July 25, 2022


In 2018, the LGA (Local Government Association) & ADASS (Association of Directors of Social Services) published an advice note aimed at local authorities providing adult social care services re arrangements and recommended ways of working when commissioning out of area care and support services.  This publication noted that a number of high-profile cases, including the Safeguarding Adults Review (SAR) into Mendip House in Somerset, had highlighted common issues relating to the quality of care and support for individuals who are out of area and risks associated with ‘out of sight, out of mind’ provision.

We know that Somerset’s Health and Care system has since experienced further challenges and activity associated with settings where there are multiple commissioners out of county with responsibility for individuals placed here in Somerset.  Common concerns associated with practices relating to the quality and frequency of reviews/support planning and care management from the host authority, inadequate quality assurance and oversight of the service being delivered and, when safeguarding concerns arise, a lack of information available about individuals that have been placed in a (host) local authority area by other authorities.  In particular, in many cases there was no notification to the host authority when people are placed in their area, leaving the host authority with poor or no knowledge of the individuals placed within that provision. In turn this creates issues if subsequently there are safeguarding concerns raised about that service.

The advice note recognised the important principle of supporting people to get the right services close to home. It is acknowledged that in some parts of the country, services in a neighbouring authority can be closer to home than services within the same local authority. It emphasised the need for host and placing authorities to be mindful of the duties of each and the need to cooperate in certain circumstances for the benefit of those with care and support needs.

More recently, an Out of Area Placement toolkit for people with a Learning Disability and/or Autism has been developed in partnership with the LGA, ADASS, NHSE, health and social care commissioners and coproduced with parent carers and those with lived experience.  The toolkit has been developed to support improvements to the out of area placement process for when people moved around the South West.

There are a number of tools and checklists for commissioners, frontline staff, community support providers and parent carers/people with lived experienced, setting out key principles for those involved in making an OOA placement where extra arrangements need to be put in place to ensure a safe and ethical transfer of both social and health care & good cross boundary information sharing; it is based on best practice when it comes to planning, info sharing, and ongoing oversight and quality assurance.

 We are now ensuring awareness and promotion of the toolkit and guidance across our local health and care services, including care sourcing and LD Commissioning teams, as well as operational health and care staff.

 The following documents are intended for care providers as a best practice guide where supporting someone in their service placed by a commissioner that is not from the host authority that the care home is located in.

Out Of Area Placement Guidance For Providers

Out of Area Placement Checklist For Providers

We encourage you to review and adopt this as part of your practice and activity, and to share with your teams and services.