Adult social care plays a vital role improving people’s lives by helping them to remain independent at home and in their community. As we continue to support people to live well within their communities, we recognise we need to do more to ensure we can effectively meet the rising demand for adult social care support and provide sustainable, high-quality support across Torbay.
During the past year, we have undertaken a significant amount of work to improve the service to enhance the support we provide to people. We have continued to remain focused on promoting independence, managing demand effectively, and ensuring we meet our legal duties under the Care Act through preventative and person-centred approaches.
The two key areas of improvement this year have been our reablement pilot and the improvement work happening to improve how people access information and guidance before needing to approach adult social care for support; both of these initiatives have delivered positive outcomes for people and our wider health and care system.
Recognising the importance of supporting people to regain and maintain their independence our delivery partners, Channel 3, helped to launch a reablement pilot in 2024. The aim was to improve people’s independence via a community pathway or on a waiting list to enable them to regain skills and confidence with everyday activities.
Key achievements of the reablement pilot include:
Building on this success, we will be integrating reablement principles further across our services to ensure more people benefit from strengths-based approaches that promote self-sufficiency. We will use the learning from this pilot to inform future commissioning.
To enhance how people access adult social care support, we have undertaken a front door service improvement activity aimed at improving demand management by promoting diversion to more appropriate services. This work aligns with our Care Act duties, focusing on early intervention, diversion, and appropriate signposting to community-based support.
Key improvements include:
As a result of these improvements, we have seen:
To improve decision-making, one initiative considered practice and process around panels to improve their effectiveness. Key improvements include:
Our aim was to standardise practices for sourcing care via the AST team to improve market management, process for practitioners and grip on spend. Key improvements include:
People who no longer need acute care recover better at home, in their own bed, surrounded by their loved ones. We have been working hard to improve how we support people to return home from hospital, with a care package if needed, for lunchtime or by 5pm.
We spent time with teams to understand the reasons why some people were delayed being discharged from hospital, the impacts on outcomes, demand and costs of people discharged through pathway 2. Pathway 2 is a model designed to integrate health and social care services for people with complex needs. By offering a coordinated, person-centered approach, Pathway 2 has significantly improved health outcomes and quality of life for many residents. This has been evidenced where individuals previously at risk of hospital admission were able to receive tailored care in their homes, leading to a reduction in unplanned hospital stays and increased satisfaction people and their carers. A multi-disciplinary team (MDT) approach was used to review individuals and understand through a social work lens if people could have achieved a better outcome. Recommendations are being reviewed but immediate actions were taken to: