Adult Social Care Improvement
We’re making big changes to improve adult social care in Gloucestershire and have recently published our Improvement plan.
Theme one - working with people
In this section
Our ambition is…
- To make early intervention and prevention, together with strength-based working, part of all aspects of our work across the Adult Social Care System and in our proactive engagement with the developing Integrated Care System in the county
- To work to further to embed our strengths-based approach, acknowledging the impact of the pandemic on our processes and workforce
- In two years’ time to be better equipped to deliver and evidence improved outcomes for people in need of care and support
- To make progress in achieving a golden thread through our operational and commissioning services evidencing how we achieve equity in experience and outcomes
- To establish a two-way dialogue and develop a coproduction culture so that we can engage, consult, and coproduce service changes with communities and people who use our services
Our Strengths
- Make the difference model of strengths-based assessment and our practice quality assurance framework embedded and practice development practices for social care specialist staff
- Transitions service which supports people moving to adulthood with complex long-term conditions as well as our Complex care teams
- Low Carers Assessment average waiting times (16 days vs 28-day target) and holistic support for unpaid carers
Areas for improvement
- Waiting times for assessment are affecting people’s experience across all our functions as demand and complexity outstrips our capacity
- We hold significant debt, over half of which is older than six months. Our Fairer Contributions policy is under consultation, the outcome of which will have financial and practice implications. We are improving our financial assessment processes.
- Improving our access for people and carers to make it easier to navigate our systems and services, including a review of our mental health social care and Occupational Therapy services delegated to GHC to ensure consistency, clarity and the delivery of joined up services
- Further development of our practice audit process to take a thematic approach when auditing the issues identified by the LGA peer challenge (Sept 2023) and ensure this feeds into our quality assurance board
- Develop our co production approach to care and support planning, in line with our Make the Difference model. Including a plan for embedding the voices of local people in the planning and design of Adult Social Care support, through co-production with diverse communities and those with protected characteristics.
Key statistics
|
Activity |
Working Well |
Improvement |
|
89,740 contacts to Adult Social Care (71466 through Helpdesk and Referral centres and 18274 through other teams); 52.8% via telephone, 30% via email, 5% online. This equates to 23,506 people subject of the contact. 56% were female. Gloucester had the biggest % of contacts 21.9%, followed by Stroud 18.59%. |
Average wait time of seven days for Holistic Carers Assessment and sixteen days for Care Act compliant assessments carried out by Gloucestershire Carers Hub. On average 195 carers assessments are completed each month, taking on average 35 days to complete. |
Carers Hub have 9370[1] unpaid carers registered, we recognise this does not translate to our ASCOF performance and we have commenced work around improving the data flows from the provider back to us. |
|
On average 886 social work assessments are completed each month. For the rolling year by primary support reason this is broken down as:
|
Social work: the average number of days an pending an assessment is 37 working days. The trend for this is a downward trajectory (meaning people are waiting less time for an assessment)
|
From Q4 2022/23 to 1st March 2023/24 the number of up to date reviews has increased from 50% up to 67% but there is still work to do to ensure that a greater proportion of people receiving a service have an up-to-date review and that we have oversight of performance for clients receiving a service for a mental health condition. |
|
|
Occupational Therapy average days pending assessment; 63.5 days. On average 40% of referrals are resolved at the Integrated Community Team (ICT) referral centre and 34% are added to the OT waiting list. Longest wait is 19 months. Current number of people pending assessment is 1246. |
|
|
70 formal complaints have been received for the 12-month period (on average 6 per month). 42 Complaints relate to communication, 17 to charging for a service, 5 relate to delay in decision making, 25 to quality or appropriateness of a service, 17 to delivery of a service, 19 to attitude or behaviour of staff. 4 Complaints received by the Ombudsman (3 closed after initial enquiry, 1 withdrawn). |
||
|
Mental Health Social Work: average days pending assessment: for East Locality[2] is 131 days (longest wait is 151 days), for the West Locality2 this is 146 days (longest wait is 354 days). 219 people are overdue a review (18 dated back to 2021) due to the challenges with recruitment prioritisation has been given to new assessments. |
||
|
The average number of people pending a social work assessment in the last 12 months is 432. |
|
|
About our assessment services
We maximise the effectiveness of people’s care by assessing and reviewing their health, care, wellbeing and communication needs with them. A simplified version of our pathway for assessment is available in appendix 7 and this utilises a strengths-based approach which we have called our Make the Difference Model. To help the public and our partners understand our teams as well as assist with recruitment campaigns we have developed a suite of promotional videos about some of our Adult Social Care teams.
Our model focuses on ‘what a good life looks like’ for people and ways to promote and enable this, including through community connections and promoting citizenship and community participation. We ensure compliance with this model through huddles and 1:1 supervision, our practice audit programme and our training and development offer, including the suite of ‘Make the Difference” training and ongoing support from the Principal Social Worker (PSW) and practice development team. Our supervision data is tracked and audited in our Operational teams. In our mental health services (commissioned and delivered by Gloucestershire Health & Care NHS Foundation Trust) we use an “Integrated Narrative Assessment” model. The two models are reflective of each other, and both use a strengths-based approach.
We know demand for Care Act assessments outstrips our current capacity and that the complexity of people we are working with has increased in acuity. This has resulted in a waiting list for all our assessment services. To keep people safe whilst they are waiting a full Care Act assessment, we have guidance for our staff in relation to how to risk stratify those people who are waiting (IR 5.7). This is managed by our Integrated Social Care Managers who have access to a pending monitoring dashboard which is accessible on SharePoint. However, as part of our pathway for people and their carers we at every stage look at how we can prevent, reduce or delay by providing information and advice, short term services or link them in with Carers Hub or other universal services (see appendix 7).
We invited the Local Government Association in to undertake a peer challenge in September 2023. They said about our operational teams…
"Many dedicated and skilled staff committed to delivering good outcomes to the people of Gloucestershire…. The peer team read, heard and saw examples of some really good services delivered by staff who are passionate, and values driven.”
Assessment waiting times
Waiting times for social care assessment are an issue for us and are regularly monitored by our operational management team and through our performance board. Reducing waiting times and optimising the experience of people and carers is a priority for us. For our social work assessment teams, the longest wait (in weeks) is in the Cheltenham locality (15.9 weeks), and the median longest wait times across all operational teams is 9.7 weeks. The average wait for social work assessment (in days) is 30.9 days – see IR9 for further detail.
The overall picture for hospital discharges in Gloucestershire is challenging. We have a dedicated hospital discharge assessment team. Specialist mental health discharges are undertaken by our mental health social work team who are integrated with GHC.
We have a trusted assessor model within our acute hospital to support and facilitate timely and safe discharge from one of our two acute hospitals, they can undertake assessments on behalf of the care provider, liaise with the MDT and discharge teams and overall support providers. This is in partnership with GCPA (Gloucestershire Care Providers Association).
Mental health social workers also take on the role of care co-ordination and actively link with other teams in GHC such as complex emotional support needs team, crisis care team etc. and the Integrated high needs team in the ICB, for example, for those requiring dynamic support. The community learning disabilities team within GHC also provides training and support to the care market.
Waiting lists for Occupational Therapy (OT) input are an issue for us with the longest wait at 19 months in the Cotswolds locality. Our largest waiting list is in the Forest locality with 293 people. On average 40% of referrals are resolved at the Integrated Community Team (ICT) referral centre and 34% are added to the OT waiting list. We have recently commissioned an independent review of OT services and are developing an urgent action plan to address the waiting list, and a medium-term improvement plan with GHC.
Approved Mental Health Professional (AMHP) Service
Gloucestershire County Council commissions the Approved Mental Health Professional (AMHP) service from Gloucestershire Health and Care NHS Foundation Trust (GHC). This has developed into a 24-hour AMHP Hub of dedicated AMHP Specialist Practitioners working alongside a pool of community AMHP’s.
All referrals received in working hours are triaged immediately by an AMHP Specialist Practitioner. All referrals out of hours are responded to by a dedicated AMHP specialist practitioner covering 24 hours 7 days a week. There is no evidence of service delay leading to low, moderate, or serious harm to patients/service users.
A commissioned app has also been implemented to improve the availability of Section 12 (MHA) medics and improve the timeliness of MHA assessments were delayed by medic availability.
Our Strengths
- Make the difference model of strengths-based assessment and our practice quality assurance framework embedded and practice development practices for social care specialist staff
- Transitions service which supports people moving to adulthood with complex long-term conditions as well as our Complex care teams
- Low Carers Assessment average waiting times (16 days vs 28-day target) and holistic support for unpaid carers
Areas for improvement
- Waiting times for assessment are affecting people’s experience across all our functions as demand and complexity outstrips our capacity
- We hold significant debt, over half of which is older than six months. Our Fairer Contributions policy is under consultation, the outcome of which will have financial and practice implications. We are improving our financial assessment processes.
- Improving our access for people and carers to make it easier to navigate our systems and services, including a review of our mental health social care and Occupational Therapy services delegated to GHC to ensure consistency, clarity and the delivery of joined up services
- Further development of our practice audit process to take a thematic approach when auditing the issues identified by the LGA peer challenge (Sept 2023) and ensure this feeds into our quality assurance board
- Develop our co production approach to care and support planning, in line with our Make the Difference model. Including a plan for embedding the voices of local people in the planning and design of Adult Social Care support, through co-production with diverse communities and those with protected characteristics.
Key statistics
|
Activity |
Working Well |
Improvement |
|
89,740 contacts to Adult Social Care (71466 through Helpdesk and Referral centres and 18274 through other teams); 52.8% via telephone, 30% via email, 5% online. This equates to 23,506 people subject of the contact. 56% were female. Gloucester had the biggest % of contacts 21.9%, followed by Stroud 18.59%. |
Average wait time of seven days for Holistic Carers Assessment and sixteen days for Care Act compliant assessments carried out by Gloucestershire Carers Hub. On average 195 carers assessments are completed each month, taking on average 35 days to complete. |
Carers Hub have 9370[1] unpaid carers registered, we recognise this does not translate to our ASCOF performance and we have commenced work around improving the data flows from the provider back to us. |
|
On average 886 social work assessments are completed each month. For the rolling year by primary support reason this is broken down as:
|
Social work: the average number of days an pending an assessment is 37 working days. The trend for this is a downward trajectory (meaning people are waiting less time for an assessment)
|
From Q4 2022/23 to 1st March 2023/24 the number of up to date reviews has increased from 50% up to 67% but there is still work to do to ensure that a greater proportion of people receiving a service have an up-to-date review and that we have oversight of performance for clients receiving a service for a mental health condition. |
|
|
Occupational Therapy average days pending assessment; 63.5 days. On average 40% of referrals are resolved at the Integrated Community Team (ICT) referral centre and 34% are added to the OT waiting list. Longest wait is 19 months. Current number of people pending assessment is 1246. |
|
|
70 formal complaints have been received for the 12-month period (on average 6 per month). 42 Complaints relate to communication, 17 to charging for a service, 5 relate to delay in decision making, 25 to quality or appropriateness of a service, 17 to delivery of a service, 19 to attitude or behaviour of staff. 4 Complaints received by the Ombudsman (3 closed after initial enquiry, 1 withdrawn). |
||
|
Mental Health Social Work: average days pending assessment: for East Locality[2] is 131 days (longest wait is 151 days), for the West Locality2 this is 146 days (longest wait is 354 days). 219 people are overdue a review (18 dated back to 2021) due to the challenges with recruitment prioritisation has been given to new assessments. |
||
|
The average number of people pending a social work assessment in the last 12 months is 432. |
|
|
About our assessment services
We maximise the effectiveness of people’s care by assessing and reviewing their health, care, wellbeing and communication needs with them. A simplified version of our pathway for assessment is available in appendix 7 and this utilises a strengths-based approach which we have called our Make the Difference Model. To help the public and our partners understand our teams as well as assist with recruitment campaigns we have developed a suite of promotional videos about some of our Adult Social Care teams.
Our model focuses on ‘what a good life looks like’ for people and ways to promote and enable this, including through community connections and promoting citizenship and community participation. We ensure compliance with this model through huddles and 1:1 supervision, our practice audit programme and our training and development offer, including the suite of ‘Make the Difference” training and ongoing support from the Principal Social Worker (PSW) and practice development team. Our supervision data is tracked and audited in our Operational teams. In our mental health services (commissioned and delivered by Gloucestershire Health & Care NHS Foundation Trust) we use an “Integrated Narrative Assessment” model. The two models are reflective of each other, and both use a strengths-based approach.
We know demand for Care Act assessments outstrips our current capacity and that the complexity of people we are working with has increased in acuity. This has resulted in a waiting list for all our assessment services. To keep people safe whilst they are waiting a full Care Act assessment, we have guidance for our staff in relation to how to risk stratify those people who are waiting (IR 5.7). This is managed by our Integrated Social Care Managers who have access to a pending monitoring dashboard which is accessible on SharePoint. However, as part of our pathway for people and their carers we at every stage look at how we can prevent, reduce or delay by providing information and advice, short term services or link them in with Carers Hub or other universal services (see appendix 7).
We invited the Local Government Association in to undertake a peer challenge in September 2023. They said about our operational teams…
"Many dedicated and skilled staff committed to delivering good outcomes to the people of Gloucestershire…. The peer team read, heard and saw examples of some really good services delivered by staff who are passionate, and values driven.”
Assessment waiting times
Waiting times for social care assessment are an issue for us and are regularly monitored by our operational management team and through our performance board. Reducing waiting times and optimising the experience of people and carers is a priority for us. For our social work assessment teams, the longest wait (in weeks) is in the Cheltenham locality (15.9 weeks), and the median longest wait times across all operational teams is 9.7 weeks. The average wait for social work assessment (in days) is 30.9 days – see IR9 for further detail.
The overall picture for hospital discharges in Gloucestershire is challenging. We have a dedicated hospital discharge assessment team. Specialist mental health discharges are undertaken by our mental health social work team who are integrated with GHC.
We have a trusted assessor model within our acute hospital to support and facilitate timely and safe discharge from one of our two acute hospitals, they can undertake assessments on behalf of the care provider, liaise with the MDT and discharge teams and overall support providers. This is in partnership with GCPA (Gloucestershire Care Providers Association).
Mental health social workers also take on the role of care co-ordination and actively link with other teams in GHC such as complex emotional support needs team, crisis care team etc. and the Integrated high needs team in the ICB, for example, for those requiring dynamic support. The community learning disabilities team within GHC also provides training and support to the care market.
Waiting lists for Occupational Therapy (OT) input are an issue for us with the longest wait at 19 months in the Cotswolds locality. Our largest waiting list is in the Forest locality with 293 people. On average 40% of referrals are resolved at the Integrated Community Team (ICT) referral centre and 34% are added to the OT waiting list. We have recently commissioned an independent review of OT services and are developing an urgent action plan to address the waiting list, and a medium-term improvement plan with GHC.
Approved Mental Health Professional (AMHP) Service
Gloucestershire County Council commissions the Approved Mental Health Professional (AMHP) service from Gloucestershire Health and Care NHS Foundation Trust (GHC). This has developed into a 24-hour AMHP Hub of dedicated AMHP Specialist Practitioners working alongside a pool of community AMHP’s.
All referrals received in working hours are triaged immediately by an AMHP Specialist Practitioner. All referrals out of hours are responded to by a dedicated AMHP specialist practitioner covering 24 hours 7 days a week. There is no evidence of service delay leading to low, moderate, or serious harm to patients/service users.
A commissioned app has also been implemented to improve the availability of Section 12 (MHA) medics and improve the timeliness of MHA assessments were delayed by medic availability.
Our strengths
- A number of integrated commissioning approaches delivering on a wealth of services supporting people to live healthier lives
- Enablement service for people with disabilities and other joint system focus to address health inequalities working with Public Health in collaboration with the ICB
- The strong VCSE role across our ICS partnership
- Know Your Patch networks strengthening relationships and community resources support our responsibility to prevent, reduce and delay ongoing care and support
Priorities for improvement
- Collaborative systemwide approach to commissioning of preventative services; including a review of our Occupational Therapy Services (delegated to GHC), development of a prevention strategy for Adult Social Care that compliments wider system initiatives, and development of an integreated equipment strategy
- Demand for our home first (reablement) service outstrips capacity from GHC resulting in us having to buy additional capacity from the external care market through our hyper-localised dynamic procurement framework
- Our current Telecare service is largely reactive and mainly supports hospital discharge rather than proactively targeting prevention and supporting us with demand management. We are procuring a new technology enabled care service which will require significant transformation to implement.
- Further develop our approach to self-directed support which may include direct payments and individual service funds. This will require us to stimulate the market to create choice for people wanting to manage their own care and support.
- Further develop our care navigator model to ensure it is interwoven with the wider system and supports consistent effective collaboration next to existing information, advice and guidance and social prescribing offers
Key statistics
|
Activity |
Working well |
Improvement |
|
42% of contacts through Adult Social Care Helpdesk led to no further action or signposting, advice or guidance. |
Social Care quality of life score 19.5 compared with a peer group average of 19.0. 92.5% of people who use services say that those services have made them feel safe and secure compared with a peer group average 88.3% |
Adults using social care receiving a direct payment 11.7% compared with 25.6% peer group average. Carers receiving direct payment 4.6% compared with 73.9% peer group average2. |
|
The number of people using our services who found it easy to locate information about the support available to them (71.9%, down from 79.5% in 2021/22). Although performance has dipped, Gloucestershire remains as the top performer in our comparator group and are in the top quartile for the third reportable year running. |
People who remain at home for more than 90 days following discharge from hospital into reablement/rehabilitation services, 93.9% of people compared with a peer group average of 83.7% of people. |
In Feb 2024, 2141 people were waiting for Domiciliary Care package, 1274 were waiting for residential care and 966 were waiting nursing care. The average wait for brokerage of care is 12 days (this is an improvement from 19 days in April 2023) (IR21). |
|
The total number of requests for telecare equipment was 132 in the year with an average of 11 items issued per month. The response rate for the responder service[2] (provided by Gloucestershire Fire and Rescue) needs to be improved and we have asked for a responder service to be provided by our new provider of TEC services (when procured). |
||
|
There have been 3051 Reablement requests, on average this is 254 per month. |
In Gloucestershire 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. We do this initially via our Adults Helpdesk who will signpost people (where appropriate) to our online directory Your Circle to help people find their way around care and support and connect with people, places, and activities in Gloucestershire. Adults Helpdesk provide signposting, information advice and guidance to help people live healthier lives. After the Helpdesk has undertaken an initial screening they may make a referral to a locality team, which a Duty team will then triage, and they will agree next steps with the individual or their representative (carers/family etc). This process is described in appendix 7.
The Care Advice Line
Part of enabling people to live healthier lives is also around providing financial advice and assessment in relation to meeting social care needs. The Care Advice Line[ii] (TCAL) are a commissioned service who provide people with advice, information, and support in relation to finances.
Feedback from people who have used TCAL recently included:
“You’ve been a star. Thank you for taking the time to explain it so clearly.” “That’s amazing it really is. You certainly know your stuff! Thank you for your persistence in calling me.”
Reablement and intermediate care
Reablement and intermediate care, are both provided by our Community NHS Foundation Trust Gloucestershire Health & Care (GHC) who provide specialist domiciliary reablement care, free for up to six weeks.
The two parts of the service work together or independently depending on the person’s needs. Increasingly we are seeing these services supporting hospital discharges, leaving an emerging gap in step up reablement and intermediate care services.
Disabilities enablement team
We support people with disabilities help themselves and to live healthier lives is through our disabilities enablement team. This team works with individuals, families, and providers to maximise independence and reduce reliance on paid support (see appendix 7 for a case study).
Telecare
The current Telecare service is operationally managed by GHC, but we are about to go to tender for a new provider. Our current Telecare service is largely reactive and mainly supports hospital discharge. The processes currently in place across the service are complex and in the past were supported by manual data management methods. Although an equipment logistics system has been introduced there continues to be a lack of good quality management Information.
Technology enabled care re-procurement is a significant project within the technology strand of our transformation programme. This move from the current offer to the use of technology enabled care digital products, such as sensors and behavioural alerts, driven from data patterns and analysis, will enable early proactive interventions to resolve issues at an early stage before escalation is required, for example avoiding hospital admission or increase in care needs.
Community equipment and minor adaptations
Minor adaptations are delivered by a commissioned provider and much of the operational processes are managed by the Integrated Community Equipment Services comprised of our inhouse community equipment provider and GHC. Our inhouse provider of community equipment supply, deliver, collect, repair, and refurbish a range of community equipment. They deliver on average between 10,000 – 12,000 pieces of equipment per month.
They work in partnership with GHC to support clinicians with their assessment of suitability for equipment. Our inhouse provider (Gloucestershire Community Equipment Loans Service, previously referred to as GIS) is also a supported employer, offering a personalised model for supporting people with significant disabilities to secure and retain paid employment. This model uses a partnership strategy to enable people with disabilities to achieve sustainable long-term employment.
An example of this is the traineeship programme which is supported by Department for Work and Pensions (DWP) and this programme is a way for people who have had difficulty finding employment due to disability or health condition to gain meaningful employment.
For more information about this offer and some case studies of people who have been through the programme please visit the Forwards website.
Healthy Lifestyles Service
Gloucestershire Healthy Lifestyles service changes provider in April 2024 but currently has a range of low-level support to help people to maintain a healthy lifestyle from stopping smoking, managing your weight to being more active.
Be Well Gloucestershire (mental health support app)
An A-Z of all the services (statutory and VCSE) that are available to support people living with Mental Health Illness has been jointly commissioned and is called Be Well Gloucestershire.
Our Positive Behaviour Support (PBS) team
Following a review into the benefits of a PBS approach across a number of client groups we now have a dedicated PBS team since 2022, to support our care provider market to effectively manage behaviours that could be deemed as challenging. This team work closely with the community learning disability Team to also provide training and support to care providers. See appendix 7 for a case study.
Community Autism Support and Advice Service (CASA)
We currently commission the Community Autism Support and Advice Service (CASA). CASA provides support tailored to an individual from groups, drop-in hubs and 1:1 support. They can provide information, advice, guidance and signposting, a wide range of support interventions, support people to reach their potential including access to work and through peer advocates. The service will be recommissioned this year, commissioners are currently undertaking soft market testing and further engagement in co-production with stakeholders.
Reducing health inequalities for people with a learning disability
Gloucestershire has had a systemwide approach to increasing and improving the quality of annual health checks for people with a learning disability. This includes the training and workforce competency within primary care as well as resources for carers, the pre health check questionnaire and the health check action plan template used support the health check and what codes are recorded by GPs. The outputs from some of this work can be viewed on the One Gloucestershire Website. The A-Z of Easy Read and accessible resources has been developed and adapted following co-produced feedback, alongside a number of learning resources, for example, tips for communication and e-learning on making adjustments which was also co-produced with experts by experience.
There are a lot of educational resources for professionals on G:Care[xiii] to support people with a learning disability. The Community Learning Disability Team also offer training to the Care Provider Market through our Proud to Learn initiative. This training for care providers compliments our e-learning offer on Proud to Learn with specialist knowledge to support people with a learning disability to remain healthier for longer.
Another example of the work in this area is the LeDeR Programme (learning from lives and deaths of people with a learning disability), Gloucestershire was part of NHS England’s pilot in 2016 and has consistently been benchmarked in the top 10 areas across England for undertaking reviews of deaths and putting learning into action. Further information from ICB LeDeR webpages.
We jointly contribute to an annual celebration 'Big Health Day' of the support available across Gloucestershire to support people with disabilities and this has been nationally recognised by NHS England.
System wide support for older people
We have developed a joint 5-year ICS Dementia Strategy which is aligned to the NHSE Dementia Well Pathway (not currently published). Our dementia advisor service provided by the Alzheimer’s Society is jointly funded by GCC and ICB and is a key countywide service providing support, information, advice and guidance to people living with dementia and their carers. In addition, we have the dementia training and education strategy, the Dementia Action Alliance resources for people with dementia at the end of their life and the Gloucestershire bereavement forum.
Our ICS frailty strategy follows a similar pathway approach focusing first on prevention and early identification of frailty and informing our community service models to include preventive and proactive care. It recognises the Adult Social Care aim to shift the focus in an older person’s social care pathway to earlier and preventative approaches.
Teams such as complex care at home, partly funded through the Better Care Fund, are skilled in enabling self-management approaches through personalised care planning. The team is multi-disciplinary including Adult Social Care navigators to provide a holistic approach to prevention and intervention.
The Ageing Well programme oversees the Enhanced Health in Care Homes Framework (NHS England, 2023) which seeks to further strengthen NHS support to the care home sector. There is a care sector support team that can provide training on areas such as falls prevention, diabetes awareness and oral health etc.
By setting out a prevention strategy for Adult Social Care, we plan to define our role and responsibilities in the context of system wide prevention activity, set out a medium-term strategy to transform the Adult Social Care pathway to shift it towards prevention and align Adult Social Care with the health sector for holistic assessment and proactive preventative joint action.
Our strengths
- A number of integrated commissioning approaches delivering on a wealth of services supporting people to live healthier lives
- Enablement service for people with disabilities and other joint system focus to address health inequalities working with Public Health in collaboration with the ICB
- The strong VCSE role across our ICS partnership
- Know Your Patch networks strengthening relationships and community resources support our responsibility to prevent, reduce and delay ongoing care and support
Priorities for improvement
- Collaborative systemwide approach to commissioning of preventative services; including a review of our Occupational Therapy Services (delegated to GHC), development of a prevention strategy for Adult Social Care that compliments wider system initiatives, and development of an integreated equipment strategy
- Demand for our home first (reablement) service outstrips capacity from GHC resulting in us having to buy additional capacity from the external care market through our hyper-localised dynamic procurement framework
- Our current Telecare service is largely reactive and mainly supports hospital discharge rather than proactively targeting prevention and supporting us with demand management. We are procuring a new technology enabled care service which will require significant transformation to implement.
- Further develop our approach to self-directed support which may include direct payments and individual service funds. This will require us to stimulate the market to create choice for people wanting to manage their own care and support.
- Further develop our care navigator model to ensure it is interwoven with the wider system and supports consistent effective collaboration next to existing information, advice and guidance and social prescribing offers
Key statistics
|
Activity |
Working well |
Improvement |
|
42% of contacts through Adult Social Care Helpdesk led to no further action or signposting, advice or guidance. |
Social Care quality of life score 19.5 compared with a peer group average of 19.0. 92.5% of people who use services say that those services have made them feel safe and secure compared with a peer group average 88.3% |
Adults using social care receiving a direct payment 11.7% compared with 25.6% peer group average. Carers receiving direct payment 4.6% compared with 73.9% peer group average2. |
|
The number of people using our services who found it easy to locate information about the support available to them (71.9%, down from 79.5% in 2021/22). Although performance has dipped, Gloucestershire remains as the top performer in our comparator group and are in the top quartile for the third reportable year running. |
People who remain at home for more than 90 days following discharge from hospital into reablement/rehabilitation services, 93.9% of people compared with a peer group average of 83.7% of people. |
In Feb 2024, 2141 people were waiting for Domiciliary Care package, 1274 were waiting for residential care and 966 were waiting nursing care. The average wait for brokerage of care is 12 days (this is an improvement from 19 days in April 2023) (IR21). |
|
The total number of requests for telecare equipment was 132 in the year with an average of 11 items issued per month. The response rate for the responder service[2] (provided by Gloucestershire Fire and Rescue) needs to be improved and we have asked for a responder service to be provided by our new provider of TEC services (when procured). |
||
|
There have been 3051 Reablement requests, on average this is 254 per month. |
In Gloucestershire 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. We do this initially via our Adults Helpdesk who will signpost people (where appropriate) to our online directory Your Circle to help people find their way around care and support and connect with people, places, and activities in Gloucestershire. Adults Helpdesk provide signposting, information advice and guidance to help people live healthier lives. After the Helpdesk has undertaken an initial screening they may make a referral to a locality team, which a Duty team will then triage, and they will agree next steps with the individual or their representative (carers/family etc). This process is described in appendix 7.
The Care Advice Line
Part of enabling people to live healthier lives is also around providing financial advice and assessment in relation to meeting social care needs. The Care Advice Line[ii] (TCAL) are a commissioned service who provide people with advice, information, and support in relation to finances.
Feedback from people who have used TCAL recently included:
“You’ve been a star. Thank you for taking the time to explain it so clearly.” “That’s amazing it really is. You certainly know your stuff! Thank you for your persistence in calling me.”
Reablement and intermediate care
Reablement and intermediate care, are both provided by our Community NHS Foundation Trust Gloucestershire Health & Care (GHC) who provide specialist domiciliary reablement care, free for up to six weeks.
The two parts of the service work together or independently depending on the person’s needs. Increasingly we are seeing these services supporting hospital discharges, leaving an emerging gap in step up reablement and intermediate care services.
Disabilities enablement team
We support people with disabilities help themselves and to live healthier lives is through our disabilities enablement team. This team works with individuals, families, and providers to maximise independence and reduce reliance on paid support (see appendix 7 for a case study).
Telecare
The current Telecare service is operationally managed by GHC, but we are about to go to tender for a new provider. Our current Telecare service is largely reactive and mainly supports hospital discharge. The processes currently in place across the service are complex and in the past were supported by manual data management methods. Although an equipment logistics system has been introduced there continues to be a lack of good quality management Information.
Technology enabled care re-procurement is a significant project within the technology strand of our transformation programme. This move from the current offer to the use of technology enabled care digital products, such as sensors and behavioural alerts, driven from data patterns and analysis, will enable early proactive interventions to resolve issues at an early stage before escalation is required, for example avoiding hospital admission or increase in care needs.
Community equipment and minor adaptations
Minor adaptations are delivered by a commissioned provider and much of the operational processes are managed by the Integrated Community Equipment Services comprised of our inhouse community equipment provider and GHC. Our inhouse provider of community equipment supply, deliver, collect, repair, and refurbish a range of community equipment. They deliver on average between 10,000 – 12,000 pieces of equipment per month.
They work in partnership with GHC to support clinicians with their assessment of suitability for equipment. Our inhouse provider (Gloucestershire Community Equipment Loans Service, previously referred to as GIS) is also a supported employer, offering a personalised model for supporting people with significant disabilities to secure and retain paid employment. This model uses a partnership strategy to enable people with disabilities to achieve sustainable long-term employment.
An example of this is the traineeship programme which is supported by Department for Work and Pensions (DWP) and this programme is a way for people who have had difficulty finding employment due to disability or health condition to gain meaningful employment.
For more information about this offer and some case studies of people who have been through the programme please visit the Forwards website.
Healthy Lifestyles Service
Gloucestershire Healthy Lifestyles service changes provider in April 2024 but currently has a range of low-level support to help people to maintain a healthy lifestyle from stopping smoking, managing your weight to being more active.
Be Well Gloucestershire (mental health support app)
An A-Z of all the services (statutory and VCSE) that are available to support people living with Mental Health Illness has been jointly commissioned and is called Be Well Gloucestershire.
Our Positive Behaviour Support (PBS) team
Following a review into the benefits of a PBS approach across a number of client groups we now have a dedicated PBS team since 2022, to support our care provider market to effectively manage behaviours that could be deemed as challenging. This team work closely with the community learning disability Team to also provide training and support to care providers. See appendix 7 for a case study.
Community Autism Support and Advice Service (CASA)
We currently commission the Community Autism Support and Advice Service (CASA). CASA provides support tailored to an individual from groups, drop-in hubs and 1:1 support. They can provide information, advice, guidance and signposting, a wide range of support interventions, support people to reach their potential including access to work and through peer advocates. The service will be recommissioned this year, commissioners are currently undertaking soft market testing and further engagement in co-production with stakeholders.
Reducing health inequalities for people with a learning disability
Gloucestershire has had a systemwide approach to increasing and improving the quality of annual health checks for people with a learning disability. This includes the training and workforce competency within primary care as well as resources for carers, the pre health check questionnaire and the health check action plan template used support the health check and what codes are recorded by GPs. The outputs from some of this work can be viewed on the One Gloucestershire Website. The A-Z of Easy Read and accessible resources has been developed and adapted following co-produced feedback, alongside a number of learning resources, for example, tips for communication and e-learning on making adjustments which was also co-produced with experts by experience.
There are a lot of educational resources for professionals on G:Care[xiii] to support people with a learning disability. The Community Learning Disability Team also offer training to the Care Provider Market through our Proud to Learn initiative. This training for care providers compliments our e-learning offer on Proud to Learn with specialist knowledge to support people with a learning disability to remain healthier for longer.
Another example of the work in this area is the LeDeR Programme (learning from lives and deaths of people with a learning disability), Gloucestershire was part of NHS England’s pilot in 2016 and has consistently been benchmarked in the top 10 areas across England for undertaking reviews of deaths and putting learning into action. Further information from ICB LeDeR webpages.
We jointly contribute to an annual celebration 'Big Health Day' of the support available across Gloucestershire to support people with disabilities and this has been nationally recognised by NHS England.
System wide support for older people
We have developed a joint 5-year ICS Dementia Strategy which is aligned to the NHSE Dementia Well Pathway (not currently published). Our dementia advisor service provided by the Alzheimer’s Society is jointly funded by GCC and ICB and is a key countywide service providing support, information, advice and guidance to people living with dementia and their carers. In addition, we have the dementia training and education strategy, the Dementia Action Alliance resources for people with dementia at the end of their life and the Gloucestershire bereavement forum.
Our ICS frailty strategy follows a similar pathway approach focusing first on prevention and early identification of frailty and informing our community service models to include preventive and proactive care. It recognises the Adult Social Care aim to shift the focus in an older person’s social care pathway to earlier and preventative approaches.
Teams such as complex care at home, partly funded through the Better Care Fund, are skilled in enabling self-management approaches through personalised care planning. The team is multi-disciplinary including Adult Social Care navigators to provide a holistic approach to prevention and intervention.
The Ageing Well programme oversees the Enhanced Health in Care Homes Framework (NHS England, 2023) which seeks to further strengthen NHS support to the care home sector. There is a care sector support team that can provide training on areas such as falls prevention, diabetes awareness and oral health etc.
By setting out a prevention strategy for Adult Social Care, we plan to define our role and responsibilities in the context of system wide prevention activity, set out a medium-term strategy to transform the Adult Social Care pathway to shift it towards prevention and align Adult Social Care with the health sector for holistic assessment and proactive preventative joint action.
Our strengths
- A new role of customer experience manager who is undertaking a full review of the Adult Social Care pathway from the perspective of people with lived experience
- Pockets of good practice in relation to EDI and co-production and initiatives seeing positive impacts for people; this is a priority for our practice development team
- Innovative approach to supporting and stimulating VCSE and community connections through Know Your Patch Networks
- Willing and engaged partnership boards
Priorities for improvement
- Accessibility of information – on our website, in printed form and in other languages
- Identifying people who are more likely to receive poor outcomes with protected characteristics is a challenge for us because of data collection improvements required
- Improve how we can incorporate feedback from people who use our services, unpaid carers, advocate and care providers into our improvement activity
- Ongoing relationships with minoritised communities across the whole of the county
- Review of advocacy use and impact with a view to identifying improvements for people with lived experience
Key statistics
|
Activity |
Working Well |
Improvement |
|
|
Older people (65 years and over) with a physical support need make up more than half of those supported by Adult Social Care (54%). People with a learning disability account for a quarter of people receiving support or care (26%), 18–64 year-olds with a physical support need made up around 15% of those in receipt of a service and people with a mental health need formed the remaining 5% of those supported. The balance of care between these groups has remained steady over time. |
Our Complaint numbers are low but of the complaints we do receive a high proportion are due to communication. We are addressing this through mapping of the customer journey and making improvements in co-production (IR3). |
We know that we have over representation of minority ethnic communities in those who are detained under the Mental Health Act within our Mental Health services. We have a joint action plan and research agreed to investigate the barriers to interacting earlier with mental health. |
|
|
Our County is characterised by a comparatively small population of ethnic minorities (excluding white minorities). The population of Gloucestershire is, however, becoming increasingly diverse. The population of ethnic minorities (excluding white minorities) increased by 63.8% between 2011 and 2021, from 4.6% to 6.9% of the population. The number of people classed as ‘other white’, which includes migrants from Europe, increased by 55.1%, from 3.1% of the population in 2011 to 4.5% of the population in 2021 (Equality Profile 2023[i]). |
We continue to have significant gaps in our data around characteristics which are considered commonly collected and provided. In particular, relating to race. |
||
|
Around a quarter each of people receiving support for a mental health condition are aged 50-59 years (24%) and one-fifth are aged 60-69 years (21%). This is a slight over-representation compared with the overall adult population (19% and 15% respectively). The proportion of people supported for their mental health grows each decade from 11% for the 20-29 years olds to 24% for 50-59 year olds before beginning to reduce for older age groups. |
|||
|
Care Act Advocacy referrals have remained consistent across each quarter of 2023-2024 (on average 124 new cases per quarter). 48% are closed within 3 months, 29% within 6 months and 13% over 6 months but less than 1 year. However, there have been some issues with the advocate ability to book in joint appointments with people and social care staff which further delays the process (IR18). |
- [i] Equality Profile Report 2023 https://www.gloucestershire.gov.uk/media/uxvcfrsp/equality-profile-2023.pdf
- The Council’s Equality Objectives[i] were approved in Sept 2023 (until 2027)
Our corporate approach to Equalities Impact Assessments
Our Corporate approach to Equalities Impact Assessments (EqIAs) for decision making have also undergone review and revision and this has been introduced with additional training and support[ii] for those completing them. These now include a broader range of factors relating to equalities, inclusion and levelling up. The revised EqIA template incorporates several significant changes, including six additional groups alongside the protected characteristics (this is on top of ‘Care leavers / care experienced adults’ which was added earlier in 2023 following Council Motion 917).
Adult Social Care Service User Diversity
We continue to have significant gaps in our data around characteristics which are considered commonly collected and provided. In particular, relating to race and other protected characteristics of sexual orientation, religion and/or belief, pregnancy/maternity, civil partnership and marriage and gender reassignment which are often considered to be sensitive personal characteristics and so disclosure rates are low. There is ongoing work being undertaken to raise awareness of the importance of conversations around protected characteristics and recording of personal data to equip staff with a strong understanding of how this information directly relates to good social work practice and the delivery of their assessment and planning work. Our monthly Practice Quality Audits now assess the recording of protected characteristics and how practitioners incorporate this information into assessment and care planning processes.
Read the full Adult Social Care diversity report[iii] from 2022-2023 (IR 13.2).
We have a well-established Community Engagement Team to help us work in co-production with some diverse ethnic communities in some localities. Working alongside our NHS Partners (specifically in the Gloucester locality), this team worked to support us during the pandemic to ensure key health and wellbeing messages were reinforced alongside faith groups to ensure messages reached out as far and wide as possible and that messages were culturally appropriate and presented in an accessible way e.g. different languages.
The Community Engagement team and the Practice Development team support a range of engagement and learning activities around diversity and dementia, carers support, mental health, Adult Social Care assessment process. For over 10 years our aim has been to build stronger, more sustainable communities and in turn improve the health and wellbeing of local people, where we can draw upon, and stimulate the provision of, the diverse range of assets within each local community. This forms part of a System wide programme called “Enabling Active Communities”[iv], which has recently been refreshed.
We jointly commissioned community-based research by the Black Southwest Network (BSWN) into Healthcare Inequalities. This report (Black South West Network, 2023) recognised that the public sector in Gloucestershire has taken positive action to work together with the voluntary sector and Black and Minoritised communities to understand what transformative action would look like in addressing health and social care inequalities. Findings from this report have been delivered.
Watch this video about some of the work some of our Community Engagement Team have been involved in with the ICB around mental health and community research that was undertaken.
Mental Health engagement with diverse ethnic groups
In our mental health services, we have undertaken engagement work with Diverse Ethnic Communities (DEC), following a report around accessibility of local mental health services for these communities, and work is underway to implement the Patient and Carer Race Equality Framework (PCREF) to ensure standards are met across these areas. We have also commissioned the University of Gloucestershire in collaboration with the ICB to undertake some community-based research with DEC.
Countywide sensory team
We have a dedicated countywide sensory team who support adults with sensory loss (focusing on the needs of visually impaired providing practical support such as equipment and cane training) to enable them to live as independently as possible.
We have also identified a number of staff across all of our locality team who have undertaken the OCN Level 3 training to support adults with dual sensory loss, the intention was that in doing so we would raise awareness of dual sensory loss in the context of our responsibilities under the Care Act to provide Specialist Assessments - i.e. improving people's access to assessment and relevant support.
Independent advocacy
Independent Health and Social Care Advocacy is a service delivered by POhWER[v] (Advocacy Services for Adults in Gloucestershire leaflet) that is designed to deliver a combination of statutory advocacy roles for people who live in Gloucestershire. POhWER offer an information and advice support service.
Know your Patch networks
Another element of our community investment is the Know Your Patch networks which bring together cross-sector partners to form a network for the needs of our communities and individuals. The six networks are hosted by community led organisations in the VCSE who receive investment for the administration of the networks. Know Your Patch Networks were established to create a better understanding of Adult Social Care and build trusted relationships across the sectors.
We have heard from the KYP Networks that:
“Formal commissioning procedures are not the be all and end all. Time and a place for grant funding, is still incredibly important.” and “We have the freedom to develop and deliver in our own way, working in partnership with xxx and collaboratively with other KYPN leads. It’s a positive and helpful model of working, that enables us to innovate and adapt to the needs of the community.”
[i] Gloucestershire County Council, Equality Objectives 2023 -2027 https://glostext.gloucestershire.gov.uk/ieDecisionDetails.aspx?ID=2115
[ii] Equality Information and analysis https://www.gloucestershire.gov.uk/council-and-democracy/equalities-and-our-duties-under-the-equality-act-2010/equality-information-and-analysis/
[iii] Adult Social Care Service User Diversity Report 2022-2023 https://www.gloucestershire.gov.uk/media/pyrnwvnp/adult-social-care-service-user-diversity-report-2022-23.docx
[iv] One Gloucestershire, Enabling Active Communities https://glostext.gloucestershire.gov.uk/documents/s69544/HCT%20intro%20presentation%20HWB%20Mar%2021.pdf
[v] Independent Advocacy POhWER https://www.pohwer.net/gloucestershire
Our strengths
- A new role of customer experience manager who is undertaking a full review of the Adult Social Care pathway from the perspective of people with lived experience
- Pockets of good practice in relation to EDI and co-production and initiatives seeing positive impacts for people; this is a priority for our practice development team
- Innovative approach to supporting and stimulating VCSE and community connections through Know Your Patch Networks
- Willing and engaged partnership boards
Priorities for improvement
- Accessibility of information – on our website, in printed form and in other languages
- Identifying people who are more likely to receive poor outcomes with protected characteristics is a challenge for us because of data collection improvements required
- Improve how we can incorporate feedback from people who use our services, unpaid carers, advocate and care providers into our improvement activity
- Ongoing relationships with minoritised communities across the whole of the county
- Review of advocacy use and impact with a view to identifying improvements for people with lived experience
Key statistics
|
Activity |
Working Well |
Improvement |
|
|
Older people (65 years and over) with a physical support need make up more than half of those supported by Adult Social Care (54%). People with a learning disability account for a quarter of people receiving support or care (26%), 18–64 year-olds with a physical support need made up around 15% of those in receipt of a service and people with a mental health need formed the remaining 5% of those supported. The balance of care between these groups has remained steady over time. |
Our Complaint numbers are low but of the complaints we do receive a high proportion are due to communication. We are addressing this through mapping of the customer journey and making improvements in co-production (IR3). |
We know that we have over representation of minority ethnic communities in those who are detained under the Mental Health Act within our Mental Health services. We have a joint action plan and research agreed to investigate the barriers to interacting earlier with mental health. |
|
|
Our County is characterised by a comparatively small population of ethnic minorities (excluding white minorities). The population of Gloucestershire is, however, becoming increasingly diverse. The population of ethnic minorities (excluding white minorities) increased by 63.8% between 2011 and 2021, from 4.6% to 6.9% of the population. The number of people classed as ‘other white’, which includes migrants from Europe, increased by 55.1%, from 3.1% of the population in 2011 to 4.5% of the population in 2021 (Equality Profile 2023[i]). |
We continue to have significant gaps in our data around characteristics which are considered commonly collected and provided. In particular, relating to race. |
||
|
Around a quarter each of people receiving support for a mental health condition are aged 50-59 years (24%) and one-fifth are aged 60-69 years (21%). This is a slight over-representation compared with the overall adult population (19% and 15% respectively). The proportion of people supported for their mental health grows each decade from 11% for the 20-29 years olds to 24% for 50-59 year olds before beginning to reduce for older age groups. |
|||
|
Care Act Advocacy referrals have remained consistent across each quarter of 2023-2024 (on average 124 new cases per quarter). 48% are closed within 3 months, 29% within 6 months and 13% over 6 months but less than 1 year. However, there have been some issues with the advocate ability to book in joint appointments with people and social care staff which further delays the process (IR18). |
- [i] Equality Profile Report 2023 https://www.gloucestershire.gov.uk/media/uxvcfrsp/equality-profile-2023.pdf
- The Council’s Equality Objectives[i] were approved in Sept 2023 (until 2027)
Our corporate approach to Equalities Impact Assessments
Our Corporate approach to Equalities Impact Assessments (EqIAs) for decision making have also undergone review and revision and this has been introduced with additional training and support[ii] for those completing them. These now include a broader range of factors relating to equalities, inclusion and levelling up. The revised EqIA template incorporates several significant changes, including six additional groups alongside the protected characteristics (this is on top of ‘Care leavers / care experienced adults’ which was added earlier in 2023 following Council Motion 917).
Adult Social Care Service User Diversity
We continue to have significant gaps in our data around characteristics which are considered commonly collected and provided. In particular, relating to race and other protected characteristics of sexual orientation, religion and/or belief, pregnancy/maternity, civil partnership and marriage and gender reassignment which are often considered to be sensitive personal characteristics and so disclosure rates are low. There is ongoing work being undertaken to raise awareness of the importance of conversations around protected characteristics and recording of personal data to equip staff with a strong understanding of how this information directly relates to good social work practice and the delivery of their assessment and planning work. Our monthly Practice Quality Audits now assess the recording of protected characteristics and how practitioners incorporate this information into assessment and care planning processes.
Read the full Adult Social Care diversity report[iii] from 2022-2023 (IR 13.2).
We have a well-established Community Engagement Team to help us work in co-production with some diverse ethnic communities in some localities. Working alongside our NHS Partners (specifically in the Gloucester locality), this team worked to support us during the pandemic to ensure key health and wellbeing messages were reinforced alongside faith groups to ensure messages reached out as far and wide as possible and that messages were culturally appropriate and presented in an accessible way e.g. different languages.
The Community Engagement team and the Practice Development team support a range of engagement and learning activities around diversity and dementia, carers support, mental health, Adult Social Care assessment process. For over 10 years our aim has been to build stronger, more sustainable communities and in turn improve the health and wellbeing of local people, where we can draw upon, and stimulate the provision of, the diverse range of assets within each local community. This forms part of a System wide programme called “Enabling Active Communities”[iv], which has recently been refreshed.
We jointly commissioned community-based research by the Black Southwest Network (BSWN) into Healthcare Inequalities. This report (Black South West Network, 2023) recognised that the public sector in Gloucestershire has taken positive action to work together with the voluntary sector and Black and Minoritised communities to understand what transformative action would look like in addressing health and social care inequalities. Findings from this report have been delivered.
Watch this video about some of the work some of our Community Engagement Team have been involved in with the ICB around mental health and community research that was undertaken.
Mental Health engagement with diverse ethnic groups
In our mental health services, we have undertaken engagement work with Diverse Ethnic Communities (DEC), following a report around accessibility of local mental health services for these communities, and work is underway to implement the Patient and Carer Race Equality Framework (PCREF) to ensure standards are met across these areas. We have also commissioned the University of Gloucestershire in collaboration with the ICB to undertake some community-based research with DEC.
Countywide sensory team
We have a dedicated countywide sensory team who support adults with sensory loss (focusing on the needs of visually impaired providing practical support such as equipment and cane training) to enable them to live as independently as possible.
We have also identified a number of staff across all of our locality team who have undertaken the OCN Level 3 training to support adults with dual sensory loss, the intention was that in doing so we would raise awareness of dual sensory loss in the context of our responsibilities under the Care Act to provide Specialist Assessments - i.e. improving people's access to assessment and relevant support.
Independent advocacy
Independent Health and Social Care Advocacy is a service delivered by POhWER[v] (Advocacy Services for Adults in Gloucestershire leaflet) that is designed to deliver a combination of statutory advocacy roles for people who live in Gloucestershire. POhWER offer an information and advice support service.
Know your Patch networks
Another element of our community investment is the Know Your Patch networks which bring together cross-sector partners to form a network for the needs of our communities and individuals. The six networks are hosted by community led organisations in the VCSE who receive investment for the administration of the networks. Know Your Patch Networks were established to create a better understanding of Adult Social Care and build trusted relationships across the sectors.
We have heard from the KYP Networks that:
“Formal commissioning procedures are not the be all and end all. Time and a place for grant funding, is still incredibly important.” and “We have the freedom to develop and deliver in our own way, working in partnership with xxx and collaboratively with other KYPN leads. It’s a positive and helpful model of working, that enables us to innovate and adapt to the needs of the community.”
[i] Gloucestershire County Council, Equality Objectives 2023 -2027 https://glostext.gloucestershire.gov.uk/ieDecisionDetails.aspx?ID=2115
[ii] Equality Information and analysis https://www.gloucestershire.gov.uk/council-and-democracy/equalities-and-our-duties-under-the-equality-act-2010/equality-information-and-analysis/
[iii] Adult Social Care Service User Diversity Report 2022-2023 https://www.gloucestershire.gov.uk/media/pyrnwvnp/adult-social-care-service-user-diversity-report-2022-23.docx
[iv] One Gloucestershire, Enabling Active Communities https://glostext.gloucestershire.gov.uk/documents/s69544/HCT%20intro%20presentation%20HWB%20Mar%2021.pdf
[v] Independent Advocacy POhWER https://www.pohwer.net/gloucestershire
Last reviewed: