity and communication.
• Embedded our Practice Values and Standards, supporting the right culture across everything we do and forming the foundation of our approach to practice quality assurance.
• Worked more strategically across the council, including with Public Health, in redesigning a One Council approach to prevention.
• Maintained our commitment to investing in the VCSE, through grants and continued partnership with Devon Carers.
• Relaunched our equalities programme to be more outward focussed and mindful of all of the seldom heard groups and communities in Devon including those isolated through rurality.

Amy Howard, Deputy Director of Integrated Adult Social Care (Operations)

Amy joined Devon in May 2025 and is a HCPC registered Occupational Therapist with extensive senior operational leadership across Adult Social Care; she is the Royal College of Occupational Therapy’s National Network Lead for Social Care and a member of the national LGA/ADASS Community of Practice for Prevention.

Amy is responsible for the operational delivery of Integrated Adult Social Care in Devon. Several members of her team work in joint agency integrated roles overseeing community-based health and care services, 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 fewer people aged 65 and over relative to our population than is typical.
• Care home fees and those for community-based services are continuing to rise but increases are now more typical to elsewhere, but fees remain above comparator averages.
• The use of pathways into care homes on discharge from hospital has stabilised, with the proportion of older people having their needs met by care homes rather than at home now marginally below the national average and typical to the Peer Group and regional comparator averages.
• 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:

• We have put in place feedback loops, including ‘mystery shopper’ activity to identify and implement changes to our ‘front door’ arrangements which have improved people’s experience with subsequent positive feedback.
• Working groups have been established and are exploring the use of AI webchat within our Care Direct Plus (CDP) Centres as a means of extending digital accessibility for individuals who self-refer, family and friends; and other health and care professional.
• 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.  We are managing demand by encouraging a strengths based approach to equipment through the Independent Living Centre with c.a. 95% of people making contact taking the advice and finding or sourcing their own solution.

• We are continuing to promote TEC solutions through empowering lives model, enabling services and a TEC test of change.

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 better regarding our aspiration that at least 90% of people receive the services in their support plan within 28 days following assessment, although we are currently below target at around 85%.
• Around 43% 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 though our Leading and Managing Effective Workflow (LMEW) programme.

Key points to note regarding our support to carers:

• As of 10 August 2025, there were 108 carers waiting for an assessment, with a median wait of 10 days and a current maximum wait of 30 days.
• We have implemented Carers Practice Standards, which have increased practice quality resulting in a significant increase in unpaid carers being identified (c.a. 1,000 additional carers over the last year).
• We have also launched a Carers Champions Group to raise awareness of unpaid carers.
• 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 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 Section 75 Adult Mental Health Partnership Agreement is provided by a Partnership Board chaired by the Head of Social Work and comprising key colleagues from the Trust and Local Authority, including finance and performance professionals.

The Trust was subject to a cyber-attack during 2022/23 and as part of its recovery implemented a new IT system and processes.  To enable a full view of the social care pathway on a single system, we are now moving all mental health data relating to adult social care onto our care management system (CareFirst).  This will better support the implementation of the revised performance framework.

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 relating to older people, people with a learning or physical disability; and autism was rated most highly..
• 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.
• 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.

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.

In the 12 months to 31 July 2025:

• 673 Practice Quality Reviews for Care Act Assessments were submitted, our target being 50 per month.
• The average score for Care Act Assessments was 82.%, an improving trend.
• Scores among staff assigned to the Devon Partnership Trust averaged 75.%.
• We have launched a PQR process for Section 42 Enquiries which aligns with our safeguarding practice standard: 79 completed with an average of 86% score.
• We are able to use learning from Practice Quality Reviews (PQR) to shape our quarterly staff ‘Learning together’ sessions, our learning and development programme and communications to staff ensuring we respond quickly to practice improvements and optimise learning opportunities.

Key points to note regarding our own workforce:

• Turnover rate is currently 7.5% and stable, but higher for Occupational Therapists than other groups.
• Sickness absence rates rose during the pandemic but 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, 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.  A workforce planning initiative is being launched with the People and Culture directorate in autumn 2025 to start to tackle this.

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 145/152 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 significant reduction in average waiting times. 
• Following assessment, we aspire to have 90% of services identified in Care and Support Plans in place within 28 days. 
• 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. ​
• Our ‘Leading and Managing Effective Workflow’ initiative has improved consistency of practice as well as productivity, with rollout team by team now completed, and sustained evidence of improvements in waiting lists and waiting times.

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

• In 2024, our Independent Living Centre hosted an interactive smart house event – offering the opportunity for public and professionals to observe, try and showcase a wide range of equipment and technology enabled care on the market today to promote independence in our purpose built environment.
• 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 to ensure monitoring of progress is informed by qualitative studies.

We commissioned an independent review of our key policies by Devon Communities Together, from the perspective of people who live in isolated rural or deprived communities to test whether they present any barriers to equality of access, experience and outcome. As a result of this we are building into our on-going and business as usual review and updating of staff guidance looking through the lens of rurality.

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 are using opportunities to work more closely  with the VCSE including:

• Deploying Rural Community Connectors: An expanded role for the VCSE in signposting and connecting rural communities to prevention/promoting independence/ IASC support.
• Working better in partnership with Anchor Institutions e.g. on housing, digital and connectivity, learning and skills. Incorporating IASC policy links.
• Using Local Care Partnerships and the VSCE engagement in these as an opportunity, e.g. aligning social prescribing across the system.
• Helping us to understand the gaps in service provision, and where they are. VCSE organisations could support a response e.g. to support hospital discharge, befriending, transport, advocacy.
• Collaborating with the VCSE Assembly Digital Inclusion Group to promote the newly developed Devon Digital Skills Framework to carers.
• Supporting retention of  community assets, such as village halls, and organisations and drawing on these to support rural and remote communities
• Repurposing council assets where appropriate to make these available for communities to develop assets to meet particular identified needs  (e.g. Tumbly Hill development as a Dementia Meeting Centre)
• Assessing equality of access to activities for children and young people
• Using their support in 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 and 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 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 adult social care 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. This was remarked upon in the July 2023 Peer Review and recent health and care engagement events.
• Using co-production to improve our information and advice, ‘front door’, and assessment processes, including their continuing monitoring and review.
• Seeking and acting on feedback from representative users of services, their carers, and voice organisations to fine-tune arrangements for responsiveness and effectiveness.
• Maintaining our commitment to co-located and co-managed integrated health and care teams, embedded in communities through 15 years of organisational and personnel changes.

The Torbay and South Devon NHS People Partner Award was presented to the Adult Social Care (ASC) Team of the Coastal Community Health and Social Care Team. Joe Teape, Chief Executive of Torbay and South Devon NHS Foundation Trust, said:

 “Going the extra mile to care — the Coastal ASC team embodies the power of partnership, compassion, and quiet excellence behind every NHS success.”

• Showing generally positive trends in Adult Social Care Outcomes Framework indicators, especially around satisfaction, quality of life, and promoting independence.
• Transforming our approach to person-led reviews by increasing quality and frequency through targeted programmes for those who may benefit most.
• Using enabling services such as Reaching for Independence — a service attracting more compliments than any other, with a positive impact on lives.

Social Care Reablement recipient

“Thanks to the team’s outstanding care, I’ve turned a corner in my recovery since returning home from hospital. Their skill and support gave me confidence when I needed it most.”

• Increasing choice and control through self-directed support, focusing where it makes the most difference and improving market sufficiency despite rural constraints.
• Using quantitative information to understand and improve performance, with tools supporting strategic, tactical, and operational decision-making.
• Using triage and dynamic risk assessment to focus limited staff capacity on those with the most pressing needs or greatest risk.
• Listening to feedback from those transitioning to adulthood, collaborating with children’s services and partners to develop our Transitions to Adult Social Care service.

Through Self-Assessment, we have identified our key challenges as:

• Continuing to reduce waiting lists and waiting times for assessment, review, and DoLS assessments through our Leading and Managing Effective Workflow Programme.

Team managers’ feedback from the Leading and Managing Effective Workflows training:

“Just brilliant to have had management training for team managers.”

“Really appreciate at last we have consistent message for work allocation expectations.”

“Knowing how to use PowerBI and check activity is a game changer.”

“This has felt like protected time, an investment in us as managers.”

• Working with Client Finance Services to deliver their improvement plan — aiming to reduce waiting lists and times for financial assessments so people can plan their finances in an informed and timely way.
• Implementing a new care management system and using its capabilities to drive improvements in practice and outcomes.
• 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 that is consistent, effective, and targeted to maximise independence before assessing and meeting any long-term needs.
• Being consistent in our home first approach — ensuring the right care reaches the right people at the right time to avoid inappropriate care home placements, particularly following hospital discharge where short-term placements are too often extended.
• Improving how we support unpaid carers by recognising the detrimental impacts of social isolation and addressing them in practice, including through respite and replacement care.

We have improved by:

• Improving our front door arrangements by shifting from a three- to two-tier operating model to reduce hand-offs and ensure people speak to those with the right expertise sooner. This has been shaped through co-production and regular feedback, including ‘mystery shopper’ exercises to check and change.
• Redeveloping our website and online tools to provide better information, advice, and signposting — co-producing the content with people who use it.
• Launching and embedding our Practice Values and Standards to support the right culture, featuring monthly ‘learning together’ events that focus on each standard.

We are improving by:

• Moving towards delivering on the stretched target to complete assessments within 28 days for 70% of people.
• Improving our practice in direct payments to ensure they are consistently promoted to those for whom they may be the best option, and supporting holders with e-learning to help them use payments effectively.
• Creating more capacity for targeted short-term interventions that promote independence by continuing to improve sufficiency in the personal care market and avoiding diversion of services in contingency.
• Encouraging and increasing the use of 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 areas for improvement — aiming for greater consistency of practice across 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. This has contributed to a significant reduction in the number of calls abandoned.
• Doing similar with people on waiting lists to check whether they are waiting well and to inform improvements in this aspect of our practice, making it more consistent.
• 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 areas for improvement — for example, in consistently applying our promoting independence and supporting policies.
• Using supervision to individually identify best practice and areas for improvement — such as embedding the wellbeing principle.
• Further improving the information we record 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:

• 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 in peer reviewing practice standards and sharing 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 673 completed in the last 12 months.
• Putting in place Practice Quality Review events with staff to improve practice.
• Ensuring learning is shared, including through our Assurance and Performance Board, Self-Assessment, and regional networks.
• Seeking independent moderation through regional partners, with an agreement reached via 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 and building that into Practice Quality Review.

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.
• Building strong integrated and co-located relationships with health partners to support good access to intermediate care and reablement services. These have positive impacts on people’s lives, including avoiding hospital admissions and readmissions, and reducing the need for ongoing support.
• Making available preventative services that adapt people’s homes and provide equipment to support independent living — including the use of apps such as AutonoMe.
• Having a well-established Independent Living Centre, soon celebrating its 30th anniversary. It supports people with advice, information, guidance, and equipment to live independently at home, and is nationally recognised for its helpful information sheets and positive outcomes.
• Achieving a consistently higher than average proportion of people with learning disabilities in employment and appropriate accommodation — maximising life chances, including social opportunities.
• Responding to the pandemic with a whole system approach to preventing outbreaks and swiftly supporting affected settings. This limited fatalities in care homes to among the lowest in the country and continues to inform our winter planning.
• Having current and recent Leaders of the Council and Lead Members actively involved in wider partnerships — including the Health and Wellbeing Board, Integrated Care Partnership Board, and Torbay and Devon Safeguarding Adults Partnership Board — to embed preventative and strengths-based approaches across strategies and delivery plans.
• Working closely with the Director of Public Health and his team to inform and implement recent annual reports on Prevention and Healthy Ageing, and collaborating with the Health and Care Scrutiny Committee on a whole system approach to prevention.

Through Self-Assessment, we have identified our key challenges as:

• Responding to a recent decline in Adult Social Care Outcomes Framework indicators measuring access to information about services for both people who use services and their carers, following several years of improvement.
• Delivering on a strategy that emphasises wellbeing and independence through prevention and short-term targeted intervention, during a period of financial challenge.
• Ensuring we capture data about the delivery of all short-term and intermediate care services across health and care in Devon, to better assess and represent their reach and impact.
• Consolidating our approach to prevention into an updated strategy — particularly in developing and extending key services such as Social Care Reablement and Reaching for Independence.

Service user

Claire Meehan, OT, changed a life by making home and community accessible again. “You’re one in a million,” said the person she supported, “you always go the extra mile.”

A message from Natalie, a young person with a learning disability, and her mum, after Charlotte from our RFI team helped her travel independently for the first time.

“Thank you for helping Tilly gain her wings and learn to fly!”

Service user

“If it wasn’t for you visiting five years ago, this would never have happened — thank you for everything you’ve done for us.” OT Grace Silbury, whose determination helped a family stay together in a safe, adapted home.

• Working with Public Health to ensure preventative approaches are targeted at preventing, delaying, and reducing needs for adult social care, and are central to ‘One Devon’ and Council strategies and plans.
• Capitalising on improved partnerships with district and city councils to increase housing with support capacity and capability, while maintaining relationships through the tensions of Local Government Reorganisation.
• 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 primarily focused on local outbreak management for over two years, to now prioritise prevention, address the impacts of Covid-19, and tackle health inequalities.
• Making more progress in modernising Technology Enabled Care Services, and increasing uptake across 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 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 demand for statutory services such as adult social care.
• Seeing more join-up between adult social care and other parts of the council — particularly 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 on its new Strategic Plan and across the system to fulfil the priorities and ambitions of our One Devon strategy — aiming to achieve its ambition of equal chances for everyone in Devon to lead long, happy, and healthy lives.
• Extending our review of governance into partnership working — including memoranda of understanding, Section 75 agreements, governance of the Better Care Fund, and Local Care Partnerships.
• Improving how we evidence and evaluate the impact of partnership working, especially initiatives jointly funded through the Better Care Fund or delivered 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 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 — both strategically and in the commissioning and development of 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 via our Equalities Reference Group and representative user-led organisations.

Service user with autism. 

Thanks to the support of Lisa Whybrow, Community Enabler in the Reaching for Independence Team, a man with autism gained the confidence to cook independently — delighting his whole family with his very first homemade cottage pie “Already got two orders in for the next one!”

• Supporting decision makers with impact assessments that encourage consideration of people with a range of protected characteristics — including through accessible consultations.
• Commissioning a Race Equalities Audit and responding to its findings by developing and beginning to deliver an 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 from our Race Equality Audit, including raising staff awareness, encouraging staff commitment, and addressing inequalities in our employment practice.
• Broadening our corporate approach to be more externally focused on those we serve — considering groups with needs linked to protected characteristics, rurality, or economic circumstance who may experience disadvantage.
• Devising more effective ways of listening to seldom heard groups, identifying potential unmet need, and providing culturally appropriate services — especially in rural areas where needs may be dispersed and not always linked to protected characteristics.

“We were able to share the learning that we took from our rural proofing review of Devon adult social care policies regionally and nationally, helping others to think about the experience of those living in rural and extreme rural areas and ensuring an equality of access, outcome and experience from the people they have contact with.” 

Nora Corkery, Chief Executive Officer, Devon Communities Together

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, recognising that the distributed and varied nature of people from ethnic minority and LGBT communities can mean their particular needs are not always considered.
• Supporting and challenging leaders to reflect on their attitudes to race and other protected characteristics — through a mentoring programme and management training.

We are improving by:

• Broadening our Race Audit Action Plan, using both qualitative and quantitative information to assess 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 listen to, understand, and respond to those who are seldom heard or whose needs are not being appropriately met.
• Including unpaid carers as a key characteristic to consider in impact assessments and in 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 this in reporting.
• Exploring differential take-up of services and inequalities in access, outcome, and experience with relevant communities — for example, in relation to safeguarding.

Introduction: Providing support

As adult social care commissioners, we are central to shaping how Devon County Council delivers support that not only meets the statutory duties of the Care Act but also reflects the evolving needs of our communities through data-driven insight. Our commissioning approach begins with a deep understanding of our communities —their characteristics, challenges, and aspirations.

We use a wide range of intelligence, including demographic data, service usage trends, and lived experience, to inform our decisions. Working in partnership with local stakeholders, we design and deliver care and support that is person-centred, evidence-based, and responsive—ensuring people receive the right support, in the right place, at the right time.

In progressing our work, over the last 12 months we have:

• Continued to develop the Provider Engagement Network, working with groups such as the Devon Care Homes Collaborative and Devon Integrated Social Care Alliance to ensure a culture of positive and equal partnership working.
• Refreshed provider support policies and approaches, and reshaped our Commissioning Team structures to support these approaches and our broader market shaping, market sufficiency, and safeguarding duties.
• Begun to define the work programme of the reconstituted theme, completing the update of our Market Position Statement and building on programmes 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, building resilience through preventative approaches — including supporting people to leave hospital in a timely and lasting way.
• Completed the re-tendering of our Community Equipment Service, seeking opportunities to achieve better outcomes, with an increased focus on Technology Enabled Care Services.
• Maintained the strength of our partnership with the NHS, despite structural and leadership changes — ensuring strategic synergy through formal Partnership Agreements, Section 75 Agreements with NHS providers, and joint governance of the Better Care Fund.
• Continued our partnerships with District and City partners, particularly on housing and homelessness — exploring how we can collectively ensure people have 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 4/152 local authorities in England.  We have seen a minor decline in quality of life but maintain a 2^nd quartile ranking of 56/152 local authorities.
• 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 rates have 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 in the past, but higher fee rates, international recruitment and attracting new providers into the market has reduced insufficiency from over 6,000 hours per week to under 650 in 2 years.  
• The most recent Capacity Tracker data shows 0.7% of domiciliary care packages were ended or returned by providers as of 15 May 2025, an improving position.
• Two care homes closed during 2023/24, but that small loss of 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 exited the market and 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 i.e. pathway 2 through discharge to assess. 
• There are currently 515 placements part or wholly funded by DCC outside the area. 
• Nearly 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​. 
• Around 80% are wholly DCC funded and 20% have an element of NHS funding.​ 
• Around half of people living in 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.

Key points to note regarding the external (i.e. 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.  
• International recruitment has led to increases in workforce capacity with the proportion of the workforce that is non-British remaining less than the national and regional averages but growing due to international recruitment.  Similarly. international recruits are starting to bring down the average age and change the gender balance of the workforce, with more younger people and more men taking up these roles.

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. 

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

• 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
• 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. 
• 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” and we have maintained that progress.
• 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.  

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 rated Good or Outstanding by the Care Quality Commission in both residential/nursing and personal care sectors than the national and regional averages — with particular strengths in being safe, caring, and well led.
• Consistently having the majority of indicators in the Adult Social Care Outcomes Framework (ASCOF) in the top two quartiles (19/26 in 2021/22, 14/26 in 2022/23, and 15/25 in 2023/24), with notably high overall satisfaction and quality of life among people who use services.
• Getting services in place in good timescales once an assessment or review has been completed.
• 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 — for example, international recruitment and provider digitisation.

“The change in leadership had left me feeling extremely anxious about the future – but being in the room together with you, and hearing you, left me feeling excited about what can be achieved by working together.”

Shrien Dewani, Independent adult social care provider

• Recognising the premium of delivering rural services through fee levels — stabilising provider finances and encouraging workforce recruitment and retention through higher wages.
• Offering a well-regarded provider quality assurance and improvement offer, with a wide range of free training for provider staff, including access to resources that support 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 — including a system-wide approach to international recruitment that has helped 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:

• Promoting the recent 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 workforce, as well as the internal adult social care workforce — maintaining links after responsibility transferred 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 access a range of affordable, high-quality services.
• Maintaining the significant progress made in market and workforce sufficiency, particularly in the personal care market in rural areas and in complex dementia support within residential settings.
• Developing our contracts and contractual frameworks, to clarify expectations around service delivery and cost, and improve discipline in price control.
• Undertaking timely reviews of individuals on a scheduled basis, to identify changing needs or previously unidentified quality issues or risks — informing provider contract and quality monitoring.
• Monitoring out-of-area placements consistently, ensuring the same level of quality assurance and review as for in-county services, especially for high-risk services and individuals.
• Profiling risk across all types of providers, and managing it to mitigate and minimise provider failure — which remains infrequent in Devon.
• Supporting providers to embrace change and innovate, particularly in digital and Technology Enabled Care Services — with a focus on small and medium-sized providers that dominate the Devon market.
• Improving the wellbeing of staff across the sector, as they recover from the pandemic — with absence and turnover levels still indicating burnout, though improving year on year and favourable compared to other areas.
• Being reliant on international recruitment to boost the adult social care workforce, reflecting 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, while correlated with better CQC ratings, are more likely to face financial sustainability challenges and may be 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 ensure review arrangements are in place that confirm people’s needs are being met — with the same expectations of providers as if they were in Devon, including through our Specialist Placements Team.

Service user feedback

Jocelyne Greene, Social Care Assessor in Northern Devon, went the extra mile to ensure a smooth transition and continuity of care across areas — leaving a lasting impression on a grateful family.

“I cannot thank you enough for the kindness you have shown us.”

• Updating our carers’ strategy delivery plan, with a focus on improving social contact and working with Devon Carers to achieve better outcomes for carers within the limits of available resources.
• Continuing our initiatives to improve recruitment and retention of frontline care staff, evaluating which approaches make the most difference — with a focus on improving staff health and wellbeing to reduce absence.
• Supporting safer recruitment, particularly in international contexts — to bring people with the right values and aspirations into the care sector in Devon, and working 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 commissioning intentions underpinned by the changing care and support needs of the population we serve.
• Making better use of Capacity Tracker, building on its status as a statutory provider return — ensuring provider information is complete and current, and using it to monitor capacity and workforce.
• Extending our approaches to manage and quality assure regulated providers, into the unregulated sector.
• Maximising operational staff capacity and productivity, to undertake more reviews and gather intelligence on provider quality — including for 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 (TECS).
• Seeking feedback from providers in a more structured way that enables us to target and drive improvement.
• Obtaining better evidence to demonstrate equity of access and outcomes, ensuring people of all backgrounds are experiencing equal access to services, achieving equitable outcomes, 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, using needs analysis (in collaboration with public health) and multi-agency teams embedded in communities and linked to primary care networks.
• Having flexible, joined-up operational arrangements with the NHS that support choice and promote independence, including short-term interventions such as reablement, intermediate care, and end-of-life care.
• Embedding locality provider forums across all areas, bringing together health and care commissioners, operational managers, and independent and voluntary sector providers.
• Collaborating with the voluntary sector to support innovative approaches, for example, dementia memory cafés that operate independently with a small grant to the consortium ensuring their safe running.
• Sharing learning and working together on system and service improvements, for example, hospital discharge initiatives involving 1:1 agency staff to help people with complex needs return home quickly while longer-term needs and funding are assessed.
• Supporting Personal Assistants and micro-providers, including opportunities for social enterprise development.
• Building strong internal relationships within the Council to secure cross-directorate support for adult social care priorities, for example, working with Public Health and Communities to manage care home outbreaks, and with the Economy function to promote health and care as the largest sector and employer locally.
• Working closely with district and city councils to develop housing with support, ensuring care needs are considered in mainstream and social housing developments.
• Partnering with district councils to deliver Disabled Facilities Grants, helping people live more independently for longer in their own homes.
• Collaborating across the NHS Devon system with Allied Health Profession leaders to shape new models of care and address workforce challenges through the AHP Council and Faculty, chaired by our Principal OT.

Through Self-Assessment, we have identified our key challenges as: 

• Understanding the needs of self-funders, supporting them to make informed decisions and ensuring the market is sufficient to meet their needs.
• Ensuring equitable access to services, by developing the market in under-served areas and increasing provision where gaps exist — particularly in rural areas with dispersed populations.
• Maintaining system flow during periods of high demand, especially in winter, while ensuring people are placed on the most appropriate care pathways for both their immediate and longer-term needs.
• Commissioning services and agreeing fee levels within constrained budgets, which are under pressure due to rising demand, increasing costs, limited supply in some areas, cost of living pressures, and declining council income.
• Supporting unpaid carers to meet their own needs, enabling them to sustain their caring role without adverse impacts on their health and wellbeing.
• Being active in housing planning and development, to encourage the creation of affordable housing that supports workforce growth.
• Sustaining strong relationships across the Integrated Care System, despite leadership changes and financial pressures, while continuing to deliver good outcomes aligned with the ‘One Devon’ five-year forward plan.
• Spreading best practice across the county, ensuring that local innovation and expertise are shared and adopted more widely.

We have improved by: 

• Using Capacity Tracker data and Office for National Statistics research to strengthen our understanding of demand from self-funders and how the adult social care market is responding to it.
• Working with district and city councils to better understand housing take-up, particularly social housing and housing with support for people with current or potential adult social care needs.
• Collaborating with carers and their ambassadors through the Carers Partnership Steering Group, using insights from surveys, focus groups, and scrutiny spotlight work to improve outcomes.
• Restructuring our commissioning team, enabling us to respond effectively to both the strategic challenges of market development and the operational realities of contract monitoring and quality improvement.

We are improving by: 

• Targeting market development on specific services and geographies, such as care homes specialising in dementia support and personal care provision in the South Hams, where supply is currently limited.
• Working across the partnership to strengthen our response to individual crises and larger-scale incidents, by embedding more proactive ‘business as usual’ approaches.
• Collaborating with NHS trusts to better understand people’s journeys through the health and care system, informing 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 shape and refine our commissioning strategies and plans.
• Participating fully in corporate initiatives to reduce non-value-adding spend, such as on agency staff or functions that do not contribute to our statutory duties.
• Working more closely with other local authorities, both within the system and regionally, to address shared challenges and build on collective successes — for example, in specialist commissioning.
• Building on ‘Team Devon’ and our established housing forums, to deliver shared aspirations for improving housing options for people with care and support needs and for key workers — using planning powers, Section 106 funding, and public sector land assets.
• Improving our commissioning of community mental health services, including a joint review and development plan for the functions delegated through our Section 75 agreement with Devon Partnership NHS Trust.
• Jointly commissioning with district council partners and Homes England, engaging the Housing LIN to assess demand and need for supported accommodation, providing a robust evidence base to inform local plans.

We plan to improve by: 

• Extending co-production from examples of good practice to our default approach, embedding it in service commissioning, development, and improvement — supported by a clear policy framework.

“Great to work alongside others and contribute to wider thinking about system changes. Good to hear about the ambitions of the Council around co-production and the story of what has happened so far. I really appreciated Solveig’s honesty and openness about the step change – it felt really realistic and honest. It was good to meet new people and catch up with colleagues I already knew.”

Jude Pinder – The Filo Project, and attendee of the Community Services Co-Pro event

• Ensuring a stronger voice in the local health and care system, contributing to the forthcoming 10-year plans for health and care to ensure the Council’s adult social care priorities are fully reflected — both in these plans and in the new Council strategic plan.

Additionally, we have responded 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 highlight good practice and its benefits, including maximising the role of the Community Services Co-Production Group in shaping the recommissioning of services such as personal care, enabling, day opportunities, and support from personal assistants and micro-providers.
• Joining up conversations within and beyond the Council to better coordinate our work with the voluntary and community sector, including the signing of the Civic Agreement with the VCSE Assembly, which formally recognises them as a key strategic partner in the health and care system.

We are improving by: 

• Publicising opportunities to engage with our Co-production Working Group and Commissioning Involvement Group, encouraging wider participation and embedding co-production more deeply into our commissioning processes.
• Reflecting on areas of activity where co-productive approaches have the greatest potential to improve outcomes, and ensuring these are clearly represented in the new Council’s Strategic Plan.

We will improve by: 

• Formalising our co-production offer and approach, supported by a clear and consistent policy.
• Ensuring co-production opportunities are considered from the outset of any new project or initiative.
• Reviewing our policy on remuneration, to ensure fair and appropriate recognition for people contributing to co-production.
• Considering the representation of people with lived experience in our governance, to strengthen accountability and ensure diverse perspectives inform decision-making.

Introduction: Ensuring safety

We work as a team across operations, professional leadership, and commissioning, to assure and improve the quality of safeguarding practice and its outcomes.  Over the last 12 months we have:

• Embedded our IASC Safeguarding Governance Group, ensuring we meet our statutory adult safeguarding functions and providing leadership and oversight of safeguarding performance, improvement, and workforce standards.
• Continued to implement an Improvement Programme focused on three core elements of safeguarding practice, starting with how we deliver operational safeguarding duties at the concerns stage — combining the three locality-based safeguarding hubs into a single centralised service to improve consistency, quality, and timeliness of triage.
• Sustained regular reporting on safeguarding practice and learning into the Performance Board, with professional leads also meeting regularly with the Director to maintain a strong focus on safeguarding.
• Developed, implemented, and begun embedding our new approach to Practice Quality Assurance, including the introduction of a safeguarding practice standard and auditing through our safeguarding practice quality review tool.
• Extended our corporate digital platform ‘Devon Assist’ into adult social care, enabling more effective recording, alerting, response, and learning from serious incidents within the service.
• Focused on the progression and completion of Safeguarding Adult Reviews, providing assurance, improvement, and learning through the Torbay and Devon Safeguarding Adults Partnership, and sharing learning across the workforce.
• Been tested in our Emergency Planning, Preparedness and Response arrangements, including through major power outages in North Devon and a Cryptosporidium outbreak affecting the water supply in South Devon.

Sarah Mackereth, Principal Social Worker – Operations, Integrated Adult Social Care

Sarah is fulfilling the statutory duties of this statutory  Principal Social Worker (PSW) role alongside the functions of her role as Head of Quality, Performance and Redesign.

Sarah previously held the PSW role in Devon and has since developed her experience across the health and care system in Devon in senior and strategic roles whilst maintaining connection and influence across the operational workforce.

Carolyne Hague MBE, Principal Occupational Therapist, Integrated Adult Social Care

Carolyne has achieved national recognition for her leadership, influence, and championing of occupational therapy, and allied health professions more broadly over many years.

Carolyne leads on prevention including the use of TEC, equipment and adaptations, and led on the development of our practice standards and values, and related practice quality assurance. She also leads our Community Equipment Service.

Helena Riggs, Principal Social Worker for Safeguarding – Commissioning, Integrated Adult Social Care

Helena’s role is an outward-facing partnership role working closely with the Torbay and Devon Safeguarding Adult Partnership Board.

A key function of Helena’s role is working in partnership to ensure the Board fulfils its core statutory responsibilities. She takes a strategic view of safeguarding performance across the partnership, ensuring there are strong systems in place for monitoring and accountability.

Helena also leads on Safeguarding Adult Reviews to quality assure and review the delivery of actions helping to ensure lessons are learned and good practice is shared.

Kayleigh Bradford, Head of Social Work, Devon Partnership Trust

Kayleigh is employed by Devon Partnership Trust (DPT) in a joint funded role with Devon County Council (DCC).

The role is responsible for overseeing the delivery of statutory social care and AMHP (Approved Mental Health Professional) services across the county that is assigned to DPT within a s75 partnership agreement between the local authority and the mental health trust.

This role provides strategic leadership, professional governance, and quality assurance for social work practice, while also acting as the key liaison between the trust and the local authority to uphold statutory responsibilities and manage risk.

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 have increased but remain 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.
• The conversion rate of concerns to enquires continues to reduce and is significantly below comparators; this may reflect higher CQC ratings of provider quality in Devon (providers rated good or outstanding) and improved triage with more concerns resolved in other ways.
• The quality of decision-making at the point of S42(1) decision, where this concern goes on to be an enquiry, is consistently audited, and the quality of those decisions are rated as good.
• We find that concerns generally 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 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.
• The ASCOF perception of safeguarding survey indicator remained 3^rd quartile in 2023/24; previous focus groups on why people feel unsafe focussed on factors in their community most of which are outside of the control of the local authority.
• 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, including issues relating to dementia and to alcohol abuse.
• Against the new national metric measuring the proportion of Section 42(2) enquiries where risk is identified and reduced or removed we are broadly in-line with comparators, ranking  97^th of 152 local authorities in England.

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

• Following a SAR review, the identified learning is progressed and recommendations embedded into operational practice including sharing at frontline and manager forums such as our Learning Together events.  
• During 2024/25 Torbay and Devon Safeguarding Adults Partnership published five SARs, including a thematic SAR focussed on mental health and suicide.
• These related to seven individuals who had suffered serious harm or died, two fewer than in the previous year, with the age profile more skewed to working aged adults.
• Themes from recent SARs referrals have included mental health, self-neglect, substance misuse, and acts of omission.

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

• Investment to increase capacity and improve productivity has been made in this year’s budget to meet rising demand.
• DoLS applications received and completed are on a rising trend nationally and Devon is among the highest in our comparator group.
• Nevertheless, through our commitment to continuous improvement we have reduced the time people are waiting for an assessment, ensuring people are safe and waiting well. 
• Approximately 60% of all DoLS applications now come from hospitals, higher than is typical in comparable areas, suggesting our hospital Managing Authorities are making appropriate applications in line with the legislative framework.
• Applications not completed at the end of 2024/25 totalled 3,298 in comparison to 3,219 at the end of 2023/24; the current projection is for this to reduce to 3,070 by the end of 2025/26.

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

• When a young person reaches the age of 16 we make contact and allocate to a worker in our Transition Adult Social Care (TASC) team and provide a designated mailbox where individual and their carers can contact us.
• 88% of young people in transition have an assessment completed by the time they turn 18, 84% of whom are eligible for ongoing adult social care support.
• There is a detailed and monitored TASC continuous improvement plan in place to improve the timeliness and impact of assessment and support planning.

In their annual report for 2024/25 on complaints, compliments and other feedback on adult social care, our Customer Relations Team highlight:

• Compliments continue to reflect the compassion, professionalism, and dedication of staff across service areas, with Social Care Reablement receiving the highest volume.
• Examples highlighting specific teams include:
  • The exceptional support and care provided by Social Care Reablement (SCR) teams, aiding recovery post-hospitalisation and assisting service users in regaining independence
  • Our residential respite services Greenfields and New Treetops were praised for their commitment and support
  • Woodland Vale, a Care Home specialising in supporting people with dementia, received compliments for their attentive care, kindness, and professionalism
  • Teams within our Care Management Services such as Care Direct and the Exeter Community Health and Social Care Team were recognised for their compassionate and efficient service
  • The Autism and ADHD Service were acknowledged for their outstanding support to people with needs resulting from their neurodivergence
  • Our Reaching for Independence teams were recognised for enabling service users to regain confidence and independence
  • The Specialist Placement Team received compliments for their hard work and patient-centred care
• We also receive feedback from staff and partners via the ‘Big Thank You!’, an electronic form which encourages people to recognise colleagues who manifest our practice values in their work.
• Complaints accounted for less than 1% of the population served annually, with a notable reduction in volume throughout 2024/25.
• 58% of complaints were responded to within target timescales, better than the previous year but requiring further improvement. 
• Analysis of upheld complaints revealed recurring themes around care quality, communication, assessment processes, and financial clarity with agreed actions relating to further improving coordination, responsiveness, and transparency in service delivery.
• 21 Local Government Social Care Ombudsman (LGSCO) complaints were received in 2024/25 down from 2023/24; of these 12 were investigated and 10 upheld
• Resulting recommendations focussed on timely assessments, enhanced care planning, better complaint handling, and stronger consideration of service users’ wellbeing, highlighting opportunities for systemic learning.

A person living with Long Covid, Chronic Fatigue Syndrome, and mobility and memory challenges, who now uses a wheelchair. Through consistent, empathetic support, she was able to settle into a more accessible home and regain a sense of control and independence. She said:

“The last few years have been the toughest I think I’ve ever experienced and I’m so thankful it’s been you alongside me… empowering me to believe that just because my body doesn’t work like it once did, I am still worthy at my core… You’ve been a genuine, reliable, safe person that I have grown to really trust… I may not have a body that can lift 200kg in the gym anymore, but I do have a little voice that tells me I’m just as strong…Thank you for empowering me to change my own life.”

Examples of good practice in ‘ensuring safety’ relating to the Torbay and Devon Safeguarding Adults Partnership (TDSAP) highlighted by the July 2023 Peer Review included:

• “Relationships between partners are reported to be strong at board level.”
• “The Chair proactively works to maintain and strengthen the role of the board which appears to be fulfilling the statutory duties.”
• “There is positive work to support providers to manage risk and improvement.”
• “Use of your Practice Quality Review tool in safeguarding supervision practice, supported by a new Supervision Policy.”
• “The Preparing for Adulthood Team is a positive development in supporting young people and their carers in a timely manner.”

Examples of strong partnership working within TDSAP include:

• The Community Engagement Group has brought together people with lived experience of Safeguarding and Voluntary, Community and Social Enterprise (VCSE) organisations across Devon and Torbay.
• The purpose of this and other forms of involvement is to ensure that people with lived experience and their carers remain central to the work of the Partnership Board.
• This has 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 groups and people with protected characteristics.

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 handbacks. Our 24/7 agency staffing support during the pandemic was commended as a national exemplar.
• Having effective multi-agency and adult social care-specific winter plans, with robust governance and escalation arrangements, including out-of-hours provision.
• Monitoring provider risk proactively, enabling early interventions to prevent reactive scenarios related to provider failure.
• Managing care home closures effectively, including a recent case where staff secured a superior alternative placement at short notice for an elderly woman with learning disabilities, following the termination of her long-term care contract — acknowledged in a letter of thanks from her sister.
• Responding to emergencies with resilience and coordination, with arrangements tested during and since the pandemic, including:
  • A major unexploded bomb found near a care home in Exeter.
  • Increasing incidence of major storms leaving care settings and service users without power.
  • A fire in a care home in South Molton requiring the re-accommodation of all residents.
  • Contamination of the water supply in South Devon due to Cryptosporidium.
• Maintaining effective links between the on-call manager, emergency duty service, NHS and council on-call arrangements, and national agencies such as UKHSA — tested daily during the pandemic and subsequently through industrial action and other incidents.

Through Self-Assessment, we have identified our key challenges as:

• Working corporately and in partnership to improve SEND services and children’s social care, both subject to Ofsted inspection — including ensuring effective support for young people transitioning to adult social care.
• Using our integrated operational arrangements to avoid funding disputes, particularly around hospital discharge, Continuing Healthcare (CHC), Section 117 aftercare (S117), and Funded Nursing Care (FNC), especially when council and NHS budgets are under pressure.
• Responding to hospital discharge pressures, which can result in decisions that don’t always align with individuals’ needs at the time — including the use of short-term residential placements that become long-term, leading to deconditioning in bed-based care.
• Monitoring services for people who move in and out of area, where quality assurance and case review arrangements can be less secure than for those accommodated within the county.

We have improved by:

• Implementing our revised provider failure policy, offering greater clarity to all stakeholders and consistency for providers.
• Working across the Council and in partnership to strengthen our emergency planning, preparedness, and response, learning from each incident and preparing for emerging risks such as cyber-attacks.
• Creating a joint role of Head of Social Work with Devon Partnership Trust, enhancing collaboration and leadership across health and social care.

We are improving by:

• Embedding learning from Safeguarding Adults Reviews, including themes such as mental health, coercive control, cuckooing, and neglect (including self-neglect), across a large rural and organisationally complex area — using staff engagement sessions like Learning Together, our newsletter, and leadership forums.
• Fulfilling the promise of our corporate Disaster and Emergency Management System (DEMS) programme, applying learning from recent emergency incidents to further strengthen 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 Transition to Adult Social Care Team (TASC), to support safe transitions between children’s and adult social care — including the recruitment of a new Assistant Director for People with Disabilities.

Feedback from a parent for young person transitioning to adult social care

“The worker was extremely professional, personal and knowledgeable. She really wanted to support and advocate for our daughter and went out of her way to make sure our daughter could make as many decisions as she could manage.”

• Improving our monitoring and operational practice for out-of-area placements, ensuring mutual quality assurance arrangements and regular reviews to keep people safe.
• Enhancing the commissioning and monitoring of services for people with mental health needs, with staff assigned and responsibilities discharged through our Section 75 agreement with Devon Partnership Trust.
• Working across the health and care system to improve urgent and emergency care, contributing to both hospital admissions avoidance and timely hospital discharge.

Family member of a person wanting to be placed out of area to be closer to their family:

“I just wanted to write to say thank you for all that you’ve done for mum. It’s amazing that you managed to find a place so near, and also so well suited to her needs. We just want to thank you for everything, and to let you know how happy we are having you taking care of things.”

• Developing contingency plans and approaches for emerging risks, including heatwaves, cyber-attacks, and future pandemics.
• Reviewing our approach to the Humanitarian Assistance Liaison Officer role, including responsibilities for rest centres and key workers.

We plan to improve by:

• Being more systematic in our learning from Serious Incidents, ensuring that insights lead to meaningful changes in practice and policy.
• Improving how we triangulate data on process and outcomes, combining this with feedback from people and qualitative insights from practice quality audits and other mechanisms — all within our practice quality assurance framework and overseen by the Practice Quality Assurance Group.
• Using the potential richness of complaints information to identify and address recurring themes, particularly where we know deficiencies often arise — such as during transitions into and between services.
• Working to better join up support for unpaid carers and the people they care for, especially where assessments and services are delivered by different organisations, to ensure a more coordinated and person-centred approach.

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 adults’ and children’s Boards, and a range of sub-groups focused on delivering the priorities of the business plan.

Paul Northcott, Independent Chair of the Torbay and Devon Safeguarding Adults Partnership Board

“There has been a clear desire from those in the Partnership to ensure that we increase the involvement of those within our communities who use services. We have looked at national best practice and in the past twelve months have actively moved towards a more sustainable and inclusive model of co-production.”

• Working with a Community Engagement Group, ensuring we learn from people’s lived experience and take a co-productive approach to improvement.
• Using a range of quantitative and qualitative data, including Making Safeguarding Personal and statutory surveys, to inform priorities — with clear examples of resulting improvements.
• Commissioning safeguarding training jointly, aligned to the partnership competency framework, which defines appropriate training based on role — e.g., a 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 manage medicines.
  • The relationship between falls prevention and safeguarding.
• Embedding the National Friends Against Scams e-Learning initiative as part of our Level 1 Safeguarding Adults training offer, addressing the noted increase in scams during the pandemic.
• Using data analysis to inform and deliver improvement, including 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 outcomes achieved under Making Safeguarding Personal.
• Maintaining the comparatively high quality of regulated services in Devon, with a greater proportion rated Good or Outstanding by the Care Quality Commission than is typical regionally or nationally — particularly in relation to safety.
• Maintaining sound multi-agency policy, guidance, processes, and training, including a revised policy to address serious incidents.
• Taking a partnership approach to whole-service safeguarding, incorporating and continuously learning from provider feedback.

Team manager giving a Big Thank You to a social worker

“The social worker demonstrated person-centred practice in a domestic abuse enquiry, coordinating a multi-agency response with housing, Police, and the GP. They facilitated joint visits, respectfully challenged when needed, and clearly evidenced the adult’s capacity. Despite initial reluctance, the social worker captured the adult’s desired outcomes and developed a proportionate protection plan that balanced immediate risks with long-term wellbeing.”

Through Self-Assessment, we have identified our key challenges as:

• Ensuring leaders across the Council and its partners are well sighted on and committed to adult safeguarding, giving it equal priority alongside child protection and driving improvement in practice.
• Embedding our approach to quality assurance of safeguarding practice, through the consistent use of practice quality reviews, our safeguarding practice standard, and the re-procurement of safeguarding training provision.
• Continuing to realise the benefits of centralising adult safeguarding arrangements within the Council, which has already led to greater consistency of practice, improved risk management, and more responsive resolution of concerns.
• Confirming and embedding consistent uptake of required safeguarding training, supported by improved monitoring of learning and development at both individual and aggregate levels.
• Exploring our comparatively low conversion rate of concerns into enquiries, and understanding the variation in activity between localities — determining whether these differences are driven solely by population, service configuration, or risk profiles.

We have improved by:

• Using our Safeguarding Governance Group to oversee delivery of improvements, strengthening safeguarding activity and performance within the Council.
• Centralising our adult safeguarding arrangements, resulting in improved responsiveness and greater consistency of practice.
• Improving our internal safeguarding operational guidance, by building on and aligning with the published partnership guidance.

We are improving by:

• Driving improvement activity through our Safeguarding Improvement Programme, including providing safeguarding practice leadership support at locality-based forums that are driven by practice, data, and insight.
• Working to further improve the timeliness of triaging safeguarding concerns, ensuring prompt and appropriate responses.
• Improving our internal safeguarding operational guidance, by building on and aligning with the published partnership guidance.
• Using our Safeguarding Governance Group to oversee the delivery of improvements, ensuring safeguarding activity and performance within the Council is informed by both qualitative and quantitative information.
• Focusing on the strategic priorities set by the Torbay and Devon Safeguarding Adults Partnership Board, specifically:
  • Seeking assurance from partners regarding practice improvements in key risk areas.
  • Seeking assurance that learning from Safeguarding Adults Reviews is embedded into practice.
  • Improving awareness, engagement, and inclusion across the partnership.

We plan to improve by:

• Implementing the next phase of our Safeguarding Improvement Programme, building on the progress made to date and continuing to strengthen safeguarding practice, leadership, and outcomes across the Council.

Summary: What we are proud of and concerned about

We are proud of:

• Maintaining consistently strong performance in the Adult Social Care Outcomes Framework, with 15 of the 25 indicators for 2023/24 ranking in the top two quartiles, and generally improving trends. Areas where performance is lower are informing our priorities for improvement.
• Achieving high satisfaction ratings among service users, ranking 4th out of 152 nationally. Key indicators related to promoting independence — such as control over daily life, quality of life, and minimising care home placements — also rank highly.
• Enjoying provider quality ratings in Devon that consistently exceed national, regional, and comparator averages, with a greater proportion of community-based services and care homes rated Good or Outstanding by the Care Quality Commission than is typical elsewhere.
• Celebrating staff and providers through our compliments and ‘Big Thank You!’ schemes and the many national and regional awards they have won in recent years, including Gold and Silver Awards in the National Social Worker of the Year (2023), a Chief Allied Health Professionals Gold Award for Excellence (2024), an MBE (2025), and several national citations of good practice.
• Working with providers on recruitment and retention to secure sufficient regulated personal care. Following the pandemic, unmet demand peaked at 6,000 hours per week; this has now reduced to around 650 hours per week, with contingencies in place to keep people waiting safe.
• Sustaining a proven track record in mitigating and responding to risks and emergencies, including avoiding and managing provider failure, responding effectively to multiple major incidents in recent years, and maintaining sound out-of-hours arrangements.
• Using an open and honest approach to stakeholder involvement in producing an annual self-assessment, consistently taken through Scrutiny Committee and Cabinet and published as an annual report. Governance is provided through a Performance and Assurance Board that invites external challenge and support.

We are concerned about:

• Continuing efforts to reduce waiting times for assessments and reviews — including financial assessments and DoLS — despite constrained resources and rising demand. Triage and allocation are risk-based, with contingencies in place to keep people safe and improved communication with those waiting.
• Managing hospital discharge and system flow, where an over-reliance on bed-based intermediate care can prevent people from receiving the right support, in the right place, at the right time to optimise recovery.
• Sustaining and supporting staff wellbeing and resilience, especially during periods of change and increased demand, while maintaining comparatively low vacancy and turnover rates and minimal use of agency staff.
• Ensuring consistent and responsive safeguarding practice, building on improvements already made, so that decision-making and thresholds remain high quality across localities, supported by learning from Safeguarding Adults Reviews and other Serious Incidents.
• Working across the council and its partners to address carers’ social isolation, which has been highlighted in recent surveys as a significant concern—particularly in rural areas — despite data showing higher-than-average access to carers’ breaks.
• Managing demand, with the cost-of-living crisis affecting service users, carers, and those at risk of vulnerability. Activity levels among people aged 18–64 are higher in Devon than elsewhere, with particular pressure during transitions from children’s services.
• Managing costs, as wage and utility price pressures threaten provider viability. Fee levels are rising faster than typical — especially for services to older people, both residential and community-based — while council budgets are not keeping pace 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 supporting people to remain at home rather than in hospital or a care home wherever possible.
• Continuing to improve productivity across all areas, including through the implementation of a new care management system and the review and redesign of our operating model to deploy capacity and capability more effectively, and to continue reducing waiting lists and times.
• Maintaining financial sustainability, even as our budget — while increasing — remains under pressure from rising demand, escalating costs, limited supply, cost-of-living impacts, and falling council income. These constraints are likely to persist for the foreseeable future.
• Supporting flow through the health and care system, especially during winter when outbreaks of infectious diseases coincide with pent-up demand for NHS services. We must continue improving transitions between services, local authorities, and providers, where risks of failure are often greatest.
• Recruiting, retaining, and developing sufficient staff across the council and the wider sector to meet our statutory duties and maintain diverse, high-quality services, including working with providers to innovate and develop new service models.
• Adapting governance and strategies to reflect the priorities of the new council, while responding to changes in government policy, the prospect of local government reorganisation and devolution, and the restructuring of Integrated Care Boards.

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