Nottingham City Council assessment

Indicative score:

2 - Evidence shows some shortfalls

What people expect:

“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.”

The local authority commitment:

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

Key findings for this quality statement

Nottingham is the 11th most deprived area in the country. Senior staff told us they felt it was important not to be defined by this deprivation but to know about this, have plans to address it, and not let it stop them making improvements. Therefore, health inequalities were one of their priorities.

Outcomes were significantly poorer in Nottingham than in some other areas of the country with a lower life expectancy. Data reflected this, with much lower rates in Nottingham at 68.97% of people aged 65 and over still at home 91 days after discharge from hospital into reablement or rehabilitation (against 81.71% nationally). There were also much lower rates (50.68%) of people who had received short-term care support and who no longer required this (against 77.60% nationally).

Part of the Care Act 2014 is the suitability of accommodation in meeting the at home care and support needs of older and vulnerable people. People’s social care needs cannot be met if they do not have somewhere suitable to live. A shortage of housing was a theme that came through from staff and partners, and a lack of resources to support people living with complex needs. Feedback from some social work teams was that this created some of their demand and meant it was harder to move people’s cases on, because people continued to be at risk due to their accommodation situation. One partner agency told us they felt the issues around housing could also lead to the over-use of residential care and another partner said there was a lack of provision for younger adults particularly. Staff told us delays in placement reviews meant that people could also be waiting in care homes when they were ready to leave. Housing was not identified within Nottingham City’s self-assessment as an area for improvement, but this was a theme through many of the social care challenges reported.

A supported living project for people with a learning disability and for people receiving some mental health services had been successful in reducing admissions into long-term residential or hospital settings, and maintaining people’s independence. As of August 2023, 79 people had been supported who might otherwise have gone into or stayed in, a residential care setting. This approach maximised people’s independence and staff told us they felt very proud of what they had achieved for people. Ongoing work in relation to this was being carried out with landlords to help people keep pets, so further supporting wellbeing.

Relationships between the local authority and health partners were positive overall. For example, the local authority was involved in an active Ageing Well programme with health partners, which focused on prevention and hospital avoidance. Public health data was used to support this ambition to focus on prevention, rather than respond to crisis. The local authority worked closely with health in providing a reablement service to help people reach their full potential after illness or injury. Positive feedback was received from people in the Customer Survey Report 2022 in relation to this service. A reablement service supporting people with a learning disability to increase their level of independence over a 12 week period was also available. Outcomes for people could include improved social inclusion, improved health and wellbeing, independent travel and access to work or voluntary opportunities.

The local authority was involved in several other projects to support people to live healthier lives, promote independence and increase choice and control. For example, a project called Imosphere was planned, bringing care, support, and financial assessments online with the aim of giving people more independence and control. Day centre services worked with people to promote independence, for example by encouraging skills around cooking and practical skills. A Wellbeing at Home volunteer service supported people to remain independent in their own home either following a period in hospital or through the avoidance of a deterioration in health and wellbeing that could lead to a hospital admission.

An integrated wellbeing service had been commissioned as a single hub for the delivery of all of wellbeing services. From this were plans to upskill the adult social care workforce to better enable them to have healthy lifestyle conversations with people as part of their roles.

Advocacy services were available to support people in Nottingham. Advocacy is used to help people gain a sense of control over their circumstances. They had strong links with the local authority. However, feedback was that referrals could be low from teams and were not always made at an early enough stage. Sometimes assessments had already been completed when advocacy services were contacted, and they had few referrals that related to support for carers.

The Census 2021 indicated that there were 24,346 carers within Nottingham City. From co-production with the local authority, carers, and partners, 5 themes were identified for focus. These included accessing the right support for the cared for, access to relevant advice and information, and access to short breaks or replacement care to get a break from caring. These formed the new Nottingham Carers Strategy, laying out intentions which would be provided to better support carers over the next 5 years.