Hertfordshire County Council: local authority assessment

There was a real commitment across the local authority to partnership working to enable strong and collaborative relationships with partner organisations which secured the best outcomes for people. The maturity and long term stability of the senior leadership team meant that this approach was consistently implemented and well understood through the staff teams. This was also consistent with the drive for continuous improvement in terms of meeting people’s needs. The feedback we received from partner organisations was overwhelmingly positive about partnership working with the local authority.

The local authority worked in a very collaborative way with a range of partners. There was a real commitment to strong professional partnerships being key to ensuring that people’s needs were met in a range of ways, particularly when accessing more than one service.

The Director of Adult Social Services and the leadership team set the culture and expectation around the commitment to effective partnership working. Feedback from staff and leaders at all levels was that whilst they had strengthened their relationships with partners during the pandemic it was actually the fact that there were already effective strong partnerships which enabled them to work very effectively together during that time.

The post of Director of Health Integration was a jointly funded post with the Integrated Care Board (ICB). The postholder was part of the local authority senior leadership team. This supported the positive relationships in place with the acute Trusts and promoted the voice of adult social care in joint strategies agreed with the ICB such as the work currently being undertaken around people with complex health and social care needs.

The partnership working was really key to ensuring positive outcomes for people. For example, the integrated hospital discharge team was a jointly funded team with health. The team spoke very highly of the positive aspects of the integration of social care and health staff working collaboratively to support people to be discharged from hospital to the place that best met their needs with a person’s own home always being the aim. They felt that the positive working relationships they had with those teams ensured that they were able to gain advice and guidance promptly when needed. For example, they were able to get prompt advice from specialist teams such as those supporting people living with dementia, specific health conditions or domestic violence which meant that people received a seamless service with limited delays.

The discharge team also worked very closely with partner organisations to ensure that any equipment was in place for those returning home. The team gave us several examples of the positive outcomes for people. This included people being able to go home on the day of their planned discharge as equipment was already in place to support their independence at home. For some people the availability of the equipment enabled them to retain their independence and reduced the need for formal homecare support. The data also supports this proactive partnership working with regard to positive outcomes for people. National data indicates that 83.65% of people aged 65 years plus were still at home 91 days after discharge from hospital which was higher than the England average of 82.18% (SLTS). The waiting lists for people waiting to be discharged from hospital were greatly reduced and targets for discharge were exceeded. 

One of the people we spoke with told us about their very positive experience of partnership working between the social worker and other organisations. They said that the social worker had co-ordinated the support with four other organisations to ensure a joined up service for the person where everyone communicated well. They had even provided all of the information in a written format which supported the person to share with their family the plans that were in place for their support. This meant that the person was able to maintain their independence and remain living at home. They told us that they had really appreciated the additional steps that the social worker had taken to ensure that all organisations worked together to meet the person’s needs effectively.

The local authority teams worked very closely in partnership with their colleagues in the District and Borough Councils in relation to housing and are key partners in the strategic housing boards. This work has been key to the identification of where need is across the county and the subsequent planning and development of supported housing. This has led to the opening of one new extra care housing complex with another planned in the areas where the need had been identified.

In addition to this there is a mature, effective partnership with the Hertfordshire Care Providers Association (HCPA) which has also led to increased availability of homecare and of plans in place to provide a considerable number of additional nursing beds by the end of the year. Another result of the strong partnership working with HCPA has been to assist in the safe and efficient discharge from hospital to care homes where that was assessed as being the appropriate place for someone through the Impartial Assessor Service which carried out 1500 assessments from April to December 2023.

Staff and senior leaders told us about the range of other organisations who they worked with in relation to developing strategies as well as directly working together to ensure people received the support that they needed. This included a range of organisations working together as part of the Making Every Adult Matter (MEAM) process which aims to support the most vulnerable people in communities. The is early in the pilot stage but has clearly had benefits for people who would previously not have received support from the range of providers in such a joined up way. People being supported by the MEAM process received consistent ongoing support from professionals working together in a joined up way. The support was provided for longer periods of time than was usual which was beneficial to people who were particularly vulnerable and whose needs had not previously been able to be met through short term support. Other key partnerships included the police, fire and other public protection bodies, particularly with regard to ensuring people’s safety, both in preventative measures and through joint investigations where harm has been caused with clear lessons learned and shared.

The Learning Disabilities and Autism Strategic Partnership Board led the continued joint working under the Transforming Care programme. Through effective partnership working there have been improved outcomes for people. For example, Hertfordshire was meeting the trajectory for reducing the use of secure beds as people moved to more community based settings. This was really positive for those people who benefited from moving out of long stay secure hospitals. This was only possible through the ongoing partnership working between the local authority, the mental health Trust, care providers and housing partners.

We spoke with a range of partners who worked with the local authority and all of those who worked directly with them spoke overwhelmingly positively about the relationships in place at all levels of the organisation. We heard from more than one partner that they found the relationship with this local authority the most positive they had ever experienced. They spoke positively about the culture of the organisation and how staff were focused on meeting people’s individual needs, always looking to be creative with partners about how this could be done.

The focus on the importance of effective partnership working was present within the local authority as well as with external partners. All of the frontline teams who we spoke with were very positive about the benefits to the people they supported of working together effectively with their colleagues across the local authority. They felt that the multi-disciplinary make-up of the locality teams ensured that they had a wide range of knowledge within their own teams. Many staff also had a very good knowledge about the range of specialists within other teams, some of this knowledge had come about due to staff having worked in other teams and some as a result of shared learning events as well as the more formal directories. 

Where there was partnership working there were clear arrangements in place for governance, accountability, quality assurance and information sharing. The staff who we spoke with were very clear about their roles and responsibilities and that of the partners who they worked with.

For example, there was a Section 75 agreement in place between the local authority and the ICB to jointly commission services for people with a learning disability and those with mental health needs. The Section 75 agreement with Hertfordshire Partnership Trust enabled the Trust to carry out the delivery of social care duties to those with mental health needs. The integrated teams that were in place due to these arrangements worked effectively to improve outcomes for people. The frontline staff teams told us how positive it was to have learning disability nurses as part of the team. The nurses provided information and support to other staff as well as working directly with people with a learning disability. The integration of nurses in the front line teams improved communication between the professionals involved in a person’s life and also reduced the number of them involved which benefited the person receiving support.

The Better Care Fund (BCF) was used to fund integrated work, including the rapid response service which had been piloted in one area of the county but following evaluation was being implemented across the whole county. This was linked to one of the priorities of the fund which was to reduce preventable admissions to hospital and had successfully achieved this outcome. Other priorities were reablement and homecare, to improve carers services and to use assistive technology to improve services and maintain independence.

We received feedback from a senior leader who felt that the local authority was ambitious and were leaders in partnership working that had improved outcomes for people with the use of the Better Care Fund.

The strong partnership working between the local authority and the health Trusts meant that progress was taking place with regard to the use of shared care records. Staff told us of the positive benefits of this which included a lack of duplication, improved communication and a much clearer understanding of the overall support that a person needed and was receiving.

The local authority had systems in place to monitor and evaluate the impact of partnership working on the costs of social care and the outcomes for people. As well as formal governance systems the positive working relationships with partners meant that when any concerns or issues arose where possible these were able to be addressed more swiftly. Where there were Section 75 agreements in place there were separate governance arrangements in place for the agreements as well as for the work being carried out under those agreements.

There were systems in place to gather the views of people who used services, this included through formal co-production boards but also through asking for direct feedback following a period of contact with the local authority. This enabled the local authority to monitor the effectiveness of their partnership working and to identify areas where improvements were needed.

The local authority worked collaboratively with voluntary, community, faith and social enterprise (VCFSE) organisations to understand and meet local social care needs. The Community and Wellbeing team commissioned the VCFSE sector and this had included commissioning services that support the organisations themselves, for example services to encourage and recruit volunteers.

The majority of people who we spoke to from the VCFSE groups were very positive about the relationship between themselves and the local authority. They spoke positively about the local authority’s commitment to improving services and meeting people’s needs. Where people did not speak so positively this was where the direct relationship was not with the local authority and so it was difficult to ascertain whether there really was an issue or whether the lack of direct communication was to be expected as the VCFSE Alliance had the relationship with the local authority and the smaller VCFSE groups. 

Whilst there was excellent partnership working with clear positive outcomes for people when we spoke to individual people they were sometimes not clear who was providing their support and did not always understand that the service they received from the VCFSE sector was in fact commissioned by the local authority. 

The VCFSE Alliance had recently been formed which provided an overarching organisation for those smaller groups who provided a wide range of services within the community. One of the priorities for the local authority’s partnership with the VCFSE Alliance was to better understand the needs of people within the different communities as they were very well placed to identify these, particularly with regard to where people may be at risk of not receiving services. The local authority involved the VCFSE sector in co-production and the development of strategies.

The Alliance told us that the local authority couldn’t be more helpful to the voluntary sector and that they were always the first to support the sector. They said that they had very positive relationships with the local authority and spoke highly about the commissioners who really got involved and understood the issues rather than just contracting with them and then having no contact.