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London Borough of Hillingdon:
local authority assessment
How we assess local authorities
Assessment published: 13 December 2024
About London Borough of Hillingdon
Demographics
Hillingdon is the second largest of London’s 32 boroughs covering 42 square miles. Over
half of this is countryside, interspersed with historic towns and villages. It shares borders
with Hertfordshire, Buckinghamshire, Surrey, Hounslow, Ealing, and Harrow. The far
south of Hillingdon is home to Heathrow Airport. Hayes, Yiewsley and West Drayton are
more urban in nature.
The council footprint has an index of multiple deprivation score of 4, meaning it was
slightly below midway between the most and least deprived. This overall score consists of
some high-income and some high-deprivation areas. In 2019, 11.4% of the population of
Hillingdon were income deprived.
Hillingdon has a population of 310,681. It currently has a greater proportion of children
and young people at 23.36% (72,581) and people of working age 63.15% (196,203) as
compared to the England averages of 20.82% and 60.57% respectively. The population is
growing slightly, but most of the population growth is expected to be in adults over 65
predicted to increase from 13.49% (41,897) to 19.48 % (62,317) of the predicted
population of 319,870 by 2041. Hillingdon is ethnically very diverse. 51.82% are from
ethnic minority backgrounds including 33.32% of Asian or Asian British heritage.
Hillingdon is in the Northwest London Integrated Care System together with 7 other
London boroughs. The local authority has a strong Place Based Partnership board
(Hillingdon Health and Care Partnership) with other key stakeholders in Hillingdon. The
London Borough of Hillingdon is a Conservative led council, with a 14% majority.
Financial facts
The Financial facts forLondon Borough of Hillingdonare:
The local authority estimated that in 2022/23, its total budget would be
£430,659,000. Its actual spend for that year was £465,044,000, which was
£34,385,000 morethan estimated.
The local authority estimated that it would spend£78,792,000 of its total budget
on adult social care in 2022/23 Its actual spend was£84,500,000which is
£5,708,000more than estimated.
In 2022/2023,18% of the budget was spent on adult social care (ASC).
The local authority has raised the full adult social care precept for 2023/24, with a
value of2% Please note that the amount raised through ASC precept varies from
local authority to local authority.
This data is reproduced at the request of the Department of Health and Social Care. It has
not been factored into our assessment and is presented for information purposes only.
Overall summary
Local authority rating and score
London Borough of Hillingdon
Good
Quality statement scores
Assessing needs
Score: 3
Approximately3785 people were accessing long-term adult social care support,
and approximately820 people were accessing short-term adult social care
support in 2022/23. Local authorities spend money on a range of adult social care
services, including supporting individuals. No two care packages are the same and
vary significantly in their intensity, duration, and cost.
Supporting people to lead healthier lives
Score: 3
Equity in experience and outcomes
Score: 2
Care provision, integration and continuity
Score: 3
Partnerships and communities
Score: 3
Safe pathways, systems and transitions
Score: 3
Safeguarding
Score: 3
Governance, management and sustainability
Score: 3
Learning, improvement and innovation
Score: 3
Summary of people's experiences
Most people could access the local authority’s care and support services easily. They
could make contact through multiple channels, including online and self-assessment
options. According to national data, the proportion of people in Hillingdon who were
satisfied with care and support they received was slightly lower than the English average,
Fewer people paid privately to buy more care and support than the England average.
Most people did not have to wait for their Care Act Assessment, although people who
needed specialist assessments from the learning disability or mental health teams were
more likely to. Most reviews were completed on time. Carers reported more mixed
experiences of accessing assessment and of understanding what sort of assessment they
had had. Most people could access helpful information about care and support easily, but
some found the increased online offer challenging. Difficulties using online sources of
information was a barrier to access for some people.
There were no waits for occupational therapy (OT) assessments for equipment and
adaptations. 90% of assessments were booked within 2 weeks, and where necessary
these could be conducted more quickly. The provision of equipment after assessments
could however be delayed, particularly if it was out of stock.Strategic management and
oversight of the Occupational therapy service and equipment provision, and an arm’s
length relationship with the outsourced providers however, did not provide sufficient
assurance that people would receive an efficient and effective service. The process for
accessing equipment varied according to whether a person was already known to social
care.
Most people had positive experiences of hospital discharge.We found it was timely, safe,
and effective. Interventions such as reablement and short-term packages of care,
resulted in a significantly better than average proportion of people being able to remain
independent for longer when they returned home.
Transitions for people with care and support needs who were moving from childhood to
adulthood were supported by a preparing for adulthood team. We heard of both positive
and negative experiences. Transitions between local authority areas, and from self-
funding to funded care were also managed safely.
Most people we spoke with who had care needs had a choice and were satisfied with the
care and support they received. A much higher proportion of carers than average were
able to access respite and short breaks, in an emergency, for less than a day and for
longer periods.
There were no notable delays for packages of care or placement after an assessment of
need. Whilst 75% of people across all primary support reasons were placed in borough,
those with complex needs who needed residential, nursing care or supported living were
more likely than others to be placed outside the borough boundary.
National data in the Adult Social Care Outcomes Framework (ASCOF Dec 2023) showed
that the uptake of direct payments as a means of receiving support was lower than
average for older adults and carers, adults aged between 18-64 and overall, but action
taken by the local authority had increased the rate of uptake by 22% in the last 12
months. There was a good support service for people using direct payments, and the
local authority had considered and addressed the barriers for people wanting to use
them.
The local authority worked closely with thevoluntary, community and social enterprise
sector (VCSE) sector to provide an early intervention and prevention offer to support
wellbeing in Hillingdon such as job clubs, and wellbeing support for people with a mental
health condition.
Preventative services provided by the local authority and partners had a positive impact
on well-being outcomes for people who might have care and support needs.Carers were
very satisfied with the commissioned carers support organisation. Most carers felt safe,
but the proportion was lower than the national average.
Where concerns were raised about people who may have experienced abuse or neglect,
these were responded to without delay. Investigations might take longer for people who
required advocacy to support them through this process. There were no waits for
Deprivation of Liberty Safeguards (DoLS) applications for people in residential care
waiting for assessment, and whilst there was a considerable wait for community based
DoLS applications, the local authority had identified a team to progress these to be ready
for the court process.
People in Hillingdon were given opportunities to be involved in developing strategies, and
the way care and support were provided by the local authority. People were listened to,
and their ideas shaped services.
Summary of strengths, areas for
development and next steps
The London Borough of Hillingdon worked very closely with system partners across the
area and had a clear focus on working together with others to achieve the best outcomes
for people who lived there.
The local authority was committed to early intervention and prevention and there was a
strategic and operational focus on reducing, delaying, and preventing needs for long-term
care and support, which was effective. The formal strategy and commitment to this was
documented in the Health and Wellbeing Strategy, to which the local authority was a
signatory. This is also reflected in the Adult Social Care Plan 2024-27 and the Better Care
Fund plan.
The local authority had a centralised contact point for all referrals, either from individuals
or other professionals. Assessment teams were based either on specialism, such as a
team of people with learning disabilities and autistic people, or mental health needs, or
on locality.
The local authority was committed to tackling inequalities and was involved in a range of
initiatives and action. At the time of our assessment, there was no data to demonstrate
the impact of these efforts. There were still some areas where inequalities of access to
information, support to participate or local provision were experienced by some people
due to their specific care and support needs, or their ability to use online resources.
The local authority had a significant number of residential and nursing care home beds,
but demand for these also came from people who paid for their own care, the NHS and
other local authorities. This meant a relatively high proportion of placements, especially
for people with complex needs had to be made outside the borough. There was limited
availability of local supported living for people with learning disabilities, particularly for
people requiring specialist provision, which contributed to out of area placements. The
local authority has plans for some additional registered care capacity.
The local authority used data and engaged with the local community to understand its
care and support needs. This included understanding of the diverse needs of different
groups of people. They recognised they needed to do further work in this area, but had
taken significant steps, particularly to ensure services for the LGBTQIA+ community were
accessible and appropriate to meet their needs in a person-centred way.
The local authority had a robust commissioning team which actively engaged with
providers to ensure a range of high-quality, diverse provisions were available to meet the
community's needs. They worked with partners to ensure commissioning and contracting
decisions were based on up to date, accurate information about performance. The local
authority had a strong risk management framework for commissioning and care
provision.
The London Borough of Hillingdon were valued by system partners for the way they
worked together to achieve good results for people. Partners recognised the local
authority worked hard at this. Integration and working together supported safe
transitions for people between health and social care. The team working with young
adults in transition had strong links with other teams, to ensure they planned at the
appropriate time, in a person-centred way to prevent crises and ensure safe transitions.
The local authority had a clear understanding of the safeguarding risks and issues in the
area. They worked with partners in respect of safeguarding to reduce risks and to prevent
abuse and neglect from occurring. Specific issues included the increase of hoarding and
the risk of suicides, for which protocols and strategies were in place.Audits had shown
however that learning from SAR’s was not embedded in policy and practice.
The local authority had strong, visible leadership team with clear roles, responsibilities
and accountabilities. Structures were in place to oversee governance, risk management,
and accountability arrangements at all levels. These provided some visibility and
assurance on delivery of Care Act duties. Some areas however lacked strategic oversight
which resulted in inequitable outcomes for some people.Where shortfalls had been
identified, for example in relation to occupational therapy assessment and the provision
of equipment, performance data dashboards were being built to improve the line of sight
on delivery.
The local authority did not currently have consistent data about performance over the
last 12 months and this had been acknowledged by them as an area for development. A
new approach to data, whilst still being implemented, was addressing this gap and
further data collection and analysis was planned to improve governance and oversight.
Staff at Hillingdon were very proud to work there and felt valued and supported. The
senior leadership team were visible, engaged and compassionate. The local authority
sought feedback and coproduction with people who used services. Whilst this was an
ongoing development, they were committed to co-production as a way of planning and
working.
Theme 1: How London Borough
of Hillingdon works with people
This theme includes these quality statements:
Assessing needs
Supporting people to live healthier lives
Equity in experience and outcomes
We may not always review all quality statements during every assessment.
Assessing needs
Score: 3
Score: 3 - Evidence shows a good standard
What people expect
I have care and support that is coordinated, 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.
The local authority commitment
We maximise the effectiveness of people’s care and treatment by assessing and
reviewing their health, care, wellbeing and communication needs with them.
Key findings for this quality statement
Assessment, care planning and review arrangements
Many but not all people could access the care and support they needed easily. The local
authority accepted referrals directly from individuals or from professionals on their behalf
(with the documented consent of the individual). People could ring or email Hillingdon
Social Care Direct (HSCD) to request support and there was an online system to complete
a self-assessment. The local authority told us they were using “leading technology” for call
triage and data collection.This included the ability to recognise existing service users to
ensure those in need of support would be answered in a timely way. They said this
helped them to manage demand effectively, identify early signs of vulnerability and
provide timely support and intervention to individuals, thereby reducing the risk of
escalating care needs. No data about the impact of this technology was available at the
time of our assessment but has since been developed.
The local authority told us their phone system recognised if English was not a person’s
first language and diverted the call if a person needed extra support. We also heard that
there were translation options on the website for people who wished to use them.
Notwithstanding these measures, some partner organisations identified digital or
telephone access only to the local authority was a barrier to some of the people they
worked with, particularly those for whom English was not their first language, those with
communication difficulties, or those who did not have easy access to the internet.
Some partner organisations also told us it was hard to make a referral and noted even
they found the online form was difficult to use and limited their ability to explain a
person’s situations clearly. The local authority told us their phone system recognised if
English was not a person’s first language and diverted the call if a person needed extra
support. We also heard that there were translation options on the website for people
who wished to use them.
A duty manager triaged referrals to prioritise and signpost to the right team. HSCD staff
are supported with information and advice from social workers in the team to gather
sufficient information to aid appropriate triage. The case is progressed through the
localities social work teams who complete the reablement or Care Act assessment.
Both reablement assessments, and Care Act assessments were explicitly strengths-based
and person-centred. The local authority used an assessment model called ‘Functional
Analysis of Care Environment’ (FACE) which was developed collaboratively with local
authorities. The most senior leaders in the local authority had a clear understanding of
the assessment process, which supported staff. Assessments considered the needs and
preferences of the person with care and support needs, and any carer supporting them,
reflecting their rightsto choice. They built on their strengthsand assets and reflected
what they wanted to achieve. Staff were provided clear guidance to support practice.
Staff told us they offered individuals a choice about where their assessment took place.
This could be in their homes, library services; the Civic Centre; or any other suitable
location they chose. They could also be assessed through remote methods such as video
or telephone calls if they preferred. Other factors such as communication needs, the
presence of others during the assessment, safeguarding concerns, and the potential for
substantial difficulty in participating were taken into consideration. Data from theAdult
Social Care Survey (ASCS, Oct 2023) found 58.2% people in Hillingdon were satisfied with
care and support they received as compared to the England average of 64.4%.
Not everyone we spoke with had a good understanding of the assessment process they
had received but had received the support or information and advice they needed to
achieve the outcomes that were important to them.
Most people’s experiences of care and support ensured their human rights were
respected and protected. We saw evidence people were involved throughout in
decisions. Leaders at the local authority were committed to supporting people from
diverse communities in Hillingdon. Staff were provided with equality, diversity and
inclusion training to support them to work with all people, including those with protected
characteristics under the Equality Act 2010 in a person-centred way. One person we
spoke to however said they hadn’t been asked about any support they needed to
participate in the assessment.
Staff told us they kept up to date with people in other teams and knew who to contact
about people’s care and could do joint visits with other people involved in their care as
well. Where there was a higher risk situation, they could discuss with their managers and
partner health team managers. Staff felt partnership working was very good in Hillingdon.
There was clear evidence of pathways and processes which ensured people’s support
was planned and coordinatedacross different agencies and services. We heard from staff
and partners about the very effective joint working between NHS and local authority staff
which successfully managed assessments at the point of hospital discharge to ensure
people were safe and had timely discharges.
The local authority had assessment teams who were competent to carry out
assessments, including specialist assessments.They had good access to training and
support, their practice was supervised, and audits were undertaken to ensure
assessments were completed appropriately, and effectively.
We heard some negative feedback about the timeliness of assessments and
responsiveness of the local authority. A partner organisation reported they had made
referrals, they found the local authority slow to respond to referrals they had made, and
people could wait weeks and sometimes months to be allocated. They also said they
struggled to get a response when chasing this up, and when the person was allocated to
a social worker, their case seemed to be closed quite quickly.One person we spoke to
waited 2-3 months between initial contact and assessment and did not remember any
contact from the local authority whilst they waited.Another partner organisation working
with people with mental health needs also reflected long wait times for Care Act
assessments.
Timeliness of assessments, care planning and reviews
The local authority had however recognised that some people had prolonged waits for
assessment and had taken action to address the issue. At the time of our assessment
there were 11 people waiting longer than 28 days. At the time of our assessment, the
local authority had 42 cases requiring assessment and allocation across North and South
locality teams, but all were within the 28-day assessment timeline and had been triaged.
Reviews were planned for six weeks after any service was initiated, and thereafter
planned annually. According to the Adult Social Care Finance Report (ASCFR) / Short and
Long-Term Support (SALT Dec 2023) 69.33% of people in Hillingdon in receipt of long-
term support had planned or unplanned reviews which was better than the England
Average of 57.14%. The local authority had recently cleared a backlog of overdue planned
reviews and told usunscheduled reviews requiring allocation were being addressed. The
oldest unscheduled review awaiting allocation was from January 2024. The allocated Duty
team Manager and front-line workers proactively reviewed cases, triaged them, and
prioritised them according to risk for allocation. This ensured urgent cases were identified
and actioned immediately, prioritising those with the highest need for intervention.
Assessment and care planning for unpaid carers, child’s
carers and child carers
The local authority told us no carers assessments were pending. Hillingdon Social Care
Direct might signpost to the local carers organisation for a specific carers assessment, but
if a cared for person is part of the referral conversation, the referral is passed to the adult
social care team to complete under a joint assessment. They told us that in all cases,
people are met with or offered a separate assessment, and the social worker will typically
follow up separately. The local authority completed 853 carers assessments under the
Care Act in the last 12 months, of which less than a third were sole carer assessments as
compared to joint assessments with the person they cared for. Joint assessments can
make it more difficult to articulate the separate needs of carers as distinct from the
person with care needs. This is because the focus of the assessment is how best to
support the person with care and support needs, whilst taking account of the impact on
the carer and their wellbeing; and because if both are present it may be more difficult for
the carer to speak freely about the impact of their caring role.
Information about obtaining an assessment was provided on the council website,
through a consortium of organisations and various voluntary sector providers. However,
carers told us that in their opinion, information about how to obtain an assessment was
not readily available and was discovered either by word of mouth or the person seeking it
out. All the carers we spoke to had however received what they called a carers
assessment or knew where to get one, and subsequently received all the support they
wanted or needed. The assessments had been completed by a variety of sources,
including carers organisations. Carers had variable experiences of accessing assessment
and support in their caring role, and not all were aware of the difference between a Care
Act assessment from the local authority, as compared to an initial assessment from the
local carers organisation. Carers organisations who provided support to carers, were able
to refer onwards where they or the carer themselves identified a statutory Care Act
assessment would provide additional support. This included support such as bed-based
respite care, rather than the sitting service the Carers Association provided, or additional
care and support in the home to reduce the burden on the unpaid carer.
Staff in the local authority told us they frequently identified carers during their
assessments of service users. They subsequently conducted carers assessments as part
of the Care Act assessment and provided information about support available. Where
they identified young carers, they signposted them to a specialist service delivered by a
partner organisation, which offered support through training and outreach initiatives.
The Survey of Adult Carers in England (SACE, June 2024) data showed carers in Hillingdon
had relatively similar levels of access to encouragement and support at 28.57%, training
at 7.41% and satisfaction with social services at 36.73% to the average figures for England.
By contrast, fewer carers in Hillingdon felt they had control over their daily life at 16.07%
as compared to 21.53% in England. Similarly fewer carers in Hillingdon 22.22% reported
accessing a support group or someone to talk to in confidence as compared to 32.98%
average in England. More significant variations were seen in the number of carers in
Hillingdon experiencing financial difficulties because of caring at 57.14% as compared to
the England average of 46.55%, and the number of carers not in paid employment
because of caring responsibilities at 40% as compared to the England average of
26.70%.The local authority told us that 45% of carers were retired.
Help for people to meet their non-eligible care and
support needs
People were given help, advice and information about how to access services, facilities
and other agencies for help with non-eligible care and support needs. The primary
sources of this information were through HSCD, and the local authority’s website, which
had links to information about a range of services. Staff in the local authority also shared
information with people during and following assessments. Partner organisations told us
they had co-produced information with the local authority, for example about how to
manage during the winter months or with the cost-of-living crisis but noted it was
distributed on the local authority website which they felt was not easy to navigate. The
local authority told us that they gathered feedback from people who used their
information and advice team (HSCD) by way of a survey. Results from these surveys
included that 100% reported that the service had made a positive difference and 100%
reported the information given was clear and that they were listened to.
The local authority’s framework for eligibility for care and support was transparent, clear,
and consistently applied. Decisions and outcomes were timely and transparent. They did
not have a separate appeal process but reported only 1 complaint in the last 12 months
related to an eligibility decision. In this case, the complaint was partially upheld and
additional short-term services provided. According to the Adult Social Care Survey (ASCS
Oct 2023) proportionately more people, 69.86%, in Hillingdon do not buy any additional
care or support privately or pay more to 'top up' their care and support as compared to
the England average of 64.63%.
Eligibility decisions for care and support
Financial assessment and charging policy for care and
support
The local authority had a framework for assessing and charging adults for care and
support. There were occasions when it was not found to be clear, transparent, timely and
consistently applied. They told us the Financial Assessment team had no waiting lists and
assessments are typically completed within a time frame of 14 to 28 days. They noted
however, more complex cases and the level of engagement with clients or their
representatives may require additional time.
We were told that the local authority had received several complaints related to financial
assessments and charging policies which were addressed through their standard
complaints process, ensuring each case was thoroughly investigated and resolved. Two
such complaints went to the Local Government and Social Care Ombudsman (LGSCO).
Some complaints related to lack of clarity of information. In the example provided, where
this was reviewed, the local authority had acknowledged that there were concerns about
the clarity of information provided. Apologies were extended, and the complaint was
addressed by ensuring better communication and support for the family. In a second
example, the complaint related to fees incurred due to an unexpected delay in return
home from short term care, following a review. The local authority took appropriate
action to redress the situation.
The local authority had a clear process to follow, guiding staff to when it would be
appropriate to refer for independent advocacy support to help people participate fully in
care assessments and care planning processes. They commission advocacy services
through a single provider, to support people throughout the assessment and support
planning stages.
Provision of independent advocacy
The local authority said that use of the advocacy contract was overseen at a seniorlevel,
and that referrals were in line with the requirements of the Care Act. This contrasts with
feedback from a partner organisation who told us theydid not get as many referrals to
support Care Act assessments as they thought they should, and sometimes referrals
were instigated by care providers rather than social workers. They told us they felt the
relationship with the local authority could be stronger. They also said they had challenges
to deliver the level of support needed in a timely manner, and to have time once in place
to complete assessments. Staff recognised that they had a good response from the
service providing advocacy in the borough, but in some cases, there was a delay before
an advocate was allocated. Staff also reported instances where delays in safeguarding
investigations being completed were caused by delays of 4 weeks in providing a suitable
advocate. They noted that this usually took 1-2 weeks.All these issues regarding advocacy
provision impacted on some people’s abilityto speak up for themselves or engage fully in
assessments. There were plans to retender the advocacy service in 2025.
Staff told us an individual’s capacity was typically assessed during the assessment
process. They may involve family members to assist the service user during this
assessment if deemed appropriate. In cases where the service user lacked capacity and
did not have family or friends to provide advocacy support, a referral was made to the
advocacy service.
Where a person was placed by the local authority out of borough, they could not access
Hillingdon’s commissioned advocacy service. Staff reported difficulties and delays but
would work in partnership with the host local authority to identify and access advocacy
support for the individual, so the person was supported with appropriate advocacy
before any decisions were made about their care.Staff told us monthly meetings were
held with advocacy providers to discuss capacity and any case issues to address any
capacity issues.
Supporting people to live
healthier lives
Score: 3
3 - Evidence shows a good standard
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
Arrangements to prevent, delay or reduce needs for care
and support
The local authority, the Hillingdon Health and Care Partnership and the North West
London Integrated Care Board (NWLICB) are jointly responsible for the Hillingdon Health
and Wellbeing Strategy. This key document incorporates early intervention and
prevention as a fundamental principle. The local authority did not have its own formalised
strategy specifically focused on preventing, reducing, or delaying the need for care and
support, but told us they were committed to delivering a range of initiatives aimed at
achieving these outcomes. All staff and partners we spoke with had a clear understanding
that early intervention was a significant part of the local authority’s approach to delivering
its duties under the Care Act.
The local authority said their focus was on addressing the root causes of care needs and
promoting independence and well-being among residents, particularly older adults. They
based their actions on proactive intervention and collaborative working across health and
social care partners, people and the local community. Stakeholders offered a range of
services, facilities, resources and other measures to promote independence, and to
prevent, delay or reduce the need for care and support.
Voluntary sector organisations were commissioned by the local authority to deliver
provisions such as job clubs, social activities and an early intervention service to adults
18+ promoting mental health and preventing worsening of mental health issues. Whilst
the local authority told us they had provided a 12-month lead in time to the change, and
support to develop business models, we heard the change from core grant funding to
commissioned services, had had a disproportionate impact on smaller voluntary groups.
Health and social care agencies had a joined-up approach to people who relied heavily on
services, including interventions and care packages to identify the most appropriate
resources to intervene early and reduce crises. Hoarding was a particular issue in NW
London.Partners in the Health and Wellbeing partnership were testing an approach,
working together to address this, but had not yet captured any outcome data.
Assistive technology was being used to support people to remain independent. The local
authority was piloting use of an aid which allowed them to understand a person’s
movements and subsequently provide proportionate, appropriate support which
reduced risk but was not restrictive.
Partner organisations felt the local authority understood the challenges people in the
community experienced, such as, housing and the double impact of cost of living and
getting into debt. It was noted Hillingdon had some specific low-income areas. The local
authority was aware of the lack of affordable housing and was explicitly seeking both to
build and to buy additional housing stock, to address this.
We heard in recent years in Hillingdon, there had been a significant increase in the
numbers of people, who had died by suicide. Partners in Hillingdon including the local
authority, voluntary sector groups and transport providers were working together to seek
to prevent this and to identify hotspots.
According to the Survey of Adult Carers in England, (June 2024)80 % of carers found
information and advice helpful which was slightly less than the England average of
85.22%.Only 12.5% of carers surveyed in Hillingdon reported being able to spend time
doing things they value or enjoy. Whilst this is consistent with the England average, it is
only 1 in 8 carers. However,carers spoke highly of the organisation commissioned by the
local authority to support them, through whom they received help to complete difficult
forms, provided benefits advice, information about local groups suitable to the carer’s
requirements, and direct support.
Data from the ASCS (October 2023) about adults with care and support needs, were
mostly consistent with average results across England. For example,62.41% people in
Hillingdon who were surveyed, said help and support helped them to think and feel
better about themselves, compared to the England average of 62.32%). 69.15% reported
they spend their time doing things they value or enjoy which was comparable to the
England average of 68.17%.
Public Health worked with organisations to support them in offering relevant
opportunities to people to meet their individual needs and interests. Staff gave an
example of how they met a person with early onset dementia who had worked for many
years in a role they really enjoyed and was becoming depressed due to having to give this
work up. The local authority worked with partners, provided training and advocated for
them to become a volunteer in a similar role within the borough, which was still
accessible to them. The person was able to volunteer for around 18 months and gave
feedback during this time they felt valued and proud they could contribute to their local
community.
The local authority had a significant extra careoffer, where sheltered housing was
provided with housing and personal care related support available on site.We heard
there were only a few vacancies, but significant demand. There was a proactive approach
by the local authority to reduce and delay demand for residential and nursing care home
placements. Staff told us in the last18 months there had been many success stories with
people known to mental health teams, where they had supported discharges from
Mental Health wards, and those struggling in the community moving on, into supported
housing and extra care.
They were now introducing daytime support for people who did not live in extra care
schemes within established services, so people could see what the schemes were like and
consider them as a more independent alternative care option.
The local authority had taken steps to identify people with needs for care and support
which were not being met. They had a Communities’ Programme team who worked
closely with the voluntary sector. A partner said they were very good at investing in
facilities and green spaces, creating resources for communities, dementia cafes, language
groups, and reaching into the heart of communities to find people.Leaders
acknowledged they needed to do more but were using community places such as the
sports centre, and running engagement events across the borough, to listen to people
and provide information and advice. Where appropriate, people would be signposted to
make a referral via Hillingdon Social Care Direct.Accelerated reform funding was being
used for work to identify unpaid carers.
The local authority considered whether reablement approaches were appropriate before
any long-term services were put in place. By screening at the front door for reablement,
this reduced the number who went on to need longer term care. Reablement was
provided as a partnership between a commissioned domiciliary care provider, and
occupational therapists who provided the care plans. Local authority staff told
us reablement programmes were based on an individual’s personal goals but getting the
therapy calls at the right time, and for long enough duration to work in an enabling way
rather than doing for the person, was challenging. Reablement was also available to
anyone on discharge from hospital who had the potential to be supported to improve
their independence.
According to the ASCS (Oct 2023)80.28% of people in Hillingdon who received short term
support no longer required support as compared to an England average of 77.55%
Impact of reablement was measured by whether the aim was achieved – but what this
meant in practice could vary from one person to another and did not necessarily mean
they did not continue to need care.
Provision and impact of intermediate care and reablement
services
The local authority also worked with partners to offer intermediate care. They had 15
nursing care beds where there was in-reach from physiotherapists and other allied health
professionals to help people to rehabilitate after hospitalisation.
The Adult Social Care Outcomes Framework – Short- and Long-Term Support
(ASCOF)/SALT: (Dec 2023) found 1.86 % of people 65+ received reablement/rehabilitation
services after discharge from hospital which was slightly lower than the England average
of 2.91%.A senior NHS leader noted the local authority guaranteed all patients on the P1
pathway whose needs could be met by provision of support in their own home, would
leave the hospital on the same day. This meant they could plan discharges for the day.
They consequently had the lowest number of patients who did not meet the criteria to
stay in hospital in NW London.The Bridging Care service was part of the P1 offer to
people leaving hospital and gave 5 days support to facilitate same day discharge.This
mitigated the immediate pressure on the wider domiciliary care market.Rehabilitation
and reablement in Hillingdon was effective.ASCOF (SALT) data also showed 92.31% of
people over 65 were still at home 91 days after discharge from hospital into reablement/
rehabilitation which was significantly more than the England average of 82.18%.
People who needed assessment for and provision of aids, equipment and adaptations to
their home, could access it. If a person was in hospital this would be dealt with by NHS
staff who had access the same services as the local authority. if a person was not
allocated to a social worker, Hillingdon Social Care Direct, were able to request a range of
minor aids and equipment such as a raised toilet seat, and only make a referral for a full
OT assessment if necessary. There was a difference of understanding between staff and
the local authority about what happened if a person was already known to a social
worker. Staff told us that in these cases, HSCD would pass the referral directly on to the
social worker who would make a referral for an OT assessment for even minor aids,
because they were not trained as Trusted Assessors for these. The local authority told us
that all people could access minor aids and adaptations via HSCD.
Access to equipment and home adaptations
Referrals were triaged by a senior OT who worked for the local authority and passed
within 24 hours to external OT providers for progression. Part of the triage was to
determine urgency. The most urgent cases were to be assessed within 2 days, high
priority within 5 days and normal priority within 14 days. We heard the local authority and
external providers worked together to expedite individual cases when necessary. The
local authority also had access to the NHS rapid response (NHS team) for critically urgent
assessments or interventions. More than 90% of assessments were booked within 2
weeks. The external provider had had a backlog with some referrals going beyond 14
days in February/March 2024 and took a pause for 1 week due to capacity, but reported
they were performing normally now. Two service coordinators at the provider were
trained as Trusted Assessors, which meant they could also order minor aids, to reduce
waiting times for all.
Oversight of the end-to-end occupational therapy process, which involved different teams
in different circumstances and an arm’s length relationship with the outsourced
providers, did not sufficiently ensure that people would receive an efficient and effective
service. The process for accessing equipment varied according to whether a person was
already known to social care and added a delay for some people.The local authority was
unable to report median and maximum waiting times over the last 12 months but had
noted this was an area for development.The local authority told us that assessments
were quality checked and signed off by a senior OT employed by the local authority, and
that cases were kept open until the equipment had been delivered, was meeting the
persons needs and had been reviewed.
Referrals for Disabled Facility Grant applications for major home adaptations, were dealt
with by a different local authority directorate.
Equipment was supplied by a provider commissioned at a regional level. Staff told us
there were sometimes issues when an item was out stock, and the equipment provider
did not keep either the local authority or the individual informed about this. They said
there was an expectation that either the person themselves or a member of staff from
the local authority would follow this up. The local authority told us in contrast that the
equipment contract manager was kept informed of outstanding orders and would follow
these up with the provider.
The individual would be without the necessary equipment, and it was unclear as to whose
responsibility it was to ensure that they had safe and sufficient care in the interim.
We heard OT staff who worked for the local authority found it more difficult than
previously to access training, for example about mental capacity, and the OT’s used by
the independent provider were responsible for their own continuing professional
development. The local authority’s contract with the provider placed responsibility on
them to ensure personnel employed in connection with the contract were sufficiently
qualified, competent, skilled, honest and experienced, and sufficiently instructed and
supervised.” The local authority told us the contract is monitored quarterly regarding
agreed key performance indicators.
The local authority told us it provided information and advice and signposted people to
the most appropriate resource at each touch point with services, from the front door to
adult social care to the point a social worker is allocated.This included unpaid carers and
people who fund or arrange their own care and support.
Provision of accessible information and advice
One way for people to access information and advice on their rights under the Care Act,
and to meet their care and support needs was via the Local authority’s Care and Support
Directory. People, voluntary sector organisations and partners all noted the online nature
of this resource was a barrier for some people. ASCS data (Oct 23) 65.68% of people who
use services found it easy to find information about support which was consistent with
the England average. Carers reported having more difficulty, and SACE (Jun 2024) showed
48.78% of carers in Hillingdon found it easy to access information and advice which was
lower than the England average of 59.06%.
The local authority was aware of these concerns and was arranging an audit of the
website to ensure it was as accessible as possible. They had committed to resolve all
accessibility issues identified by the audit which were within their control. Nevertheless
there was presently some inequitable access for people who were not able to use online
sources of information.
Direct payments are money a local authority pays to people regularly (or someone acting
on their behalf) so they can arrange their own support, instead of receiving social care
services arranged by the local authority.The local authority had a lower uptake of direct
payments than the England average of 26.22%. Data showed only 633 people,
representing13.65 % of total service users received direct payments. These were 19.83%
of service users aged 18 - 64 compared to the England average of 38.06%, and 7.75% of
service users aged 65 or over compared to the 14.80% average in England. ASCOF/SALT
data (Dec 2023) shows 100% of carers who received a service, did so via a direct payment.
Staff told us however they had had a 22% increase in direct payments in the last year.
People reported it was hard to recruit personal assistants, so the local authority now gave
them a list of providers of payroll services and recruitment support for Personal
assistants which had helped.
Direct payments
Data from the local authority showed more people from ethnic minority groups used
direct payments (360 out of 633), than white British people (270), with 3 people not
disclosing their ethnicity. Just less than a third (190) of payments were ongoing personal
budgets for carers, used to support them in their caring role.About one third each were
used to employ personal assistants or to pay for agency care. The remainder was used
for daycare.
There was a direct payment support service and people had ongoing access to
information, advice and support.The local authority said ordinarily, a person would be
able to use their direct payment to begin care within 4 days and most could within 2
weeks, although it could sometimes take longer.
People were signposted to use the Council’s care and support directory but could
purchase care from any provider. The local authority said they advised people who
required personal care that they should use a CQC registered provider and consider their
rating and most recent inspection report. We were also told the local authority had
increased the direct payment rate for those who wanted to recruit personal assistants,
rather than use a regulated domiciliary care company.
In the 12 months to March 2024, 60 people stopped using direct payments. All stopped
because they were no longer eligible or suitable to the person. No-one was reported as
moving from direct payments because they were unable to meet their needs through
them.
Equity in experience and
outcomes
Score: 2
2 - Evidence shows some shortfalls
What people expect
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
The local authority commitment
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.
Key findings for this quality statement
The local authority had regard to its Public Sector Equality Duty (Equality Act 2010) in the
way it delivered its Care Act functions; there were equality objectives to reduce
inequalities and to improve the experiences and outcomes for people who are more
likely to have poor care.
The local authority understood its local population profile and demographics. They had
introduced technology to gather data on referrals into Hillingdon Social Care Direct to
capture whether the service was accessible to all. Leaders demonstrated both a
commitment to address and an awareness of the inequalities across the borough. There
were inequalities identified based on deprivation, which was linked to certain parts of the
borough, and based on ethnicity and other protected characteristics.
Understanding and reducing barriers to care and support
and reducing inequalities
Efforts by the local authority to support the principles were embedded in staff training,
person centred ways of working and efforts to engage and co-produce with seldom heard
groups. There was no written strategy, but a leader told us a workstream and delivery
plan were being implemented. At the time of our assessment there was no data or
reported outcomes to demonstrate the impact of initiatives and measures in reducing
inequality. Nevertheless relationships were being built and engagement was improving.
Leaders told us during Covid efforts were made to reach out to seldom heard groups and
over time this has resulted in trusted relationships with different communities.
Community groups created during the pandemic were still active and were used as a
gateway to engagement.
Senior leaders recognised hearing the voice of people/communities was an ongoing area
for development across the local authority. They had co-production boards but
acknowledged the need to widen participation, so they didn’t just hear from the same
people. Managers gave examples of how efforts to hear from wider communities were
being addressed using ballot boxes to hear people's voices, and visits to schools to seek
the experience of people with lived experience of care and support needs. Staff were
going into the community and working with organisations and people who were
supporting disadvantaged and marginalised peoplesuch as Muslim communities, Gypsy,
Roma and Traveller communities and asylum seekers.
There was recognition some communities, for example the significant Somali community
in Hayes, had strong religious and cultural beliefs which meant traditional ways of
offering support and engagement were ineffective. The local authority and voluntary
sector partners had reached into these communities, through people with the same
languages and culture, to better understand and offer support which was accessible. We
heard they had been invited to numerous celebrations, such as Eid celebrations alongside
local authority members, police and other professionals as guests of groups. This
promoted strong community links and good working relationships between community
groups and professionals.
Staff told us they have sought and used information and guidance about how to make
services equally accessible to people from the LGBTQIA+ community and liaised with
another local authority who had developed expertise in this regard. Staff told us there
were not enough services for the LGBTQIA+ community, but there was a project to set up
access in the local library for advice and signposting services.
It was explicit in domiciliary care contracts providers should be able to meet the needs of
any client for whom they were commissioned, in addition to valuing diversity and
inclusion strategies. Providers were also asked about the languages their staff spoke, to
ensure people were receiving care in their own language. Staff told us of the partnerships
they worked with, such as language and interpretation services, MIND charity, and the
Hillingdon for All hub which was a consortium early help and wellbeing organisation.
Staff were provided with training in equality and diversity, and there was a staff forum.
Examples of cultural awareness training included Gypsy, Roma and Traveller
communities, Hate Crime, LGBTQIA+ and Sexual Orientation, Neurodiversity and
Learning Disability Awareness.
The local authority told us that 74% of people requiring accommodation-based services
such as residential care or supported living, were able to remain in borough. People who
needed care and support because of their learning disabilities were however more likely
than others to be placed further away from people that they knew, due to a lack of local
supported living. This created a risk of disconnection from people that were important to
them, which might impact on their wellbeing, and other outcomes.
Inclusion and accessibility arrangements
The local authority had a translation and interpretation service. This was available in over
250 languages for telephone calls, face to face and online meetings, and translation of
documentation. The service also had a subscription to a web-based tool which aided
understanding and communication for people who find reading text difficult, and a
library of easy read documents and could provide large print or braille versions if
required. Use of this service was not fully embedded in all teams and a partner
organisation told us information was not always being provided in accessible languages
by the local authority.
The local authority maintained a spreadsheet listing the languages staff were fluent in,
including British Sign Language, and Makaton.
Some people found the online nature of Hillingdon Social Care Direct, and sources of
information such as the social care directory, inaccessible. This was because of
communication barriers, such as not having English as a first language, or wider barriers
to communication caused by their health and care needs. For some people this was
simply because they did not have access to the internet. This created an avoidable
inequity of experience.
During assessments staff used various tools tailored to the individual's communication
preferences. They considered the persons preferences for different types of visuals. They
considered where and how the assessment should take place to best support the person
to feel safe and engage. They considered other factors such as the individual's
engagement levels, preferred time, and medication schedule, which could impact their
participation in assessments.
The local authority commissioned a report in 2020 “Making the Council more Autism
Friendly” which led to numerous initiatives. An environment checklist was developed
which was completed annually. This was used in front facing areas of the local authority
and focussed specifically on how the environment might impact on the needs of autistic
people.
Staff and leaders were mindful of, and working to address, any accessibility issues or
limitations on services offered which might impact more on one group than another.
They gave examples of providing additional written guidance to help older people use
assistive technology and speaking to catering staff in care establishments about limited
menus.
The local authority said that oversight of commissioning and use of the advocacy contract
was managed, and that referrals were in line with the requirements of the Care Act. This
contrasts with feedback from a partner organisation who felt not all staff had a robust
understanding of when and how to use advocacy, which meant that people might not be
offered it in a timely manner, to support them to speak up for themselves or engage fully
in assessments. Staff also reported instances where delays in safeguarding investigations
being completed were caused by delays of 4 weeks in providing a suitable advocate. They
noted that this usually took 1-2 weeks. This was inequitable.
Public Health had sought to engage with people about health and wellbeing. Based on
feedback about what would be the most accessible way to do so, they had set up a series
of craft workshops in a venue known to be trusted by those they wanted to reach. This
enabled them to build connections with the community and provided useful information.
Theme 2: Providing support
This theme includes these quality statements:
We may not always review all quality statements during every assessment.
Care provision, integration and continuity
Partnerships and communities
Care provision, integration and
continuity
Score: 3
3 - Evidence shows a good standard
What people expect
I have care and support that is coordinated, and everyone works well together and with
me.
The local authority commitment
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.
Key findings for this quality statement
The local authority worked with local people and stakeholders and used available data to
understand the care and support needs of people and communities. This included people
who were most likely to experience poor care and outcomes, people with protected
characteristics, unpaid carers and people who fund or arrange their own care, now and in
the future.
Understanding local needs for care and support
The local authority had collected data about demographics, health conditions and
mortality rates, and the impact of behaviour on health in their Joint Strategic Needs
Assessment (JSNA). They also reported on the wider determinants of health and
wellbeing, such as deprivation, employment and housing or homelessness.
Understanding of these contributing factors was evident in the initiatives the local
authority put in place, either singly or more often in partnership with health and other
partners, such as work to support people to access benefits, to cope in cold weather
when experiencing fuel poverty, and to intervene in the housing market to increase the
availability of affordable homes. The local authority demonstrated it understood these
measures contributed to wellbeing, and to reduce, delay or prevent the need for care and
support, for example in response to people with mental health needs.
Staff and
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