Research and analysis

Evaluation of DHSC's Grant to Streamline Local Authority Adult Social Care Assessments

Published 7 November 2024

Applies to England

This research was commissioned under the previous government (11 May 2010 to 5 July 2024) and therefore does not reflect the policies of the current government. The views expressed are the authors’ and do not necessarily reflect those of the government.

Executive summary

Introduction and method

The Department of Health and Social Care (DHSC) commissioned Ipsos, in partnership with the Institute of Public Care at Oxford Brookes University (IPC), to conduct an evaluation of the Grant to Streamline Local Authority Adult Social Care Assessments (‘the grant’). This was a one-off non-ringfenced grant of £27 million shared across all local authorities with responsibility for adult social care (ASC). The grant was released on 29 March 2023.

The aims of the grant are to support local authorities to continue the progress they have made in innovating their assessment approach and processes across 3 key impact areas:

1. Reducing waiting lists.
2. Maintaining and improving the quality of ASC assessments.
3. Moving assessments to digital platforms, where appropriate, to improve access, choice and flexibility for people.

The evaluation used the following evaluation methodologies to address the agreed evaluation questions:

• a full scoping and evaluation design phase including the co-development of theories of changes for both the grant and wider ASC assessment digitising and streamlining work at a national level
• a survey of all 153 local authorities with responsibility for ASC (of which 40 responded fully and 10 provided a partial response), covering wider progress in streamlining ASC assessments, their awareness and use of the grant and its impact
• 23 case study interviews across 7 local authorities (3 to 4 per local authority) exploring in more detail implementation of ASC digitising and streamlining activities, their use of the grant and the outputs, outcomes and impacts linked to the grant

The sample of local authorities included in the survey and interviews should not be considered representative of all local authorities. Therefore, findings can only be considered robust when ascribed to those local authorities which have engaged with the evaluation. Those local authorities which chose to engage in the evaluation may have had a different experience of spending the grant from those which did not. However, it should be noted that the participating local authorities included a good mix of local authorities from across the country and of different types, including counties, metropolitan and unitary local authorities.

Key findings

Among the local authorities who took part, the grant has been used by many for its intended purpose within a relatively short timeframe, with a minority having used it for other purposes. Of the authorities participating in this evaluation, around:

• 30% used all of the grant for ASC digitising and streamlining activities specifically
• 45% used some of the grant for these intended activities, or at least plan to do so
• 25% have not yet allocated the grant or have allocated the funding to other areas due to competing funding pressures and the relatively small size of the grant

Local authorities have spent the grant on activities which were prioritised in the grant guidance. This includes:

• purchasing digital tools such as self-assessment and screening portals
• funding transformation of ASC processes such as moving paper-based forms online
• funding staff roles in transformation or to provide screening and triage functions
• training and wider support to enable the use of digital tools and manage ASC demand

Activities funded or part-funded by the grant broadly reflect those that the grant was intended for. Local authorities reported that the grant has contributed to some outputs and outcomes across a range of areas linked to digitising and streamlining and is likely to continue to do so. A small number of local authorities have recorded measurable outcomes such as reductions in waiting lists and improvements in the speed of processes.

Outputs (what has been delivered or produced as a result of the grant funding) include:

• investments in new technologies and digital tools
• transformation of processes linked to ASC assessments including moving to digital platforms
• improved data management including access to and quality of data
• increased resources to work on digitising and streamlining activities

Outcomes (intended and unintended changes experienced by stakeholders as a result of the grant funding) include:

• reductions in assessment backlogs and/or waiting lists
• improved awareness of and ability to manage demand for ASC assessments
• improved staff resource allocated to more appropriate areas of high needs
• improved access to assessments (often due to reductions in backlogs)
• improved choice and quality of information for those seeking ASC assessments

While longer-term outcomes and impacts have generally not been reported at this stage because of the short period since the grant was dispensed, some local authorities are confident that the activities that the grant had supported will lead to sustainable reductions in waiting times, and an increased focus on personal needs and choice for those seeking ASC assessments in the future. Barriers to achieving outcomes include the grant not being of sufficient size, wider funding pressures across local authorities, difficulties implementing digital tools, and a lack of certainty around the correct approach to take.

The grant has enabled the progression of digitising and streamlining ASC assessments within many local authorities, however, most feel that further support is needed. For example, most local authorities had already made some plans to streamline and digitise ASC assessments. However, stakeholders in case study local authorities reported that the grant had enabled them to accelerate plans, or to undertake additional activities beyond those which had been planned previously.

Local authorities would like further support for streamlining and digitising ASC assessments, and reported that they would benefit from additional funding, sharing of learning and guidance for these areas.

Conclusions

Drawing upon the findings from the evaluation, the following conclusions have been made for DHSC and local authorities working on streamlining and digitising ASC assessments.

Spending of grant funding and prioritised activities

Despite the grant not being ringfenced, and the risks this potentially created, 30% of local authorities participating in this evaluation have used all of the grant for its intended purposes and around 45% have used some of the grant for intended activities, or plan to do so. Local authorities had clear wider intentions to fund activities in these areas. However, a significant minority (around 1 in 4) have not yet spent the grant on intended activities. All the intended activities appear to have some merit and it is not yet possible to fully assess which are most effective at producing desired outcomes from the local authorities included as case studies.

Outputs, outcomes and impacts generated by the grant

There are significant limitations upon the evaluation’s ability to capture outcomes and impacts at this stage, most notably the time since the grant was dispensed, and the difficulties in measuring change and attributing them to the grant specifically. However, many local authorities have reported outputs and outcomes linked to the grant that map to the ‘theory of change’ (ToC) for the digitising and streamlining workstreams, which include:

• resourcing: funding a dedicated productivity lead or ‘transformation specialist’
• digitisation: procuring and implementing digital efficiency tools already available on the market, for example self-service tools or online portals
• innovation: embedding transformation or business process experts to improve operating models, for example use of virtual assessments; trusted assessment arrangements

Enabling of digitising and streamlining of ASC assessments

Local authorities who have engaged with this evaluation view the grant as a significant enabler of ASC assessment digitising and streamlining activities, and the achievement of outcomes. Without the grant, most local authorities had plans in place anyway, but would not have progressed them as quickly, or have added additional activities to their plans.

Implications for national digitising and streamlining workstreams

The non-ringfenced funding model for the grant is viewed favourably by many local authorities due to the lack of monitoring and reporting requirements and flexibility to innovate or pool with other capital spending, which is likely to have increased overall spending on digitising and streamlining ASC assessments in some local authorities. The guidance provided with the grant was also reported as being helpful. Evaluation findings indicate that in many cases some (45%) or all of (30%) the funding was spent on relevant activities within local authorities and was not taken for competing priorities, however this was not the case for around 1 in 4 surveyed local authorities which had not yet allocated the funding. Only 1 in 27 surveyed local authorities had already spent it all on other activities.

While feedback from local authorities who took part in this evaluation on the funding model was positive, a ringfenced grant may have ensured that all of the funding, rather than most, has been or will be spent appropriately within the expected timeframe. Furthermore, many local authorities would welcome additional funding and support, including many of the activities highlighted in the ToC development process for the national approach to digitising and streamlining (see annex).

Introduction and context

Introduction

The Department of Health and Social Care (DHSC) commissioned Ipsos, in partnership with the Institute of Public Care at Oxford Brookes University (IPC), to conduct an evaluation of the Grant to Streamline Local Authority ASC Assessments (‘the grant’) - as detailed in the executive summary. The amount for each local authority was set using the adult social care relative needs formula (RNF) with a minimum amount of £130,000 per local authority paid in a single instalment.

The grant represents one element of a 2-year programme of work to streamline and digitise local authority assessment processes, building on charging reform preparations. The grant was intended to support local authorities to build capacity and generate efficiencies in their assessment processes. Examples of innovations which local authorities may have chosen to use the grant for on this basis include the procurement and implementation of digital efficiency tools, embedding transformation or business process experts to improve operating models, or increasing ratios of social work assistants.

The aims of the funding are to support local authorities to continue the progress they have made in innovating their assessment approach and process, as part of preparations for charging reform, while also maintaining a strengths-based approach.

Background context

Establishing the digitising and streamlining workstream

During the preparations for charging reform, it became clear that, as a result of planned reforms, local authorities would experience increasing pressure on the assessment process and overall services. Digitising and streamlining approaches had been identified through collaboration between the sector and central government to help manage the additional demand and a second tranche of implementation funding was planned to help fund this activity.

When charging reform was delayed, however, some of the planned activities, particularly those which help to build local authority capacity and generate efficiencies in their assessment processes, were still considered valuable. For example, although there is no consistent national data on waiting lists and delays to accessing social care, there are consistent reports of existing delays to all types of ASC assessments, including annual reviews. As a result, some local authorities have a large backlog of assessments, which can delay access to care and mean that some people already in receipt of ASC are not receiving annual reviews as planned, increasing the risk that they receive inappropriate levels or nature of care.

DHSC has, therefore, established a 2-year programme of work to transform and streamline local authority assessment processes, building on charging reform preparations. The grant represents one aspect of the workstreams that are intended to support progress within local authorities across these areas.

The case for change

There are significant gains to be made by the streamlining and in some cases digitisation of assessment processes as seen across other sectors, which could support a reduction in waiting lists. Local authorities are also encouraging innovative approaches to optimising the use of workforce, including those in assistant and trainee roles carrying out assessment functions where appropriate, and implementing trusted assessor models. These workstreams are hoped to build capacity and use resources more effectively within the ASC assessment system.

Key policy and programme stakeholders identified significant factors that demonstrate the case for streamlining and digitising ASC assessments. These factors are:

• ASC waiting lists are high, across most local authorities and assessment types (with local variation)
• technology and systems exist to streamline and digitise some processes
• the public is increasingly digitally literate and expects to engage digitally with services
• charging reform is likely to increase demand, particularly in more affluent areas
• digitisation will allow staff to focus on more detailed, meaningful assessment work
• there should not be a decline in the quality of engagement and support for those seeking access to care

Methodology

This section describes the methodology used to evaluate the grant, including how the steps taken address the agreed evaluation questions. Evaluation methods included an initial evaluation scoping and familiarisation phase, followed by the development of a theory of change. A mix of 3 methods were used to gather data from local authorities - a survey, case study interviews, and desk research of local authority documents and materials (see Table 1 below). These activities are described in further detail below.

Table 1: summary of how the methods employed as part of the evaluation address the evaluation questions

Evaluation question	Survey of local authorities	Case study interviews	Desk research of local authority materials
Has grant funding been spent?	Fully addressed	Partially addressed	Partially addressed
How was it spent?	Fully addressed	Fully addressed	Partially addressed
Was funding spent on intended activities?	Fully addressed	Fully addressed	Partially addressed
What was prioritised and why?	Partially addressed	Fully addressed	Partially addressed
What outputs have been generated to date?	Partially addressed	Fully addressed	Partially addressed
What outcomes have been generated to date?	Not applicable	Fully addressed	Partially addressed
How has grant funding enabled ASC assessment streamlining work?	Not applicable	Fully addressed	Partially addressed

Scoping and familiarisation

Initial scoping and familiarisation work was undertaken through 2 methods:

• 4 scoping interviews with 7 key policy stakeholders from across DHSC and the Local Government Association (LGA), using a semi-structured topic guide that had been pre-agreed with DHSC
• a review of initial key policy documentation submitted by DHSC to the evaluation team

Summarised findings from these scoping activities were reported to DHSC through the evaluation design report.

Theory of change development

The scoping activities described above were used to identify theory of change (ToC) elements (inputs, activities, outputs, outcomes and impacts) for the grant to inform the approach to the evaluation of the grant. These were reported to DHSC through the evaluation design report.

Additionally, a draft ToC for broader ongoing national involvement in the digitising and streamlining of local authority ASC assessments has been developed to inform this and future evaluation work, drawing on:

• in-depth interviews with 8 key policy and programme stakeholders from DHSC, NHS England (NHSE), the Association of Directors of Adult Social Services (ADASS), Social Care Institute for Excellence (SCIE) and the LGA
• a co-development workshop with the same stakeholder group to review and comment on draft ToC elements

The finalised version of this ToC, and the elements identified for the grant, can be found in the annex.

Survey of local authorities

An online survey of local authorities across England was conducted to capture the extent to which the grant has impacted upon local authorities’ efforts to streamline and digitise adult social care assessments.

All local authorities eligible for the grant were invited to participate in this survey (these were the 153 councils with responsibility for adult social care). The invitation email was sent to the Director of Adult Social Services at each of the local authorities and advised the recipient that the survey could be completed by the most appropriate person or people within their team with support from other colleagues (with one response per local authority). Ipsos sent 2 email reminders during the fieldwork period to encourage participation, and DHSC independently sent a further 2. The survey was open between December 2023 and February 2024.

The survey was designed to take approximately 10 minutes to complete and included both closed questions and open-ended response questions.

The survey included questions relating to:

• online-self assessments of needs eligibility and online financial self-assessments
• awareness of the non-ringfenced grant
• grant allocation
• potential outcomes of the grant

In total, 40 local authorities provided a complete response to the survey and 10 partially completed the survey (defined as completing at least the first question, which was ‘Which local authority do you belong to’). A breakdown of these local authorities by NHS region is provided in Table 2 below. The sample includes a broad range of types of local authorities (county, unitaries, metropolitan and London boroughs), regions, urban or rural areas, level of deprivation (IMD decile), and the percentage of the population in the local authority who are 65 years and over. Local authorities responding to the survey were also asked if they were willing to participate in follow-up case study interviews (see the section ‘Case study interviews and evidence gathering’ below).

Table 2: breakdown of sample that responded to survey of local authorities

Region	Complete	Partial	Total response	Local authorities in region	% local authorities in region responding
East of England	3	1	4	11	36%
East Midlands	3	1	4	10	40%
London	7	5	12	33	36%
North East	5	0	5	12	42%
North West	5	0	5	24	21%
South East	5	1	6	19	32%
South West	4	0	4	15	27%
West Midlands	3	2	5	14	36%
Yorkshire and the Humber	5	0	5	15	33%
Total	40	10	50	153	33%

In the analysis of survey results in the ‘Findings’ section below, partially completed responses have been included where there is a response available for that question. Where we mention the percentage of local authorities in this report we mean the percentage of participating local authorities. The data presented in this section is not weighted and therefore reflects the profile of the achieved sample. When base is less than 20, we present numbers. (‘Base is less than 20’ means when the number of people who answered the survey is less than 20.) In these cases, the numbers are presented to show how people responded to the survey, but they should not be taken as representative of the sector as they may be biased towards those more aware of the grant or involved in streamlining activities. Base sizes vary because of routing in the questionnaire to ask relevant questions.

About a third of all local authorities participated in the survey and the sample was broadly representative in terms of measurable characteristics of local authorities. However, it’s likely that the participating local authorities were more engaged with spending the grant and activities related to its aims than the local authorities which did not respond. This is a limitation of the evaluation to bear in mind when interpreting the findings and conclusions.

Case study interviews

Based on submissions from the survey, and knowledge held by DHSC and ADASS about grant spending plans, the evaluation team initially identified 21 local authorities to approach for case study interviews. These local authorities fulfilled pre-agreed sampling considerations to ensure they represented the range and diversity of grant spending activities in a variety of contexts (for example, type of local authority and deprivation levels). In total, 7 local authorities responded to this approach and were included in the final sample. Table 3 below details which local authorities are included in the case study interviews and the number of interviews conducted. One other local authority was included, where 4 interviews were conducted, however, they have been anonymised.

Table 3: local authorities included in the final case study interviews sample

Local authority	NHS region	Type	Rural or urban classification (3-fold)	IMD - Rank of average score	Population aged 65 years and over	Number of interviews conducted
Cheshire East	North West	Unitary authority	Urban with significant rural	128	22.0%	3
Dorset	South West	Unitary authority	Predominantly rural	120	30.0%	3
Halton	North West	Unitary authority	Predominantly urban	19	19.0%	4
Lambeth	London	London borough	Urban	62	8.6%	3
Sunderland	North East	Metropolitan district	Predominantly urban	28	20.5%	3
Surrey	South East	County	Predominantly urban	145	18.9%	3

Within each case study local authority, 3 to 4 interviews were conducted with those involved in the management of the grant, implementing the planned activities, and, where possible, in evaluating the impact within the local authority. In total, 23 interviews were conducted across the 7 local authorities. Interviews were semi-structured around a topic guide that was pre-agreed with DHSC. The local authorities included in these interviews should not be taken as representative of the sector as they may be biased towards those more aware of the grant or involved in streamlining activities.

Gathering evidence of outcomes and impact

For each local authority included in the case study interviews, the evaluation team also requested relevant information from the local authority such as business cases, figures on assessments, staffing figures, documentation relating to how assessments are carried out, and other evidence to support the assessment of outputs, outcomes and impacts achieved to date linked to the grant.

The evaluation fieldwork was conducted during what, for many local authorities, remains the early stages of their activities linked to the grant, and therefore time was a significantly limiting factor in capturing outcomes and impacts at this stage. Furthermore, outcomes and impacts were in most cases only partially attributable to the grant itself. This is because in many cases the grant has only part-funded activities, and ASC assessments are operating in a complex environment with many external factors influencing any observable or measurable changes.

In the case study interviews 3 of the 7 local authorities were able to supply supplementary data and evidence supporting the assessment of outputs, outcomes and impacts: Dorset, Halton and Sunderland. This evidence addresses areas such as reductions in waiting times for specific care assessment processes, reductions in waiting lists for some processes, satisfaction with assessment processes for those seeking them and improved access to support for carers. The evidence has been triangulated against qualitative data from interviews and mapped against the key outputs, outcomes and impact identified in the ToC elements both for the grant and DHSC’s wider digitising and streamlining workstreams (see the section ‘Theory of change development’ above).

Analysis and reporting

Survey analysis was conducted in Excel, with results for multiple choice questions presented in a series of data tables and charts. Open-text responses were thematically analysed with quotes purposively sampled to demonstrate and reflect key points.

Interview data was thematically analysed against the evaluation questions across all local authorities, both individually to develop the case study insights identified below and at a grant-level to address the process and impact evaluation of the grant itself.

A triangulation meeting was held within the evaluation team to assess findings from the survey of local authorities, case study interviews and supplementary evidence submitted by local authorities against the agreed evaluation questions. An overall formative assessment of the grant, including process and emerging impacts, is provided in the ‘Findings’ section below on this basis.

Findings

This section details the evaluation findings in full, structured around the agreed evaluation questions. It includes quantitative data (from the survey), qualitative evidence (from the case study and theory of change interviews), and summaries of relevant activities in specific case study sites.

Use of the grant

Most local authorities who responded to the survey confirmed that they have spent, or plan to spend, some or all of the grant. Seventy-five per cent of local authorities who responded to the survey reported having spent, or having a plan to spend, some or all the grant on streamlining adult social care activities, with 30% having already spent all of the grant on these activities. Where local authorities reported spending some of the grant on other priorities, the survey did not capture what proportion was spent in this way or what the other priorities were.

A small number of surveyed local authorities (5%) reported having only spent the grant on other priority activities, not directly related to ASC streamlining. Among those who had not spent the grant or had allocated some or all of it to other priorities, a range of reasons were reported. This included competing funding priorities within the local authority and the grant budget not being sufficient to cover anticipated costs to implement change to operating models.

Table 4: stage of spending the non-ringfenced grant

Stage of spending	Percentage (%)
We have spent all the grant on adult social care streamlining activities	30
We have spent some of the grant on streamlining activities and have spent the rest on other priority activities not directly related	16
We have not spent the grant yet but have a plan for how we will spend it on streamlining initiatives	16
We have spent some of the grant on streamlining activities, and are considering which activities to spend the rest on	14
We have not spent the grant yet but are considering which activities to spend it on	7
We have spent the grant on other priority activities, not directly related to adult social care streamlining	5
We were unaware that this grant was available	5
Other	1
I don’t know	7

The number of authorities which responded to this question is 44. Question: ‘What stage is your local authority at with spending the non-ringfenced grant on streamlining preparations?’

All 7 case study local authorities reported that they had either spent or allocated to spend the grant funding on streamlining adult social care activities, though the level of understanding about whether the grant had been spent since completing the survey varied depending on the participants’ role within their organisation.

Those in business development in adult services or finance managers and business partner roles tended to be key decision makers in the grant fund allocation and were therefore more aware of incoming grant funds.

Other staff (such as principal social workers, service managers, and systems and digital managers for adult social care) were made aware of the grant fund and their specifications. Some of these staff even helped inform parts of the planning and decision making around this grant fund allocation, but they were generally less aware of when and how grant funding had been allocated.

How the grant was spent

A variety of activities were reported by surveyed local authorities who had spent or were planning to spend some or all of the grant on streamlining adult social care activities. In this section we provide an overview of how the grant was spent. In later sections we explore how these relate to the intended inputs, activities, outputs and outcomes of the grant funding in more detail.

These activities included:

• embedding proportionate approaches to assessments (68%)
• delivering a change program to embed streamlining improvements to operating models (55%)
• embedding transformation or business process experts to identify opportunities to streamline (52%)
• efficiencies in processing financial assessments (48%)

Table 5: activities the grant funding has been allocated to (or planned for)

Activity	Percentage (%)
Embedding proportionate approaches to assessment (self, online, virtual and phone)	68
Delivering a change programme to embed streamlining improvements to operating models	55
Embedding transformation of business process experts to identify opportunities to streamline operating models	52
Making efficiencies in processing financial assessments	48
Embedding ‘trusted assessors’ to support assessment processes to improve capacity	39
Supplementing social worker vacancies with higher ratios of assistant or trainee roles	19
Use of additional resources to meet demand	10
Other	3

The number of authorities which responded to this question is 31. (Those who have spent or plan to spend all or some of the grant on streamlining activities in surveyed local authorities.) Question: ‘Which, if any, of the following activities have you allocated or do you plan to allocate this grant funding to?’

Of the surveyed local authorities 8 indicated an increase in the use of technological and digital tools for financial self-assessments, while 3 conveyed a similar increase for care needs assessments. Five surveyed local authorities acknowledged a more general increase in the use of technology and digital tools, including automated apps, portals, and online resources.

A local authority in the North East said:

Implemented automated telephony app for triage proportionate 6 week and annual review.

A local authority in the North West said:

For financial assessments it’s about working with the software supplier more to make it more fit for purpose in collating all info needed to compete a financial assessment.

Case study local authorities corroborated the survey findings above; they mentioned the grant funds were entirely, or partly, allocated to the following activities:

• reviewing and streamlining assessments, often through co-production with internal stakeholders and/or key partners. Some of the assessments mentioned were:

  • Deprivation of Liberty Safeguards (DoLS) assessments
  • safeguarding assessments (including required resourcing and reporting). In one case, additional project management resource was brought in to lead on this (part-funded by grant)
  • ‘moving and handling’ risk assessments
  • care needs assessments
  • CQC assessment processes
  • financial assessments

• purchasing digital tools to further streamline assessments and move away from paper-based assessment processes

• reviewing and digitising more proportionate recording processes

• reviewing and improving documentation, guidance and training about current local authority ASC digital tools or portals as well as processes for staff. One case highlighted this was particularly important for new joiners who, due to the resourcing crisis in the sector, do not often have prior care experience

• additional specialist resource brought in to look at business systems in the directorate to review, identify required changes and improvements, system functionality and information recording

• additional resource to help reduce backlog of assessments (for example, DoLS assessments) and annual reviews

Digital tools for care assessments and feedback

Local authority case studies reported purchasing new digital technology, for instance, grant funds were used to purchase Imosphere tools (Strengths-based Toolset for Adult Social Care) and resource allocation systems. They also reported using the funds to ensure their existing digital tools were efficiently utilised, for example, they used the grant funds to streamline System C (formerly Liquidlogic) portals, such as the delegation portal, the citizen portal and the online financial assessment portal. One local authority explained they had previously purchased one or more of these digital tools to help streamline portals because of the adult social care charging reform, however, due to lack of resource, capacity and different priorities within the local authority, progress came to a standstill.

The customer feedback telephony app, or telephony service, was another highly valued digital tool according to a few local authority case studies. This low-tech and automated telephone service has been implemented or is due to be implemented for varying purposes. One local authority reported they were planning to spend part of the grant fund on developing a telephony service for people using their services to provide feedback. They believed it will offer substantial quantity and quality of data about their services.

The case study local authority, said:

Another [activity] we’re looking at doing is we are going to develop a telephony service to capture more views from people that use our service, so that’ll be an automated system. We’re targeting (…) around 45% of our population [so around 4000 customers] to try and get that feedback. We’re aware of another local authority have done that [and] have been quite successful so we will take that feedback and that will help inform our practice. [The service] goes live on the 19th, well, fingers crossed, goes live on 19th February [2024].

Another case study had previously implemented this service for their 6-week post assessment and care plan and their 4-week pre-annual review. An interviewee reported that because of this streamlining activity, social work managers could better prioritise who they needed to see in person, rather than having 80 reviews to do in a month with no direction on the cases’ urgency. The local authority aimed to achieve a 45% call response rate within the first year of use, which equates to around 1,700 annual reviews to be supported by the app. Currently, they are achieving a 51% call response rate. They also anticipated that 70% of calls, approximately 1,100, would indicate no issues with care and support planning or ability to manage care and support resulting in allocation for proportionate review, and they’ve reported finding this in practice.

Furthermore, those customers who indicate no concerns or issues with care and support by the telephony app are scheduled to receive a follow-up call from unqualified staff to complete the review form in full, rather than a qualified worker (though still overseen by them for quality purposes and authorisations). This local authority went on to say that once they have set up their new digital tools from Imosphere (Strengths-based Toolset for Adult Social Care) paid for by the grant (expected timeframe: July 2024), and dependent upon the level of digital inclusion accessibility to online tools, they also intend to request a self-assessment form be completed by these customers, who have already been triaged by the telephony app.

Digital tools for financial assessments

In addition, of the surveyed local authorities who reported increased use of technology and digital tools to make efficiencies in processing financial assessment, 4 specifically mentioned that they now have access to the Department for Work and Pensions (DWP) Searchlight portal and use it to make efficiencies in processing financial assessments.

A local authority in London said:

Our financial assessment team now has access to DWP information. We are working on an online financial assessment process and ready reckoner.

A local authority in the South East said:

We are developing an online financial assessment so that residents can calculate how much they are likely to pay towards their care.

Business transformation expertise and collaborative working

Many surveyed local authorities who allocated or planned to allocate the grant towards operating models said they used these to increase efficiencies. They also mentioned embedding transformation or business process experts to support this streamlining work.

A few local authority case studies confirmed they have used the grant to fund transformation and business process experts’ salaries. One of the experts’ current focus was delivering portal user acceptance testing workshops, alongside the systems and digital team, as a co-production exercise with internal stakeholders. Following this, they would look into further streamlining the ASC teams’ reviewing processes. The business process expert explained that co-producing online assessments would lead to high data quality referrals in a self-assessment style and would save a lot of time for staff and improve customers’ journeys.

Further to this, some local authorities mentioned that they are reviewing existing or developing new operating models to support streamlining.

A local authority in the North East, said:

Undertaking a review of the community social work teams operating model and practice […] Identifying areas to reduce bureaucracy and create efficiencies.

A local authority in the South West, said:

We are currently developing a new target operating model to improve operational systems and processes and inspire improved organisational culture.

With a proportionate and strengths-based approach in mind, case study local authorities described the inefficiencies of their current front door service, or front door model, and the need to streamline and reduce duplicate referrals. As one case study explained, not all referrals need social work input, and the ones that do quite often do not lead to needing formal adult social care services.

A few local authorities explained that offering the Three Conversations Model, with a main focus on ‘Conversation 1: Listen and connect’ at the front office, plays an important role in streamlining adult social care assessments. This model suggests the first conversation is where the local authority listens actively to understand what really matters to the customer and connect them to resources and support which would help someone get on with their chosen life independently. With a multidisciplinary team at the front door, local authorities can focus on the person’s assets and strengths, consider all the resources and support that they can connect the person to and help make those connections. The view is that the current, commonly known, customer services team that focuses on only signposting or providing advice across many local authorities would be replaced.

Of note, these local authorities were at varying levels of this model’s implementation. For example, one local authority introduced front door hub and huddles at the start of February 2024 offering this ‘Conversation 1: Listen and connect’ approach. They reported to have helped transfer referrals to appropriate support at the front door, as opposed to transferring to an assessment. Another local authority said they were currently in the process of getting all the relevant teams together and had been working with the occupational therapy team, social work, and community voluntary sector (for example, Age UK) to also sit in that front door model.

A case study local authority said:

Currently the way we work can be seen as a little bit silo-y at times, so we are trying to have more blended teams [and] greater links with our voluntary and community sectors. We’re going to have a brand new redesigned front door that will allow us to have some of those multidisciplinary, across organisational conversations at the very start of a customer journey with us.

Increasing staff resources and capacity

The grant was also used by some surveyed local authorities to plug recruitment gaps by upskilling existing employees and/or recruiting new ones. Six local authorities indicated that the grant had been used to supplement social worker vacancies with higher ratios of assistant or trainee roles. This included 4 local authorities who reported increased capacity to allow for the assessment of supported year in employment (ASYE) programme, which gives newly qualified social workers extra support during their first year of employment.

A local authority in London, said:

We have developed a mentoring and work shadowing programme for staff who are not ready to undertake formal training, however, would like to explore and/or develop skills to be able to access social worker training when ready.

A local authority in the North West, said:

Increased agency and offered additional hours to cover waiting lists.

A few local authority case studies hired additional resource to help reduce backlog and improve processes. Support with the DoLS assessments was mentioned, as well as hiring agency staff.

Case study: funding digital transformation activities in Lambeth

Lambeth’s digital transformation strategy includes various planned digital innovations and the rolling out of new tools to enable transformation across their ASC system. This includes the introduction of chatbots for screening and advice, the digitising of paper-based processes, piloting of artificial intelligence (AI) tools and the introduction of new software for caseload management and recording. This work is only just starting, and precise costs are still being scoped out, however the grant has been allocated to these activities and will help fund them.

Lambeth Council said:

The grant will be split into software elements (for example improvements with existing software provider) and 6 or 7 distinct project areas. We will build up a resource plan identifying different types of staff; data technicians, web-designers etc. for each of those products. There is some funding allocated from the council that will be combined with grant to deliver this.

Stakeholders in Lambeth anticipate that this transformation workstream will lead to the following key outcomes:

• quicker assessment processes
• early interventions and preventative approaches by targeting those who have more acute care needs early
• an improved experience for those seeking ASC assessments
• more information for staff to inform resourcing and quality assessment
• Locally, the grant is viewed as a key enabler of these activities:

The grant has absolutely helped to do it [the digital transformation], would have got there but would have taken much longer… we are then off and running.

Case study: introduction of Imosphere in Cheshire East

Cheshire East Council has used a portion of the grant to fund 2 management posts within the client finance team to release capacity for digital and streamlining work. This includes working with an independent provider, Imosphere, to introduce a financial self-assessment tool for those seeking an ASC assessment. Currently they are still using paper-based financial assessments, so there is a clear potential for efficiency savings and more accurate data from digitising these assessments. Stakeholders reported that the tool will create a ‘2-way conversation’ that doesn’t get delayed by postal communication and is more responsive to changes.

Alongside this work, the local authority has started to create new online forms and pathways - maintaining guided information from previous tools but asking more about individual circumstances and giving more meaningful information. This work was described as essential, specifically given the challenges faced by the local authority in recruiting qualified social workers to meet the expected demand for assessments. The new, online approach enables social care teams to have a good understanding of a person’s needs before they action anything or go to see them. They are currently piloting the tool within a specific area, alongside the introduction of a trusted assessor model. The local authority is keen to observe the impact and mindful of potential risks to the quality of assessments from the introduction of digital tools.

It [the planned changes] will allow us to direct our resources more intelligently to where they need to be. Like many local authorities, we’ve got tremendous budget pressures at the moment, the workforce has not grown, even though the demand and complexity has increased.

Stakeholders from the local authority reported that the grant has been a significant enabler to this work taking place within the current timeframes:

Without it [the grant], almost certainly, we would not be in the position we are now, having worked with Imosphere to develop this online self-assessment, we would not be in this position.

The need was always apparent, the strategy was always there, but we would be further behind than we are now.

The grant’s use on intended activities

The ToC development work detailed in the annex identified the following activities as those expected to take place as part of the grant funding process:

• resourcing: funding a dedicated productivity lead or ‘transformation specialist’
• resourcing: finding ways to supplement hard-to-fill social worker vacancies with higher ratios of assistant or trainee roles
• digitisation: procuring and implementing digital efficiency tools already available on the market, for example self-service tools or online portals
• innovation: embedding transformation or business process experts to improve operating models, for example use of virtual assessments; trusted assessment arrangements

As outlined earlier in this report, most local authorities who responded to the survey reported having spent some or all of the grant on ASC assessment streamlining activities (75%). Fifty-two per cent of the surveyed local authorities reported having used or plan to use the grant funding for both new and existing streamlining activities; 29% indicated that they used or plan to use the grant for new streamlining activities only.

Table 6: activities the grant has been used for (or is planned for)

Activity type	Percentage (%)
Both new and existing activities	52
They are new activities	29
They are a continuation of existing activities	19

The number of authorities which responded to this question is 31. (Those who have spent or plan to spend all or some of the grant on streamlining activities in surveyed local authorities) Question: ‘Which of the following best describes the streamlining activities that you have used or plan to use the grant funding for?’

However, in a relatively small number of the local authorities surveyed, competing funding priorities and pressures may have impacted grant spending, with 21% of local authorities reporting having spent or planning to spend some or all of the grant on other activities (not directly related to streamlining ASC assessments). Just 7% of local authorities that responded to the survey had not yet spent the grant but were considering which activities to spend it on.

It is important to note that local authorities that used the non-ringfenced grant for streamlining activities are likely to be overrepresented within the cohort that took part in both the survey and case study elements of this evaluation. Local authorities that used the grant to support activities unrelated to streamlining assessments may have been less inclined to engage with or prioritise requests to contribute to the evaluation. Nonetheless, several case study interviewees felt that the model for this grant - that is, non-ringfenced funding with guidance on the activities it was intended to support - worked well for a grant of this size. Interviewees appreciated the flexibility it afforded local authorities to decide exactly which types of streamlining activities would be most useful within their local context and to innovate. The ability to spend the grant funding in this way, without burdensome monitoring and reporting requirements, was considered an enabler. It also meant that local authorities at different stages in the development of digitising and streamlining could use the funding in a way which was appropriate in their context.

A case study local authority, said:

I think it was quite general, which I think is a good thing, because sometimes when a grant is really restrictive it can be very difficult to try and shoe-horn something. But it was sufficiently detailed for us to think about how we might be able to use it, but not so over-restrictive that it hampered anything that we wanted to do. I thought it was quite balanced.

Prioritisation of the grant and reasons why

The majority of local authorities surveyed reported that the prioritisation of streamlining ASC assessment pathways has increased in their local authority since March 2023 (70%). Of this, 16% felt that prioritisation had greatly increased. As noted above, around half of local authorities had used or planned to use the grant funding for both new and existing streamlining activities (52%).

Implementing digital tools was reported as a key activity for more than half of the local authorities who felt the grant had contributed to their streamlining progress. Some local authorities also described specific areas of assessment activity that had been prioritised: filling vacancies, providing proportionate assessments and training trusted assessors. A small number of local authorities commented that they had increased capacity and were developing training programmes for employees to progress their careers and fill social work vacancies.

It was not clear from survey responses exactly why these activities had been prioritised. However, in-depth fieldwork with case study local authorities illustrated examples of the motivations for their chosen streamlining activities. Overall, local authorities acknowledged that streamlining ASC assessments was a necessity - particularly in the context of preparing for charging reform and wider financial pressures. Local authorities noted the need to be able to reduce backlogs and manage growing future demand more efficiently and within limited budgets. This was particularly pertinent for local authorities with both older populations and a higher proportion of likely self-funders.

Where local authorities had used the grant funding to contribute to existing streamlining activities, the ability to continue and maintain the pace of progress was considered especially valuable. Additionally, the expected benefits of providing the ASC workforce with more efficient tools and processes was a key motivation - reducing the administrative burden for staff and enabling them to spend more time with people seeking assessments or service users. Alongside improving staff satisfaction, local authority interviewees were motivated by the prospect of improving the experiences of people seeking assessments.

Additional findings around the activities prioritised by grant funding and the reasons behind this are detailed under ‘How the grant was spent’ and ‘The grant’s use on intended activities.

Case study: streamlining and digitising assessment forms in Surrey

Many of Surrey County Council’s ASC processes continue to rely on paper-based forms, which they plan to change over the next few years. On average, there are around 10,400 contacts each month. About 14% of them are recorded online, and the aim is to increase this considerably, with the eventual plan to mandate that all professionals have to send their referrals online. As a result, staff won’t be spending as much time searching and duplicating information or completing the forms to create records. The grant has funded transformation-focussed roles to focus on moving processes online, and partially funded the purchasing of online tools to use for migrating the recording of ASC processes to online portals.

Interviewees from the local authority reported that this transformation workstream should improve efficiency in processing a referral and communicating information between staff. Staff will be able to push back on referrals that have missing information by the portal (instead of by email) and the ASC professionals, who are referring in, will be able to log in to their portal account, see what they’ve submitted, and the status of their referral:

We’ve often heard in the past from professionals: ‘We’ve submitted something to you, we’ve sent an email in, and we don’t know what has happened to it’.

Furthermore, the digitisation of these processes will enable the local authority to create a single referral pathway for all new care and needs assessments, allowing for initial triage and assessment functions to be performed by more appropriate professionals and freeing up resources elsewhere in the system:

There’ll be more resources. We’ll have different people with different skills on the front door, for example, occupational therapist skills, information and advice skills, social work skills. Instead of all of these referrals going into a scattered number of teams, they’ll come into one place where we will have expert professionals who can answer those queries a bit differently at the front door. People won’t necessarily come back to have an assessment if they can be given the right information, advice, preventative kind of services at the front door. This will create more time for social workers, allowing them to work with people who need social care and do yearly reviews.

Stakeholders reported that the grant has enabled this work (which was planned before the grant) to progress more quickly through increasing staff capacity and purchasing online tools, and plans are now in place to introduce digital systems in some teams.

Outputs generated to date

Outputs are defined as what is delivered or produced as a result of an intervention. The theory of change (see annex) outlines the expected outputs of grant funding and national involvement in ASC assessment digitising and streamlining. These are:

• digitisation: increase in local authorities having access to digital tools
• digitisation: increase in local authorities utilising digital tools
• resourcing: increase in delivery of virtual care assessments where appropriate
• resourcing: increase in care assessments undertaken by assistants, trainees, or other more junior roles where appropriate
• resourcing: improved talent pipeline for social worker posts from assistants and/or trainees
• culture: local authorities reporting improved confidence and/or progress in the delivery of streamlined ASC assessment pathways and reducing waiting lists

Due to the absence of available data, these metrics have not been quantified as part of this evaluation. Throughout the survey and case study fieldwork with local authorities, it was noted that the outputs of streamlining activities are only measurable in some cases; in many local authorities, implementation of activities has not yet reached a point at which outputs can be observed. Nonetheless, three-quarters of local authorities that responded to the survey reported increased confidence in their ability to streamline ASC assessments and increased understanding of how to do so now or in the future.

Over half of surveyed local authorities (51%) reported improvements in the optimisation of their operating models since the grant funding was released in March 2023. Of the respondents who agreed that the grant has contributed towards streamlining in their local authority, more than half indicated it had supported investment in and the implementation of new technologies or digital tools (52%), and the progression of streamlining assessment processes (52%). The grant also enabled some local authorities to hire additional staff or resource (30%).

Table 7: reasons the grant has contributed towards the progression of adult social care assessment streamlining

Reason given	Percentage (%)
Helped implement digital tools or invest in new technology	52
Helped streamline assessment processes	52
Allowed hiring of additional staff and resources	30
Helped reduce waiting lists, times or demand	19
Supported partnerships with other organisations	11
Other	11
Don’t know	4

The number of authorities which responded to this question is 27. (Those who agree that the grant has contributed to progression of adult social care assessment streamlining in surveyed local authorities.) Question: ‘Why do you agree that the grant has contributed towards the progression of adult social care assessment streamlining?’ (Open text question coded into categories.)

Most local authorities reported that they were monitoring the changes expected as a result of their streamlining activities. These include a combination of both outputs and outcomes. The most common measures reported were monitoring performance, cash savings, quality assurance data and audits (37%), as well as waiting list and assessment and referral management data (32%). Other measures included reviewing customer feedback and complaints (15%) and using satisfaction surveys (10%). The digital tools implemented by local authorities include inbuilt data collection functionality, and the telephony systems noted above can be used for obtaining feedback from people using the local authority services. This means that, although for many local authorities it is too soon to evidence outcomes of their streamlining activities, it will be possible to measure outputs, outcomes and impacts in the future.

Case study interviews with local authorities further highlighted examples of outputs from streamlining activities. These included:

• the introduction of new digital tools and telephony systems
• revised and improved joined-up processes
• improved data management and quality
• improved feedback from people receiving ASC assessments
• where new tools or processes have been sufficiently developed and implemented, improved information is available to the ASC workforce (provided through these new tools or processes)

Case study: Dorset Council is using the Bridgit online carer support tool to allow carers to create a self-help plan and proactively manage demand

Dorset Council aligned its grant spending to its ‘Our Future Council’ programme - an overall approach to managing customer journeys and trying to make sure the local authority as a whole is meeting people’s needs within a lower resource base. As part of this, the council part-funded the use of Bridgit; an online tool that allows carers to run a self-assessment which provides financial and health advice, suggested tasks, goals to accomplish, local services and nearby events. Stakeholders at the council are pleased with the numbers engaging with the tool to date:

We’re looking at the numbers of people who are using that tool, and we’re now at 6,000 carers who have created a self-help plan for themselves, which is incredible. And the numbers just keep going up month on month as well.

Bridgit automates functions such as signposting, service promotion and basic carer support tasks such as plan creation and needs assessments. This tool is viewed as an important contributor to the council’s ambition to reduce demand on those working on carer’s assessments and support, allowing teams to focus less on administrative tasks and more on meaningful support provisioning and reducing backlogs in assessments:

I think if there’re more people that can self-help and there’re more people that can fill out information themselves, we can get through that backlog and we can spend the right time with the people that actually need it, and then we can start doing some more of that proactive and more of that preventative work. So, I don’t believe there is any intention whatsoever to do any reduction and resourcing or anything like that, it’s refocusing the work and spending the right time with the right people that need it.

In total (as of February 2024) 5,492 self-help plans have been created by carers in the region. Many individuals were not previously known to the local authority, which means that the data created has helped the council assess and manage demand both now and, in the future, more accurately. Furthermore, forecasts shared by the council project resource savings from reducing the need for council staff to create care plans and conduct needs assessments.

A reduction in the number of people needing full carers’ assessments could have some unintended consequences, as some stakeholders noted. The local system will need more time to understand if the self-help approach means those who need more help, and a formal assessment, are getting through to that stage, or whether others who need this type of help are not reaching the formal assessment stage.

Outcomes generated to date

Outcomes are defined as the early or medium-term results of an intervention. The theory of change (see annex) also outlines the expected outcomes of grant funding and national involvement in ASC assessment digitising and streamlining. These are:

• reduction in waiting times for assessments, as defined by local authorities
• increase in speed of access to ASC assessment processes
• greater standardisation of access to assessment processes for those with ASC assessment needs
• more person-centred assessments with a greater focus on individual needs and greater identification of appropriate care
• reallocation of resources to more complex cases with a greater level of need
• increased satisfaction with ASC assessment processes, linked to survey data and complaints

Due to the absence of available data, these metrics have not been quantified as part of this evaluation.

Local authorities that responded to the survey reported the extent to which the streamlining activities implemented had impacted on these outcomes since the grant funding was released in March 2023. Forty per cent of local authorities reported improvements in their capacity to handle increasing volumes of people requesting assessments. Over a third of local authorities reported improvements in the time between first contact or referral and the decision about whether to conduct a full care and financial assessment or signpost to alternative support (38%); and improvements in the timeliness of annual reviews for those already drawing on long-term care and support packages from the local authority (38%). Thirty-one per cent of local authorities surveyed reported an improvement in the time between deciding a full care and financial assessment is required and the final outcome of the assessment. These local authorities described how the grant has increased their capacity to deliver assessments and supported positive changes to systems and processes, including promoting more tech-enabled assessments.

Table 8: impact of the grant on capacity and timings

Impact	Somewhat improved (%)	Greatly improved (%)	Total (%)
Assessment capacity (ability to handle increasing volumes of people approaching the local authority for support)	33	7	40
Time between first contact or referral and decision about whether to conduct a full care and financial assessment or signpost to alternative support	33	5	38
Timeliness of annual reviews for those already drawing on long term care and support packages from the local authority	26	12	38
Time between deciding a full care and financial assessment is required and final outcome of the assessment	24	7	31

The number of authorities which responded to this question is 41 to 43. Question: ‘Since the grant funding was released in March 2023, to what extent, if at all, have streamlining activities implemented in your local authority impacted on …’ (Series of statements to which participants could respond using a 5-point scale from greatly improved to greatly worsened.)

As described in the section ‘How was the grant funding spent?’, a small number of local authorities used the grant to hire additional staff resource to help reduce backlogs.

A local authority in the North West, said:

“The additional capacity through recruitment of agency staff has assisted with reducing waiting times for assessment and waiting lists for allocation of casework.”

A local authority in Greater London, said:

“[Progress has been made] due to the increase in capacity to complete and implement new approaches, following the increase in staffing from the grant funding.”

Thirty-eight per cent of the local authorities surveyed reported an improvement in the quality of assessments since the grant was issued. Thirty-six per cent felt that service users were receiving more targeted and appropriate care.

A local authority in Greater London, said:

“It has allowed increased IT and professional training, jointly delivered for assessing staff, to ensure that decision making is proportionate and strengths based.”

However, in most cases the local authorities that responded to the survey reported no change yet in areas of user satisfaction, across both those approaching the local authority for care support (56%) and the social care staff delivering assessments (56%). Over three-quarters (78%) reported no change in the number of complaints to the Local Government Ombudsman; 1 in 10 reported that the number of complaints had somewhat improved. Notably, 15% of local authorities’ respondents reported that they were using the number of complaints to measure the outcomes and impacts of their streamlining activities.

Almost a third of the local authorities surveyed reported improved transparency and standardisation of systems to enable better links between the NHS, care providers and other local authorities (31%). Forty-three per cent felt that value for money had improved since March 2023.

Seventeen per cent of local authorities that responded to the survey reported no improvements in outcomes since March 2023. Five per cent of local authorities reported that they had not yet implemented any streamlining activities. As noted in the section ‘Has grant funding been spent?’, among the local authorities who had not spent the grant or had allocated some or all of it to other priorities, a range of reasons were reported. This included competing funding priorities within the local authority, and the grant budget not being sufficient to cover anticipated costs to implement changes to operating models.

Interviews with case study local authorities provided a further, more detailed understanding of how streamlining activities are expected to result in improved outcomes. As described in the outputs section above, many local authorities remain too early in the implementation of their activities to report observable outcomes.

However, increased capacity funded by the grant supported 2 case study local authorities to either clear or reduce their backlog of outstanding assessments. Longer-term, it is anticipated that this reduction in outstanding assessments will enable shorter waiting times for new people ‘joining the queue’. One interviewee noted a potential unintended consequence of eliminating waiting times for assessments, and the need to understand these outcomes in the wider context of local systems with limited capacity.

A case study local authority, said:

“What I can say is that we’ve virtually eliminated waiting times for a package of care. That bit of the waiting times. But that will get worse when we’ve cut down the waiting time for an assessment. Because the faster people go through an assessment, the quicker they’ll get in the queue for a package of care. And so we haven’t got it all right at the same time.”

Interviewees also highlighted the important role of effective signposting to quality information and guidance. By implementing digital tools that provide personalised signposting to relevant information, based on data input by those seeking support, it is expected that people will gain access to the information they need more quickly. In turn, local authorities anticipate a reduction in people requesting assessments, as they will have been able to self-serve to access information and support that meets their needs. In managing demand for assessments in a more effective way, the local authority is better able to focus the resources of its ASC workforce on those with more complex support needs.

Another likely outcome of self-assessment approaches identified by local authorities is improved choice and less restrictive access to assessments - chiefly as these approaches, supported by digital tools, do not require the people requesting assessments to call the local authority during office hours. Nonetheless, interviewees acknowledged the need for accessible options, particularly for people who are unable to access the internet.

Local authorities also noted that improved systems will enable ASC staff to receive better information (for example, from health partners) ahead of engaging with people seeking assessments. This is expected to enable more efficient, targeted conversations, a reduction in administrative burden for staff, and a better customer experience - particularly meaning people seeking care or support need not repeat themselves.

Likely outcomes identified by local authorities also included digital technology supporting a more productive, motivated workforce. Job satisfaction and more manageable workloads were identified as potential benefits - although the need for a collaborative and supportive approach to implementing changes to assessment processes was highlighted.

A case study local authority, said:

“I’m confident these activities will have the expected impact… There has been, and there continues to be a cultural shift and it wouldn’t be fair not to say… there’s always a level of anxiety. So, what does that mean for me if the activity that I do today is taken off me or looks different, what does that mean for my role? But I think the fact that we are talking to our teams throughout all of this development work is really helpful to them, because they feel they’re having a say, so they’re not feeling threatened by the introduction of a digital tool that means it ‘dilutes their role’.”

Overall, interviewees agreed that the intended outcomes were not simply focused on timeliness, but also on assessment quality - with streamlining activities aiming to support a greater focus on individuals’ needs and improved experiences. Approaches such as trusted assessor models are expected to potentially contribute to both assessment timeliness and experience outcomes - for example, by enabling providers to conduct review assessments when they are due (timeliness) and enabling people drawing on care and support to complete their review with someone familiar to them. Streamlining activities that support a proportionate response to individuals’ needs are similarly expected to improve the experience of people drawing on care and support.

Case study: Sunderland City Council’s implementation of an ASC feedback app

Sunderland City Council has part-funded the implementation of an adult social care feedback app to more effectively, and in a less resource intensive way, gather feedback from customers to advise how they felt about the assessment, care planning and care provision. The information gathered through the app will be used to support proportionate 6 week and annual reviews, and the more effective management of resources.

There are a number of emerging outcomes from the implementation of the app, some of which are outlined below.

A more proportionate approach to reviews - they were aiming to achieve a 45% call response rate within the first year of use, which will equate to around 1,700 annual reviews being supported through the app. On average 70% of annual reviews result in no change to care and support planning, estimated at 1,100 per year, and it is this type of review which the telephony app approach is intended to support.

They have now developed a process whereby those customers who indicate no concerns or issues with care and support through the app (projected at 70%) will receive a follow-up call from unqualified staff to complete the review form in full, rather than the customer receiving a planned review in the usual way with a qualified social worker. This will be overseen by a qualified social worker for quality and final authorisation.

Currently they are achieving a 51% call response rate and, as anticipated, 70% of calls indicate no issues with care and support planning or ability to manage care and support, resulting in allocation for proportionate review.

The app also steers customers to information, advice and guidance, which will potentially further reduce demand for assessments in the longer term.

Exporting data from this app and matching it to their ASC case management system has allowed the local authority to evaluate good practice and areas for improvement at both a team and worker level:

We have seen an improvement in terms of waiting times because people do have that self-assessment option and although it’s not the final product, they still have the option to complete the tool that we have currently in place. So, we’ve seen a reduction from the numbers that we had, you know, last year or a few months back to what we’re seeing today.

There are further plans to streamline and digitise other ASC assessment processes in the future, and interviewees felt the grant has accelerated progress in this area:

Fundamentally, it’s not something brand new but it has accelerated the progress we’ve been able to make because we were having these conversations pre-pandemic but actually having the funds available to then pick up pace is what makes a difference.

How the grant funding has enabled ASC assessment streamlining work

Stakeholders interviewed throughout development of the ToC described the concept of ‘streamlining’ in a variety of ways. Some focused specifically on the digitisation of assessments, through digital tools and advanced technology, and associated efficiency gains. Other interviewees highlighted that streamlining encompasses local authorities carrying out assessments in a way that is efficient and proportionate, while always ensuring the right approach is used for the individual drawing on care and support. Interviewees also described approaches that eliminate unnecessary duplication.

A ToC development interviewee, said:

Everyone who comes into contact with social care, in whatever form they do, should only have to tell their story to as few people, as least often, as possible. Let’s get the information onto computer systems and make sure it flows out to all the right places and all the right people… Repeat yourself as little as possible, be able to see what is held about you, and be able to check and approve that information as much as possible. Streamlining is about making sure all those points of connection are live and work properly.

As mentioned above, it is important to note that local authorities that used the non-ringfenced grant for streamlining activities are likely to be overrepresented within the cohort that took part in both the survey and case study elements of this evaluation. Local authorities that used the grant to support activities unrelated to streamlining ASC assessments may have been less inclined to engage with or prioritise requests to contribute to the evaluation.

Sixty-six per cent of the local authorities that responded to the survey agreed that the grant has contributed towards the progression of streamlining ASC assessments in their local authority; 7% disagreed. Interviewees across the 7 local authority case studies broadly agreed that although the grant was not the only factor that contributed to their progress, it had supported their ability to resource and maintain the pace of their activities - some of which were already underway prior to the grant funding being received.

A case study local authority, said:

It provides the focus, you know, that kind of money, that kind of guidance, that kind of support says, ‘Guys, this is what you need to be working on, this is what’s important.’ So it provides us that focus. So without that would we be focusing on something different? I don’t know; would it be something that’s at the forefront of our minds? I don’t know. So definitely it provides us the focus and it speeds things up.

However, some interviewees noted that their local authority’s spend on streamlining activities is significantly higher than the value of the grant, suggesting that, while it has provided some assistance, the grant may not have had as great an impact as initially hoped for.

A case study local authority, said:

It has helped… but if the grant wasn’t there, we’d be doing it anyway. So, on a scale of 1 to 10, where it’s helped, it’s probably at about a 3… It has helped, but maybe it hasn’t had as big an impact as was envisaged, certainly in my local authority.

Insufficient funding and inability to prioritise streamlining activities were given as reasons by the few local authorities that responded to the survey and did not agree that the grant had contributed towards their ASC assessment streamlining progress.

A local authority in the South West, said:

We have not been able to prioritise the streamlining of adult social care assessments. Our ITD resources are limited and we’re already working on other service priority areas of work.

More broadly, 70% of survey respondents reported an increase in the prioritisation of streamlining ASC assessment pathways in their local authority since March 2023. While this increased prioritisation cannot be attributed directly or exclusively to the grant, it indicates local authorities’ increased focus on this area since the grant’s allocation. Twenty-one per cent of respondents reported no change in the prioritisation of streamlining ASC assessment pathways.

The majority of local authorities surveyed (73%) reported requiring further support to implement streamlining activities. The types of support most frequently identified were increased financial support, grants or funding (29%) and increased resources, capacity or staffing to embed changes (29%). Respondents also highlighted a need for increased knowledge-sharing to illustrate best practice (17%). Twenty per cent of the local authorities surveyed reported needing no support to implement streamlining activities.

Local authority interviewees expanded further on the kinds of support DHSC or other bodies could provide to help their local authority in streamlining assessments. These included:

• clear national guidance and definitions to ensure expectations are aligned both across local authorities and with other adult social care sector bodies (for example the Care Quality Commission)
• a collaborative approach between central government, local government and the NHS to build a common narrative and understanding
• increased sharing of knowledge, best practice and ‘what works’ - including enabling formal ‘buddying-up’ or peer support opportunities
• support with forecasting and modelling to enable local authorities to better plan for likely local needs over the next 5 to 10 years
• developing a framework of basic requirements for digital system suppliers, for both financial and care needs assessment tools. Several interviewees suggested this standardisation would mitigate the need for each local authority to purchase ‘bolt-ons’, as there are common actions for most local authorities’ assessment processes which would be better defined. This national framework approach may also support innovation in the supplier market, as the standardised needs across local authorities would be better understood

Case study: Halton Borough Council’s implementation of the ‘first assessor’ model and redesign of front door and outreach support

Halton Borough Council used funding provided through the grant to fund 2 key activities within their ASC assessment pathway.

Firstly, they funded additional dedicated support for front door referrals and Deprivation of Liberty Safeguards (DoLS) from June 2023. This has enabled them to clear the backlog ‘at the front door’ and allocate the correct support for those being referred within 24 hours. The additional resource includes increasing the number of first assessors from 1 to 3, to reduce initial triage waiting lists and reallocate resources to more complex cases. Therefore, they have granted an additional 135 authorisations since receiving the funding, bringing the waiting time for subsequent allocation of support down to less than 12 months.

Overall, the implementation of a first assessor model has led to a waiting list fall from 1,000 to 250 days to have a review between Q4 2022 to 2023 and Q4 2023 to 2024. In terms of support for short term care needs, the waiting list has reduced from 130 people to 50 for an assessment or review and stakeholders feel this is now having wider system impacts:

The changes to ways of working have led to a more productive workforce who can focus on meaningful tasks…staff have more time to speak to clients, reviews are more informed. Assessment work is more outcomes-focussed.

Secondly, Halton Borough Council has established a Prevention and Wellbeing Service with the support of a redesign of adult social placing outreach support. This team is focusing on people accessing community support before requiring support from adult social care where appropriate, and is seen by stakeholders to have reduced demand and associated pressures upon ASC staff, while also assigning community support to individuals where that is the best approach:

With more capacity at the front door being able to have an outcome focused approach to the discussion, the right support is being identified.

Although the implementation of a first assessor model and a prevention-focussed front door service were already planned, the grant has enabled the local authority to progress these redesigns more quickly and allocate more resources to their team of first assessors, which stakeholders feel has improved both the speed and impact of this work:

There is a dual track approach, tackling short-term and immediate issues using the grant, and a broader 2-year transformation programme for wider, longer-term initiatives…The grant has been a massive boost - it has meant we can employ an additional 2 posts and undertake the streamlining activities and reduce waiting times for assessments very tangibly.

Stakeholders hope that being able to evidence the impact of this additional resource will lead to long term planning for sustainably funding these roles internally.

Theory of change for national digitising and streamlining

This section draws together findings from the ToC development work for the national ASC assessment digitising and streamlining workstreams, alongside findings from the evaluation of the grant itself, to respond to the following key lines of enquiry as defined by DHSC.

The draft ToC for broader ongoing national involvement in the digitising and streamlining of local authority ASC assessments was developed through:

• in-depth interviews with 8 key policy and programme stakeholders from DHSC, NHSE, ADASS, SCIE and LGA
• a co-development workshop with the same stakeholder group to review and comment on draft ToC elements

Interviewees from case study local authorities were also asked for their views on national involvement in digitising and streamlining activities. The finalised version of this ToC can be found in the annex.

The types of activity required on a national scale

Through the ToC development process, the following activities were identified for national work to support the digitising and streamlining of ASC assessments.

For DHSC, these activities are:

• the development of guidance and toolkits that build on the Care Act; focussed on procuring and implementing digital tools, alongside transformation of ASC processes
• sharing case studies demonstrating examples of best practice and challenges in key areas
• engagement activities with local authorities such as webinars and other staff events, to promote guidance, tools and best practice examples
• the creation of market standards for digitisation tools and/or procurement guidelines, which could include developing a list of approved suppliers and systems
• working with digital tool suppliers to improve products and make them more suitable for use in ASC assessments, including integration and interoperability with existing systems and training for local authority staff
• facilitation of peer-to-peer learning and support

For local authorities these activities are:

• changes to social worker roles, focussed on increasing the number of assessor roles that do not require a social worker qualification, with responsibility for conducting ASC assessments
• creation of productivity or transformation specialist roles within local authorities
• procuring and implementing digital efficiency tools already available on the market, for example self-service tools or online portals
• improved data standards and reporting within local authorities feeding into standardised national datasets
• developing guidance for those seeking ASC assessments on how to access and use tools

Many of the activities that local authorities have reported were funded or part-funded by the grant, as described in the ‘Findings’ section, map well to the activities identified for local authorities through this process.

The grant itself forms just a part of the activities identified for DHSC at a national level. The guidance issued alongside it, and examples of good practice it has enabled that are detailed within this report, can be used as first steps to develop guidance, share case studies and facilitate peer support between local authorities.

Local authority case studies included in this evaluation have highlighted that many local areas are including several of these activities in their transformation plans concurrently. For example:

• combining technology for triaging with use of unqualified staff: following up assessment functions in digital tools (for example telephony apps) with a full assessment through an unqualified assessor rather than a qualified worker (though still overseen by them for quality purposes and authorisations)
• clearing assessment backlogs while shifting time and resource focus to more preventative measures and local needs assessment activities: while clearing waiting lists for assessments through transformation of processes, shifting resources that are freed up to more preventative activities such as the creation of local prevention and outreach services
• digitising paper-based assessment processes and improving ongoing case management and data quality standards: moving assessment functions from paper-based to online systems, then using this data to integrate with other follow-on processes to improve the speed of assessments and allow assessors access to richer information, allowing them to be more informed and person-centred

There is some evidence that the grant has encouraged approaches covering multiple activities working together to produce greater outcomes.

The types of local and targeted support needed

Most surveyed local authorities reported that they would like further support beyond just funding at a national level to streamline and digitise assessments. Those local authorities included in case study interviews also expressed a desire for further support, in terms of additional funding, sharing of learning and guidance, to support these activities.

While the grant has generally been seen as an enabler of streamlining and digitising ASC assessments, further support is required to support many local authorities to progress this further. Grant funding was viewed by stakeholders within local authorities as just one part of a wider support package to address the digitising and streamlining of ASC assessments. Other elements of this support package suggested by local authorities involved in case study interviews included:

• guidance on best practice, peer support from other local authorities and best practice examples
• a framework to support the procurement of digital tools that support streamlining ASC assessments
• working with software providers to improve products for use within ASC
• training and staff development, such as national training guidance or modules

These activities broadly align with the ToC developed for national digitising and streamlining workstreams, and therefore we can be more confident based on the evaluation findings that these activities will enable digitising and streamlining work locally, and that support of this nature will be accessed and used by local authorities, were it to be made available.

From the 7 case studies included in this evaluation, we did not find significant differences between local areas for the type of support required. However, stakeholders at a national level identified the following factors that may lead to significant local variation:

• levels of pre-existing digital tools within systems
• levels of demand for ASC assessments, which are high everywhere but can vary
• demographics, most notably age profiles and levels of affluence

These factors should be considered when creating support offers for local areas. In addition, local authorities and sector representatives should be allowed to input into support offers to ensure they are co-developed and account for local contexts.

The barriers and challenges to take-up of the grant

A small number of local authorities who responded to the survey reported no outcomes linked to the grant or that factors had prevented them from achieving outcomes so far. Furthermore, while all the local authorities included in case studies reported some achieved or projected outcomes, they were also aware of challenges and limiting factors that had to be overcome to achieve these.

The barriers and challenges cited by local authorities included:

• the grant not being of sufficient size
• wider funding pressures across the local authority
• difficulties implementing digital tools (due to a lack of alignment with existing systems or a need to train and enable staff to use the tools)
• a lack of certainty around national policy direction (linked to the charging reform delay) and therefore the correct approach to take

At a national level, 2 risks were identified by the ToC development process that could specifically impact the take up of national support.

First, there is a risk that local authorities facing funding pressures are unlikely to engage with additional support and/or prioritise this work. Many local authorities face increasingly acute funding pressures and there is no immediate incentive to work outside their local authority, engage with the national support programme and spend money or resources on transforming processes (even if there is the potential to save resources in the longer-term).

Second, a nationally delivered workstream does not account for local contexts. There is a risk that DHSC does not appear to be taking advice and learning from the sector itself, or that nationally mandated changes do not sufficiently account for local contexts, which could significantly reduce engagement from local authorities. DHSC should ensure it incorporates knowledge and feedback from local authorities and sector representatives when delivering national workstreams.

Areas DHSC should focus on to support national improvement

Stakeholders involved in the ToC development process and interviewees from case study local authorities identified the following areas of focus for DHSC to support national improvement of streamlining and digitising ASC assessments:

• further funding: further grants of this nature would be welcomed by most local authorities included in this evaluation
• guidance and sharing of learning: including guidance and toolkit on procuring digital tools and process transformation, sharing case studies of best practice and overcoming challenges and facilitation of peer-to-peer learning and support
• shaping the digital tools market: national procurement guidelines, creation of market standards, working with digital tool suppliers to improve products and make them more suitable, including integration and interoperability with existing systems and training packages for local authority staff
• workforce: creation and/or formalisation of non-qualified roles focussed on a responsibility for conducting ASC assessments

The types of intervention which offer the greatest opportunities for impact at a system level

Through the ToC development process, stakeholders identified potential impacts at a system level. The potential impacts are:

• reduction in overall system pressures linked to ASC assessments placed upon local authorities and staff working within these processes
• improved understanding at a national level of waiting lists, waiting times and ASC assessment quality across all local authorities
• more proactive management of social care demand and needs rather than being a highly reactive state, including identification of emerging need at an individual level
• improved market for digital tools with national standards and more tailored to the needs of local authorities
• improved data and intelligence locally around local ASC needs

Longer-term system level impacts linked to the grant are by their nature harder to capture as part of the evolution of the grant, and case study local authorities were not able to report measurable changes in these areas. The only impact on this list that has been demonstrated at this stage is ‘improved data and intelligence locally’, which has been demonstrated in several case studies through the procurement of innovative digital tools. Furthermore, the case studies included in this evaluation demonstrate the greater impact of multiple digitising and streamlining activities occurring at once, as those areas who are working on areas across ASC processes concurrently have been able to demonstrate the most outcomes. This highlights the importance of seeing the digitising and streamlining workstreams nationally as a combined package, rather than a series of isolated activities.

It is not possible at this stage to assess the extent to which different interventions will offer the greater opportunities for impact. However, local authorities were confident that the activities that the grant had supported would lead to sustainable reductions in waiting times and an increased focus on personal needs and choice for those seeking ASC assessments in the future.

Conclusions

This section draws upon the evaluation findings above to make some key conclusions around areas of interest for local authorities and DHSC.

Spending of grant funding and prioritised activities

The findings from this evaluation confirm that in many cases, grant funding has been spent on or allocated to the activities that the grant was intended to contribute towards, as identified in the guidance issued by DHSC and the ToC elements established during the scoping stage (see annex).

Prioritised activities cited most often by surveyed local authorities and local authorities involved in case study interviews include:

• purchasing digital tools such as self-assessment and screening portals
• funding transformation of ASC processes such as moving paper-based forms online
• funding staff roles in transformation or to provide ‘front door’ screening and triage functions
• training and wider support for both staff and those seeking ASC assessments to enable the use of digital tools and manage ASC demand

These prioritised activities map well to those identified in the scoping interviews by key policy stakeholders as the intended uses of the grant. Despite the grant not being ringfenced, and wider funding pressures within most local authorities, the entire grant has been used for its intended purposes in a relatively short timeframe by around 30% of local authorities who responded to the survey, with another approximately 45% having spent or planning to spend some of the grant in this way. However, a significant minority (around 25%) of local authorities have not yet allocated the grant or spent it on intended activities.

Local authorities included in case study interviews were also asked about their motivations for spending or allocating the grant funding in the way that they have chosen to. Stakeholders within these local authorities mentioned:

• their preparations for charging reform and the anticipated increase in demand
• a desire to improve their efficiency and productivity
• improving processes for staff to make their jobs less onerous and reduce time spent on administration
• senior staff spending time on more focussed detailed casework
• more proactive work on managing care needs in local population
• improving the experience of those seeking care assessments

It is too early to assess within the volume of data collected as part of this evaluation which activities have been the most effective or produced the best outcomes.

Outputs, outcomes and impacts generated by the grant

The fieldwork in this evaluation has been conducted during what, for many local authorities, remains the early stages of their activities linked to the grant, and therefore time is a significant limiting factor in capturing outcomes and impacts at this stage. Additionally, outcomes and impacts are nearly always only partially attributable to the grant itself; this is because in many cases the grant has only part-funded activities, and ASC assessments are operating in a complex environment with many external factors influencing any observable or measurable changes. Many longer-team outcomes and impacts are also difficult to robustly measure.

However, most local authorities who responded to the survey have also reported some emerging outputs and outcomes linked to the grant across a number of areas. Furthermore, all case studies have qualitatively reported outputs, and some emerging outcomes and impacts, linked to the grant. In some cases local authorities have reported measurable outputs and outcomes liked to the grant and report that they expect further outcomes and impacts to occur in the future. The evidence collected so far suggests that the grant has contributed to some outputs and outcomes across a range of areas linked to digitising and streamlining and is likely to continue to do so.

Most commonly, local authorities reported through the survey and interviews a number of outputs and outcomes linked to the grant. These outputs include:

• investments in new technologies and digital tools
• transformation of processes linked to ASC assessments including moving to digital platforms
• improved data management, access to and quality of data
• increased resources to work on digitising and streamlining activities

The outcomes include:

• reductions in assessment backlogs and/or waiting lists
• improved awareness and ability to manage demand for ASC assessments
• improved staff resource allocated to more appropriate areas of high needs
• improved access to assessments (often due to reductions in backlogs)
• improved choice and quality of information for those seeking ASC assessments

Longer-term outcomes and impacts linked to the grant are harder to capture within the timeframes of this evaluation, and most local authorities were not able to report measurable changes in these areas. However, stakeholders from local authorities included in case study interviews were confident that the activities that the grant had supported would lead to sustainable reductions in waiting times and an increased focus on personal needs and choice for those seeking ASC assessments in the future.

It is also notable that some of the intended outputs relate to availability of data, through the use of digital tools or new approaches to seeking feedback and review for those in receipt of services. This will facilitate future measurement of outcomes.

Some local authorities reported no outcomes linked to the grant (through the survey) or that factors had prevented them from achieving outcomes so far. These barriers included the grant not being of sufficient size, wider funding pressures across the local authority, difficulties implementing digital tools (due to a lack of alignment with existing systems or a need to train and enable staff to use the tools) and a lack of certainty around national policy direction (linked to the charging reform delay) and therefore the correct approach to take.

Enabling of digitising and streamlining of ASC assessments

Findings from both the survey of local authorities and case study interviews indicate that for those local authorities who have spent or allocated the grant, it is viewed as a significant enabler to ASC assessment digitising and streamlining activities. While it is important to note that local authorities represented in this evaluation are likely to be those that have spent the grant on intended activities, and those who are more invested generally in streamlining and digitising ASC assessments, there were no local authorities who felt that the grant has not contributed to these activities.

In all cases, local authorities included in case study interviews had already made some plans to streamline and digitise ASC assessments prior to the grant being awarded. The potential introduction of charging reform, alongside the wider motivations described above (see ‘Spending of grant funding and prioritised activities’), means that there were already clear incentives to progress these areas. However, stakeholders reported that the grant had enabled them to accelerate plans, or to undertake additional activities beyond those which had been planned previously.

A small number of local authorities who responded to the survey reported that the grant has not significantly contributed to their ASC assessment streamlining progress. In these cases, they cited insufficient funding and an inability to prioritise streamlining activities over other pressures as the reasons for this.

Most surveyed local authorities reported that they would like further support at a national level to streamline and digitise assessments. Those local authorities included in case study interviews also expressed a desire for further support, both in terms of additional funding, sharing of learning and guidance, to support these activities. While the grant is generally seen as an enabler of streamlining and digitising ASC assessments, many local authorities who responded to the survey indicated that further support is required to support them to progress this further. Activities identified in the ToC for these national workstreams (see annex) could form the basis of an approach to this.

Implications for national digitising and streamlining workstreams

Some stakeholders from local authorities included in case study interviews commented specifically on the model of grant funding, whereby funding was non-ringfenced with no specific monitoring or reporting requirements, and guidance was issued by DHSC to support local authorities to manage and spend the grant.

Generally, this model of grant delivery was viewed positively, particularly for a fund of relatively small value such as this. Those working within local authorities felt that the lack of monitoring and reporting requirements, alongside the grant being non-ringfenced, had reduced the administrative burden on their local authorities and encouraged innovative use of funding, including combining with other monies to enable and speed up existing plans around digital transformation and streamlining. The flexibility also meant that local authorities could spend the money on activities most appropriate for their stage in the streamlining journey.

This feedback suggests that the funding model used for the grant is viewed as a suitable model for future grants of this nature by local authorities who participated in this evaluation. However, it should be noted that around 25% of local authorities reported through the survey that they have not yet planned how to spend the grant or do not intend to spend the grant as intended, and this remains a risk associated with non-ringfenced grant funding models. Similarly, for the 45% of local authorities that reported spending some of the grant on other priorities, it is not clear what proportion was spent in this way or what the other priorities were.

Grant funding was viewed by stakeholders within local authorities as just one part of a wider support package to address the digitising and streamlining of ASC assessments.

Local authorities included in case study interviews suggest this support package includes:

• peer support from other local authorities and best practice examples
• a framework to support the procurement of digital tools that support streamlining ASC assessments
• working with software providers to improve products for use within ASC
• training and staff development such as national training guidance or modules

These activities broadly align with the ToC developed for national digitising and streamlining workstreams, and therefore we can be more confident based on the evaluation findings that these activities will enable digitising and streamlining work locally, and that support of this nature will be accessed and used by local authorities.

Annex: theory of change elements for grant funding and national involvement in adult social care assessment digitising and streamlining

As part of the scoping and familiarisation phase, draft theory of change (ToC) elements for the grant funding process have been developed. These act as an evaluation guide to explain the logic behind the grant funding and provide an overarching framework to support survey and topic guide development, analysis, interpretation and reporting of the subsequent process evaluation findings. Figure 1 shows the following information in a visual format.

Context

Although the implementation of charging reform has been delayed, some of the planned activities, particularly those designed to lay the groundwork for charging reform (including activities relating to adult social care needs and care assessments in local authorities) are still considered valuable. Therefore, DHSC has established a 2-year program of work to transform and streamline local authority assessment processes, building on charging reform preparations.

The case for change is:

• adult social care waiting lists are high across most local authorities and assessment types (with local variation)
• technology and systems exist to streamline and digitise some processes
• the public is increasingly digitally literate and expects to engage digitally with services
• charging reform is likely to increase demand, particularly in more affluent areas
• automation will allow staff to focus on more detailed, meaningful assessment work
• there should not be a decline in the quality of engagement and support for those seeking access to care

Rationale

There are anecdotal reports of delays to all types of adult social care (ASC) assessments, including annual reviews. As a result, some local authorities have a large backlog of assessments, which can delay access to care and mean that some people already in receipt of ASC are not receiving annual reviews as planned, increasing the risk that they receive inappropriate levels or nature of care.

The grant funding will support local authorities to generate efficiencies in their assessment processes, including increased ratios of social work assistants, with the ultimate aims of:

• reducing assessment delay
• promoting standardisation of proportionate assessments
• providing a better service for those drawing on care

Inputs

The following inputs are linked to the grant funding process:

• financial: a £27m non-ringfenced fund was paid as grants across all 153 upper tier and unitary local authorities in England in March 2023 to support continued prioritisation of this work among other pressures. Each local authority received at least £130,000. Guidance was provided to local authorities on how this money could be spent. For example, it could be spent on funding a dedicated productivity lead for one year to review local systems and implement digital efficiency tools, embedding transformation experts to improve operation models, or supplementing social workers with assistants or trainees
• guidance and grant management: case studies of activities already implemented in some local authorities were provided alongside wider guidance on streamlining ASC assessments.  However, grant funding was distributed as a non-ringfenced Section 31 grant, and there was no obligation for the funding to be spent on these types of activities. The guidance also makes it clear that it is important that ‘efforts to improve productivity do not lead to a decline in the quality of engagement… and support for those seeking access to care’. DHSC has commissioned an evaluation of the grant funding to provide a baseline assessment of how funding has been spent and develop a ToC for national involvement in supporting local authority assessment activities
• local authority staff capacity: while a one-off payment does not support simply expanding existing staffing levels within existing models of assessment delivery, it is intended that the grant temporarily supports continued capacity within local authorities for project management and analytical support to develop new assessment models (for example procurement of digital solutions or reorganisation of resourcing). For example, some local authorities have been able to maximise budgets by recruiting occupational therapists and trainees to cover certain elements of persistently vacant social worker roles

Activities

As part of the grant funding process, we expect the following activities (with activity owners) to take place:

• resourcing: funding a dedicated productivity lead or ‘transformation specialist’ (local authority)
• resourcing: finding ways to supplement hard-to-fill social worker vacancies with higher ratios of assistant or trainee roles (local authority)
• digitisation: procuring and implementing digital efficiency tools already available on the market, for example self-service tools or online portals (local authority)
• innovation: embedding transformation or business process experts to improve operating models, for example use of virtual assessments; trusted assessment arrangements (local authority)
• other activities which support local authorities to prepare for planned aspects of charging reform policy which are likely to lead to increased volumes of people requiring ASC assessments, for example a lifetime cap on eligible care costs, increasing the means-tested upper capital threshold and lower capital limit. This may include review and revision of assessment pathways, including spending on tools for new models and expertise and resource to conduct reviews (DHSC)

Outputs

The following outputs have been identified as those expected to take place as part of the grant funding process:

• digitisation: increase in local authorities having access to digital efficiency tools
• digitisation: increase in local authorities utilising digital efficiency tools
• resourcing: increase in delivery of virtual care assessments where appropriate
• resourcing: increase in care assessments undertaken by assistants, trainees, or other more junior roles where appropriate
• resourcing: improved talent pipeline for social worker posts from assistants and/or trainees
• culture: councils reporting improved confidence and/or progress in the delivery of streamlined ASC assessment pathways and reducing waiting lists

Outcomes

The following outcomes (and associated stakeholder groups) have been identified as those expected to take place as part of the grant funding process:

• reduction in waiting times for assessments, as defined by local authorities (local authorities, people who draw on care and support and carers and/or loved ones)
• increase in speed of access to ASC assessment processes (local authorities, people who draw on care and support and carers and/or loved ones)
• greater standardisation of access to assessment processes for those with ASC assessment needs (people who draw on care and support and carers and/or loved ones)
• more person-centred assessments with a greater focus on individual needs and greater identification of appropriate care (people who draw on care and support and carers and/or loved ones)
• reallocation of resources to more complex cases with a greater level of need (ASC workforce, local authorities, people who draw on care and support and carers and/or loved ones)
• increased satisfaction with ASC assessment processes, linked to survey data and complaints (people who draw on care and support and carers and/or loved ones)

Impacts

Impacts are defined as longer-term system level outcomes outside of the initial 2 years of the funding programme. We’ve found that the following impacts are associated with the grant funding process:

• faster hospital discharges and reduced burden on the wider social care system
• improved understanding at a national level of waiting lists, waiting times and ASC assessment quality across all local authorities
• improved understanding and evidence about impacts of reduced ASC waiting times and improved ASC assessment outcomes on NHS and healthcare system
• reduction in overall system pressures linked to ASC assessments placed upon local authorities and staff working within these processes
• improved market for digital tools with national standards and more tailored to the needs of local authorities
• more proactive management of social care demand and needs rather than being in a highly reactive state, including identification of emerging need at an individual level
• increased streamlining of ASC assessments, reducing waiting lists and subsequent wider pressures upon the health and social care system
• promoting standardisation of access to ASC assessments, to provide a better service for those drawing on care and more standardised reporting on waiting lists (including to DHSC) over time
• increased focus on personal needs and preferences in the ASC assessment process

Risks and assumptions

A number of risks and assumptions have been identified as those associated with the grant funding process.

The risks are:

• grant funding is not spent on intended activities. There is a risk that local authorities will use funding for other means or simply to address financial gaps given the significant financial strain that the sector is under, and the timing of the grant funding awards (close to the 2022 to 2023 financial year end)
• grant funding is not sufficient. Allocations (a minimum of £130,000 per local authority) are not sufficient to fund significant or measurable changes in the outcome areas identified in the ToC elements
• grant funding is not spent effectively. With limited guidance on how to spend funds, local authorities may not spend the grant in an efficient or effective manner
• poorer experience of ASC assessments. With an emphasis on streamlining activities and digitisation, there is a risk that these activities result in compromises in the depth, quality or accuracy of ASC assessments, leading to a poorer overall experience for those being assessed. There should be no reduction in the quality standards of assessments provided from the streamlining changes implemented and, subsequently, no reduction in suitability of care packages provided. There is also a risk with digitisation of excluding those experiencing digital poverty (those who live without, or with very minimal, access to the internet and digital technologies capable of connecting to it)

The assumptions are that:

• additional funding will support local authorities to continue with development and implementation of streamlining approaches identified during charging reform preparations
• local authorities want and will seek additional guidance and support (including peer support) to implement streamlining and digitisation activities
• digital tools for streamlining ASC assessment processes are or will be available on the market to produce and use appropriately within these contexts
• those seeking ASC assessments increasingly want to use digital tools as part of their ASC assessment
• those seeking ASC assessments would access and use digital tools as part of their ASC assessment processes if they were made available
• funding transformation leads of other pathway review work within local authorities will lead to improved and/or streamlined ASC assessment processes
• local authorities will treat ASC assessment streamlining and digitisation as a priority

A ToC (Figure 1) has been co-developed for national involvement in digitising and streamlining activities.

Figure 1: theory of change diagram