Market Position Statement for Independent Sector Providers ... · in the UK and abroad, snooker, gym, swimming, horse riding, agricultural things, college and theatre. • Opportunities

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Market Position Statement for Independent Sector Providers

who may wish to provide support in the County of Staffordshire for All Age Disability Customers

1. Who is this document for? This background document is to broadly signal intentions to existing and potential social care and support providers for All Age Disability citizens residing in the County of Staffordshire. The aim of the document is to help support Commissioners and Providers in working together to best deliver support for All Age Disability citizens and their families, ultimately enhancing the quality of their lives. For the avoidance of doubt All Age Disability encompasses Learning Disability (All Ages), Autistic Spectrum Conditions (All Ages), Physical Disabilities (under 18) and SEND (up to age 25). 2. The County of Staffordshire, its All Age Disability Customers and its

Priority Outcomes Staffordshire County Council is a two-tier authority with eight (8) district/borough councils (The borough of Newcastle-under-Lyme, the district of Staffordshire Moorlands, the borough of Stafford, the district of Cannock Chase, the district of South Staffordshire, the borough of Tamworth, the district of Lichfield and the borough of East Staffordshire). Staffordshire is a large rural County covering 2,623 sq. km. Despite the rural nature of Staffordshire, the vast majority of its population live in the five large towns (Newcastle-under-Lyme, Cannock, Burton upon Trent, Stafford and Tamworth) and numerous market towns, small villages and hamlets across the County. Each district/borough varies in profile with considerable differences between the North and South of the County. This makes the County diverse in terms of population profile and social issues, which is reflected in the type of care and support needed in each District. A map of the County is included as Appendix One and details of how to work with us are included in Appendix Two. Detailed, continually updated information in respect of each of the eight districts can be found at https://www.staffordshireobservatory.org.uk and www.pansi.org.uk and www.poppi.org.uk.

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It is anticipated that the overall All Age Disability population in Staffordshire will increase by around 1.3% in the next 3 years. The major increase is projected to be in those over the age of 55 as People with Learning Disabilities and/or Autism continue to live longer and the age groups 0 – 18 and 25 - 34. There are a number of citizens currently under the age of 18 (mainly in educational residential establishments), who are likely in future to need accommodation and care and support solutions in either residential or community support settings. Evidence is also emerging of an increased complexity of need across the County, including as people live longer, more incidences of Dementia. Staffordshire County Council’s Whole Life Disability Strategy sets out what we will do to deliver our vision which are listed below:

• Build a Healthy Staffordshire, with an environment that improves health and wellbeing for all.

• Help people to help themselves, by giving simple, clear information and advice to enable and empower (PH) them to take responsibility for keeping themselves healthy, safe and prosperous.

• Grow communities to support people, and which help people to live independently in their own home, with care and support from family, friends and the whole community.

• Offer extra help for those who need it, to prevent and respond at times of crisis to get people back to independence.

• Be honest about the options available, so that people understand who is eligible for support and who will pay for it and talk to people affected by any changes before they are implemented.

• Maintain long term care services, working with our partners and providers to ensure that when people do require support, we can offer quality and safe services that meet people’s needs.

Please note that additional detail in respect of the above and specific commissioning intentions is available in the Whole Life Disability Strategy 2018-2023. https://www.staffordshire.gov.uk/Care-for-all-ages/Whole-life-disability-strategy/Whole-Life-Disability-Strategy-2018-2023-FINAL.pdf 3. What have the All Age Disability Citizens of Staffordshire and their

families told us so far? A cross section of citizens and their families have told us they would like the following:

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• Individualized community support and more flexibility of support, to learn, enjoy and achieve in life and make genuine friends.

• Reassurance that support will be made available for carers when they need a break.

• Genuine choice and control in everyday life, just like everyone else.

• Better information around the support they may be able to access.

• Citizens and families want to be genuinely involved and listened to.

• People are genuinely supported by the Council and Providers during the shift towards self-directed support.

• To have well paid work opportunities (with support where required), as opposed to minimum wage or voluntary work, with an increased disposable income.

• Support to make friends, be part of group activities and to do things together as a family.

• Support to live an ordinary life, playing and learning alongside friends within their communities.

• Support in making a smooth transition to adult life.

• Families want opportunities to carry on or return to work.

• Flexible support to respond to the fluctuating needs of illness and impairment.

• Access to personal assistants to help support with day opportunities, through personal budgets and direct payments.

• Transparency and greater understanding of what services and support cost.

• More opportunity for support during the 24-hour day including at evening time, centred around a Citizen’s needs and preferences e.g. cinema, drama class, disco’s, bowling, meet more people, go to the pub, going on holiday in a group in the UK and abroad, snooker, gym, swimming, horse riding, agricultural things, college and theatre.

• Opportunities to try things and see what works best, with simple solutions where possible.

• Ultimate Choice and Control over how the money allocated to them is spent.

• People do not want to lose touch with their peers where building-based services are reprovided and would like local opportunities to meet and socialise with others.

• Citizens wish to feel safe, free from abuse, harassment and crime and included within their community e.g. Citizenship Watch Scheme, Changing Places, increased wheelchair access and with less people abusing disabled facilities.

• Ability to choose their care and support provider and staff.

• Citizens and their families want a voice, to be valued, to be supported in developing their confidence, self-esteem and to be seen in a positive light.

• Opportunities to make genuine connections with their communities. A cross section of citizens has told us thus far that they would like the following specifically in relation to accommodation:

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• Choice and control in respect of where they live and increased options in respect of the types of accommodation available.

• Genuine Choice and control over whom they live with and whether they live alone or in friendship groups, with a more reasonable amount of time to make the transition from existing accommodation setting to new.

• Support and security in respect of their accommodation choice i.e. secure tenure, with help managing money and paying bills in relation to their accommodation.

• Repairs done well and in a timely fashion by professional people.

• Accommodation that is big enough and flexible enough, so they have their own space when they wish, but also access to communal space if they so wish.

• The speed of finding suitable accommodation needs to be improved with less “red tape” and fewer professionals involved in the move.

• Accommodation is accessible and adaptable so as citizens age they can remain in their existing setting

4. What are the areas that need strengthening in respect of the All Age

Disability Provider Market in Staffordshire? Whilst progress has been made in shaping the Independent Sector market for All Age Disabilities, there are a number of areas that need addressing further in order to ensure a diverse, sustainable and quality marketplace, shaped by the demands of citizens and their families. These are broadly summarised below:

• Improve capacity in Staffordshire in meeting a diversity of accommodation and care and support needs of those with Challenging and or/Complex Needs, including forensic needs i.e. those often going into Out of County specialist residential provision or currently in “Winterbourne” type accommodation i.e. Transforming Care.

• Increase in high quality local ‘’step down’’ accommodation i.e. improve Local Housing Offer. To note, at present we have a number of supported living schemes across the County of Staffordshire and this is not an area we are looking to develop further at the moment.

• Increase in expedient and quality accommodation solutions for those with a lower level of need and those living with parents.

• Increase in the availability of accommodation and care and support options for those between the ages of 18 and 21, often coming from Out of County specialist residential education.

• Increase in accommodation and support options for those with Learning Disability and Dementia.

• Increase in accommodation and support options for those with Autism.

• Increase in Supported Living in the area of Tamworth.

• Increase in Core and Cluster type arrangements, especially in East Staffordshire.

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• Increase in number of Personal Assistants in some areas of the County e.g. Newcastle.

• Increase in the provision of “background support” for Citizens who for large parts of the day and night are independent.

• Increased opportunities for support during the 24-hour day as opposed to traditional “9 to 5”.

• Increase in the provision of preventative services which help prevent or delay the development of care and support needs or reduce care and support needs (including carer support needs), that builds on Citizen and community assets.

• Increase in day opportunities, especially for those with more complex needs.

• Strengthen support and signposting for citizens who wish to gain and improve everyday life skills, to enable them to live as safely and independently as possible.

• Strengthen universal services and general signposting for citizens and their carers, thus reducing the numbers relying on crisis support.

• Improve quality and cost effectiveness of support and genuine involvement of citizens and families in judging quality of support.

• Increased genuine opportunity for real employment.

• Increase support (local offer) for those people up to the age of 25 with special educational needs and disabilities (SEND).

• Development of new opportunities for short breaks and activities for disabled children and young people that help develop the skills needed to live as independently as possible, whilst providing parents/carers with a genuine break from the caring role.

• Increase in the availability of foster placements as an alternative to residential care for disabled children and young people who are able to have their needs met in community settings.

• Increase in Providers in the Staffordshire marketplace able to offer price competitive residential care for disabled children who have complex needs, as we currently place over 50% of our disabled children “Out of County”.

• Increase in Providers who can provide accessible information and advice, including via social media, to all not just those with eligible care needs.

5. Where do we want to be, what will have to change and what are we going

to do? In order to continue the shift towards personalisation and community-based support, Commissioners and Providers need to work together to ensure person centred approaches and coproduction in Commissioning and market development, thinking locally and acting personally, seeking to work in accordance with NICE Guidelines, where applicable. Delivering cost effective, personalised and community-based support in the current financial environment requires a willingness and commitment from everyone involved

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to think and act differently. Stimulating markets and developing new models of care and support, needs all parties to be open to new ideas. Market intelligence and systems of communicating information to Citizens and their families need to be improved. Communication, information and interaction between Commissioners and Providers needs to be further enhanced. Over the next three years, Staffordshire County Council will become less of a direct purchaser of services or a provider of services, it’s primarily role will be that of a Commissioning one. It will act in many ways as a conduit between providers, citizens and carers, using its influence and resources to ensure innovation and developments take place in a harsher economic climate. Citizens and their families will increasingly purchase care and support directly from Providers via Personal Budgets, ISFs and Direct Payments, with care and support Citizenly driven as opposed to service driven. The end result must be a diverse, sustainable market that meets Citizen aspirations and provides choice and control for citizens and carers, meeting needs, not wants. There will be less direct commissioning by the local authority, which will take on more of a shaping and influencing role within the local market and encourage collaboration between Providers. This will result in fewer block contracts between Council and Provider. Staffordshire County Council has a greater responsibility towards the entire local All Age Disability population, rather than just those people accessing support via the Council, encompassing people who already purchase their own care. This means wider responsibility to ensure that sufficient provision is in place across the market. Care markets will need to become more diverse, with high quality and sustainable providers that can be meet the needs of those who wish to self direct their own support. As Citizens have greater control, so the local authority position vis a vis the market changes – from one of market control to one of market facilitation. Current plans to move forward include:

• Implement the Whole Life Disability Strategy 2018-2023.

• Establishing a series of Framework Agreements/Dynamic Purchasing Systems for use by Social Work teams and for access by citizens who wish to self-direct their support.

• Establishing a Provider Forum for Housing and Support to discuss and agree a way forward in respect of issues such as National Living Wage, recruitment, retention and business sustainability.

• Establishing a clear Housing and Support Pathway for citizens and their families.

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• Ensuring we measure our performance as Commissioners against the principals, ethos and approach detailed in the Commissioning for Better Outcomes route map.

http://www.local.gov.uk/documents/10180/5756320/Commissioning+for+Better+Outcomes+A+route+map

• Establish a Brokerage Function.

• Ensuring Staffordshire has a quality Citizen Service Fund (ISF) offer in place.

• Ensuring a diversity of Community Support accommodation options are available to Citizens as opposed to purely Residential Care, through the use of the Community Support (Regulated) Framework Agreement that allows Care and Support Providers to support Citizens to source accommodation more expediently.

• Reshaping of In-House services (Residential and Day Opportunities).

• Continued dialogue with Provider Forums such as SARCP (Staffordshire Association of Registered Care Providers) and others in respect of All Age Disability market opportunities.

• Working to find ways of further encouraging User and Carer led organisations and Social Enterprises.

• Implementation of the Assistive Technology strategy that encourages the use of Assistive Technology by the Independent Sector.

• Encouraging the Independent Sector to proactively approach the Commissioners with innovative ideas and local investment to improve life for All Age Disability customers in Staffordshire, without comprising procurement regulations, financial regulations or standing orders.

• Working with local district and borough councils to ensure All Age Disability customers are able to access universal services and general needs accommodation.

• Working with a range of housing partners to increase housing opportunities, based on countywide housing need.

• An asset-based approach from front line staff that fully takes in to account Citizen assets and community assets, underpinned by an ethos and approach of personal responsibility and just enough support. Front line staff will be encouraging independence for citizens as opposed to creating dependence.

• Adult Learning Disability Team, Commercial Unit and Strategic Commissioning working to strengthen market intelligence in terms of knowledge around supply, demand and unmet need.

• Review Procurement practice against wider national reforms of public procurement with the aim of ensuring choice and control for customers, value for money over the long term, sustainability of supply and capacity building with small and medium providers.

• Review short breaks provision, adult placement and supported living across the County of Staffordshire.

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• Continue the shift of resources away from larger scale residential and specialist building based day services provision to community support.

• Continue the shift from in house provision to provision within the independent sector.

• Working closely with the relevant CCGs around integrated commissioning.

• Procurement and legal working with key partners to change (within the limits of law) traditional procurement to ones that trust disabled citizens and their families to know what is best for them and enable them to shape the support they need in the best way to make them equal citizens of Staffordshire.

6. Where is our money currently spent and how will this change? In light of the national economic situation and the on-going comprehensive spending review, it’s imperative that Staffordshire County Council continues to ensure that its funding is spent wisely, to meet the needs of the people of Staffordshire.

In 2018/2019, Gross spend in terms of All Age Disabilities is detailed below

Budget Narrative Independent Sector (£m)

In House (£m)

Total (£m) % of

overall budget

Residential and Nursing Care 38.995 3.074 42.069 45.4

Supported Living 20.873 0.938 21.811 23.6

Respite 0.961 1.142 2.102 2.3

Transport 0.072 0.379 0.451 0.5

Direct Payments 14.391 - 14.391 15.5

Day Care 2.041 2.790 4.831 5.2

Domiciliary Care 1.517 - 1.517 1.6

Assessment and Care Management + Provider Staffing - 4.416 4.416 4.8

Adult Placement 1.008 - 1.008 1.1

Total Gross Expenditure 79.858 12.738 92.597 100.0

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Over the next three years, the financial position will continue to be extremely challenging and its imperative that Commissioners and Providers work together to ensure that services are high quality, Individualized and cost effective. Independent Sector Providers will be expected to be more proactive with Commissioners where they feel that support provided can be done so more cost effectively whilst maintaining good quality outcomes for citizens and the Council will seek to work with Providers who can prevent or delay the development of care and support needs or reduce care and support needs. In the next three years, it’s anticipated that there will be a shift in expenditure that can be broadly summarised below: 1. As more accommodation options are made available to citizens, a shift in

expenditure will occur in the Independent Sector from Residential Care to Community Support.

2. As the Council ceases in the main to be a Provider of services through the

rolling out of the In House reprovision programme (Residential and Day Opportunities), a shift in expenditure will take place from In House to the Independent Sector, it is envisaged predominantly towards Community Support as opposed to Residential Care.

3. There will be a continued shift from block contract spend (via contracts between

Council and Provider) to expenditure from Council to Citizen to Provider, via the self-directed support route.

4. For the avoidance of doubt, the Council are not saying that it will not support

the purchase of Residential Care for All Age Disabilities. Where there is an assessed need, a proportion of expenditure will continue to be in respect of Residential Care which will need to be person centred, enabling, modern and tailored to the Citizen, ultimately increasing choice, control and independence. Residential Care will be procured through a new Dynamic Purchasing System.

7. Conclusion - Where Commissioners and Providers need to work together In order to ensure a flexible, vibrant, diverse, sustainable, quality, cost effective market in Staffordshire, it’s imperative that Commissioners and Providers work together to ensure a plan is in place and delivered to:

• Enable and support Choice and Control for citizens and their families.

• Support citizens to translate their ambitions into reality.

• Ensure that support is quality, cost effective and supports the whole community.

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• Create stronger, more collaborative relationships where Commissioners and Providers work together to shape the range of support available, making the best use of available resources whilst putting the citizen at the centre.

• Develop opportunities for All Age Disabilities to access universal services e.g. leisure, local facilities, housing and health.

• Develop opportunities for access to education and learning.

• Shift away from block contracts between Council and provider and deliver the personalisation agenda in active partnership.

• To encourage Providers to sell support directly to citizens and their families in order to meet their needs i.e. Direct Payments, Personal Budgets, and ISFs etc.

• Work together progressively to do things differently.

• Create a collaborative environment where we work through the challenges together and improve information and communication.

• Ensure that citizens are supported to live independently and safely in their own homes and communities where they wish to do so.

• Ensure carers are appropriately supported i.e. flexible short breaks.

• Increase the availability and diversity of alternative housing options e.g. supported living and transitional accommodation/improved Local Housing Offer.

• Promote the use of Assistive Technology.

• Ensure that residential provision is enabling, person centred and tailored to the citizen.

• Ensure that prevention and early intervention support is available within the market that prevents, reduces and delays needs and costs.

• Improve the quality of support provision.

• Ensure that the Councils Commissioning staff is competent and effective Commissioners and that engagement with Providers is honest, positive and genuinely collaborative.

• Ensure that citizens and their families are genuinely at the heart of co-production work between themselves, Providers and Commissioners.

• Ensure support for those with a Learning Disability and/or Autism is seamless e.g. from Child to Adult.

• Ensure that new businesses and organisations are encouraged and supported.

• Ensure that information is available for Citizens and their families in respect of services available and their quality.

• Ensure that people are given the opportunity to live and be supported in Staffordshire where they wish to be, as opposed to Out of County.

• Ensure that the future is about outcomes, not about “services”.

• Ensure the right balance between quality and cost to make the best use of resources and achieve positive outcomes for citizens.

• Ensure that the focus is on life and supporting citizens to aspire for and achieve their aspirations in terms of education, employment, where they live, health and a good social life.

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• Increase in providers who can support, enable, nurture and develop children with disabilities and work with the All Age Disabilities Assessment and Care Management function (Independent Futures) in a truly integrated manner.

• Increase in Providers who have an ethos and approach that promote well-being, reinforce personal responsibility, and promote independence and resilience, under pinned by an asset-based approach (Citizen and community).

• Increase in Providers who can support citizens through All Ages and on the path of life, building trust along that journey.

• Increase in Providers who can support the Council in helping build stronger local communities, harness community capacity and capacity for self-management.

• Increase in Providers who take a genuine co-production approach with citizens, carers and families.

• Good communication is in place between Providers and Communications around the sustainability of the Provider market, recruitment/retention and workforce planning.

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Appendix One – The County of Staffordshire

Appendix Two

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Appendix Two – How to work with us and useful links in respect of All Age Disabilities

How to work with us Those in the Independent Sector who wish to work with us are urged to express general interest in Learning Disability and/or Autistic Spectrum Conditions at the link below, so they are automatically notified of all All Age Disability Procurement opportunities. http://contracts.staffordshire.gov.uk/ http://www.staffordshire.alito.co.uk/ If you are a Supported Living Provider with Learning Disability and/or Autism vacancies (contracted with this Council or otherwise) in the County of Staffordshire, please inform Alison Dean in our Commercial Unit by emailing [email protected]. Alison circulates supported living vacancies to the Social Work Teams on a monthly basis. If you wish to discuss plans you may have as a provider in Staffordshire in relation to services for All Age Disabilities or any aspect of documentation on this website, then the All Age Disabilities and Mental Health Strategic Commissioning team are more than happy to talk to you. In the first instance, please contact [email protected]. Andy can help identify the best person in the team to talk to. Useful Links Staffordshire Connects – is a website where every private, public and voluntary business or organisation offering products, services, activities or things to do to help people live a more independent, healthy active safe and fulfilling life can advertise for free. Providers are urged to put their details on the website (see link below): http://helpyourself.staffordshirecares.info/kb5/staffordshire/directory/home.page Staffordshire Observatory - Staffordshire Observatory provides research and analytical support to Staffordshire Strategic Partnership. The overall aim of the Staffordshire Observatory is to provide Staffordshire Strategic Partnership with a robust, comprehensive evidence base which informs decision making and service delivery, leading to better outcomes for the residents of Staffordshire. This website is being developed to provide a ‘one-stop-shop’ to access a wide range of data, information and intelligence on Staffordshire and its communities: http://www.staffordshireobservatory.org.uk/homepage.aspx