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Market Position Statement: Care in the Home

  

Care in the Home

  

Extra Care

  

Day Care Services

  

Assistive Technology and Digital Solutions

  

Adults with Physical and Sensory Disabilities

  

Sensory Impairment and Communicator Guides

Care in the Home 2023

Foreword

Welcome to Staffordshire’s Market Position Statement for Care in the Home. Our hope is that all care providers will find this a valuable resource, whether you currently work with us or not.

We are only able to support people who draw on care and support thanks to the huge range of providers who work across Staffordshire. Care providers have been at the heart of our response to COVID-19, and we continue to thank you for the care and support you provide to people with health and social care needs.

As we look ahead in this Market Position Statement, we hope that we will not have to experience anything like the turbulence and challenge presented by the pandemic, but we can expect that we will all have to adapt to other challenges – including some changes that we can already identify, and others that may be less immediately evident. The challenges of social care reform,workforce, a changed landscape for integration and improving personalised and strength-based approaches will undoubtedly form part of our journey over the coming years. And, as we have learned over the last two years, the pace of change in areas such as digital and other technologies might also give us opportunities – and challenges in ways that we are not even aware of yet.

We would like to understand your challenges as well as your ideas about what we could improve together, and we want to hear from your teams and the people whom you support as well.We are clearly entering into a difficult economic period in the country, and we know that the challenge will be to continue to commission services in a tough financial context, even though we have prioritised investment into these services. Some of the solutions will come from technology, but most will come from people – all of us, working together, building on best practice and testing new and innovative solutions. I hope that you find this Market PositionStatement a helpful element of how we achieve that.

Dr Richard Harling
Staffordshire County Council Director of Health and Care

Answer:

There are several challenges across the sector

  • People are living longer with increased complex need

  • People want and deserve high quality care

  • People want a choice in the care they receive

  • Retention and recruitment of a skilled workforce

  • Uncertainty of long-term funding

The opportunities are:

  • Increased co-working and multi-disciplinary approaches to support people with complex needs

  • Support for quality improvement, sharing best practice, and setting out clear actions plans for services where quality concerns are identified

  • A commissioning approach which encourages several providers in each local area

  • Collaborative working to set out support for our social care workforce, including better support for people’s journey into work, promoting and valuing the role of social care workers,improving awareness to support for wellbeing, and a better coordinated approach to training and development

  • Setting out the case, with other partners, for improved long term certainty of funding

Answer:

Staffordshire is a county of contrasts and is home to a distinctive blend of urban and rural areas, with green areas, housing developments and traditional market towns.

  • There are also large contrasts in the resident population in terms of deprivation and employment. Annual average earnings are still below the national average, although life expectancy has fallen for both men and women, as have rates of fuel poverty, although demand for adult social care services has increased. It should be noted that recent increases in fuel prices nationally may reverse this reduction in fuel poverty.

  • Staffordshire has a population of approximately 871,000 people and there are more people aged 65 and over in Staffordshire compared to the national average. The overall population of Staffordshire was projected to increase between 2017 and 2027 by 2% with a significant growth in people aged 65 and over (18%) and aged 85 and over (39%).

  • The impact of this ageing trend is likely to see approximately 65,900 more people aged 65+ by 2030, and it is anticipated that therewill be 12,250 more older people aged 85+. There is an increasing demand for acute services and healthy life expectancy is 63 for men and 65 for women, which are both below the current retirement age.

  • We are currently supporting approximately 3,300 people with social care needs via care in the home. This is likely to increase as life expectancy increases as adults are living longer but healthy life expectancy is still below the current retirement age, which in turn can lead to more complex needs and support. This could translate into as many as 500 additional packages of care by 2025.

  • In addition, the number of adults that left hospital with a care package and required support was 382 in 2021.

  • It is expected that we need to grow the use of community led support, and it is expected that there will be increased demand for home care following the Covid 19 pandemic, although at this stage (August 2021) it is difficult to predict what this might look like. 

Answer:

Older people in Staffordshire: The table below shows the projected needs of older people living in Staffordshire.  

Table 1: Projected needs of older people in Staffordshire 2021-2040

Population aged 65 and over

197,600

209,800

229,600

247,500

257,000

30%

Limiting long-term illness

100,600

108,800

119,100

128,300

135,100

34%

Unable to manage at lea

st one self-care activity on their own

56,000

60,700

67,000

72,100

75,900

36%

Unable to manage at least one domestic task on their own

56,500

61,500

67,800

72,800

77,100

36%

Number of falls in last year

52,200

56,000

62,200

67,400

70,500

35%

Number of hospital admissions due to falls

6,200

7,000

8,000

8,500

9,100

46%

Dementia

13,600

15,00

17,000

18,800

20,400

50%

 20212025203020352040% change 2021-2040
  • Around 51% of people aged 65 and over in Staffordshire are estimated to have a limiting long-term illness. Between 2021 and 2040, this is projected to increase to 53%, which would equate to 34,500 additional people

  • Around 28% of older people are unable to manage at least one self-care activity on their own. This is projected to increase to 30% or 19,900 additional people by 2040. In addition, around 29% of older people are unable to manage at least one domestic task independently

  • National research indicates that around seven in ten people aged 65 and over who are admitted to hospital due to a hip fracture require post support and care. In Staffordshire around 52,200 people aged 65 and over are estimated to have fallen at least once in the last 12 months which is predicted to increase by 35% to 70,500 people by 2040

  • If the prevalence of dementia remains the same, the ageing population means that the total number of people aged 65 and over with dementia in Staffordshire is projected to rise from around 13,600 in 2021 to 17,000 in 2030; an increase of 25% and to 20,400 by 2040; an increase of 50%

Adults aged 18-64 in Staffordshire Based on 2018-based population projections, the number of Staffordshire residents aged 18 to 64 is predicted to remain static between 2021 and 2040.  

Table 2: Population projections for those aged 18-64 in Staffordshire 2021-2040

 20212025203020352040% change 2021-2040
 

Population aged 18-64

518,100

520,300

519,300

518,000

521,300

0.6%

Learning disability (18 and over)

7,000

7,200

7,400

7,600

7,700

10%

Mental health conditions

97,800

98,200

98,100

97,900

98,500

1%

Autism spectrum conditions

7,000

7,200

7,400

7,600

7,700

10%

Moderate personal care disability

21,700

22,000

21,600

20,900

21,000

-3%

Severe personal care disability

4,700

4,800

4,700

4,600

4,600

-2%

Impaired mobility

30,200

31,100

30,600

29,200

29,100

-4%

 

Answer:
  • The annual gross expenditure by the Council on Adult Social Services was more than £400m in 2021/22, with 87% of this spent directly with the care market. The Council’s budget for 2021/22 includes additional income from the 2% adult social care precept of £11.1m.

  • Adult Social Care is expected to find a saving of £6.8m during 2022/23, £50,000 of which is expected to come from care in the home provision.

  • Over the last four years Adult Social Care has had to make savings in the region of £41 million and has plans to make further savings of £2.4million in 2021/22.

  • The actual costs of delivering services during COVID-19 have increased, but have been met, to date, from additional COVID-19 grant funding provided by the government. For Adult Social Services, the additional costs associated with managing the COVID-19 pandemic, come on top of a rising demand for social care and the need to change and adapt services to meet people’s needs and support them to stay independent, where they can.

  • All of this is set against a backdrop of settlement funding allocations beyond the current year (2022/23) being unknown and key reforms to local government funding including the Fair Funding Review, Business Rates localisation, and reform of adult social care funding being repeatedly delayed.

  • Despite this uncertainty, the Council remains committed to its vision – to support people to be independent, resilient, and well.

Answer:

The net Health & Care budget for adult social care in 2022/23 is £243.3m

  • The Council spent £210m (net) on adult social care in 2020/21 compared to a net expenditure of £208m 2018/19 and £200m in 2017/18, indicating increasing pressures on budgets. The spend on adult social care is over 41% of the overall Council spend

  • In 2021/22 we issued around £29.8m in support grants to our careproviders, £15.8m of which to home care providers.

  • In addition to savings previously agreed, the Council needs to make ongoing further savings of £19.7 million by 2026-27. We want to work with providers in addressing this challenge. 

Answer:
  • Support and encourage people to access mainstream facilities in the community.

  • Offer information, advice, and support- providing help at the right time to prevent and reduce the need for more intensive support.

  • Improve digital access to services making better use of technology,innovation, and on-line services

  • Actively promote direct payments to give people the greatest freedom and flexibility to meet their needs

  • Continue to work with the market to ensure the availability of good care in the home services

  • Develop services that help avoid unnecessary admissions to hospital or residential care and enabling people to return home safely from hospital

  • Support people with complex needs to live as independently as possible, with choice and control over their lives and the services that they access.

Answer:
  • A job in the care market needs to be appealing and to be held in high regard by society. Key to a properly functioning, high quality and sustainable adult social care market is a workforce that is well trained, professional, caring, appropriately paid with progression opportunities and with satisfaction with both their jobs and employers. The latter point is telling, as many carers who leave caring roles move to different care jobs, indicating greater satisfaction with the caring role than their employer. Where these positive factors do not fully exist, this is manifested in a high turnover of staff.

  • Diversity in the care market can provide resilience in the workforce,especially if a high percentage of workers are reaching retirement age and the profession is not appealing enough to new workers.

  • Information from the ‘Skills for Care Workforce Minimum Data Set’ highlights social care staff turnover rates during 2020/21 of 22% for direct care staff in CQC registered non-residential care roles. 24% of direct care staff are aged 55 and over and therefore likely to leave the workforce within the next 5-10 years.

  • The latest employment overview data from Skills for Care shows that in Staffordshire 49% of non-residential direct care workers were employed on zero-hour contracts, or 2,700 jobs. In comparison CQC non-residential services across England had an average of 53% of all workers employed on zero-hours contracts or 270,000 jobs.

  • For the most up-to-date information please visit the Skills for Care website.

  • We are developing a new workforce strategy which includes joint actions to promote social care as a career and to encourage all staff within the sector to take advantage of the training, development, and apprenticeship opportunities available to them to advance their career in care. 

Answer:

In adult social care, we support the County Council’s vision of being an ambitious, innovative and sustainable county, where everyone has the opportunity to prosper, be healthy and happy – including people with adult social care needs. In particular, we support the Council’s priority outcome that everyone in Staffordshire will be healthier and independent for longer, with a priority to encourage good health and wellbeing, resilience and independence. These outcomes and priorities increasingly shape our approach to strength-based working, integration, prevention and community services.

For the care in the home and supported living sector, the more successful we are in achieving these outcomes and priorities, the fewer people (as a percentage of the whole population) will enter long term care. Therefore,the quality of their care and their eventual outcomes will remain hugely important. The average complexity and extent of care needs of people who require care in the home will continue to increase over time, and this will continue to have implications for the physical environment, skills within the care teams, and links with primary, community care and other services.These will all continue to grow in importance over the coming years..

Our strategic objectives for the whole of the council’s Health and Care Directorate are to:

  • Promote good health and independence, and encourage and enable people to take personal responsibility for maintaining their well-being

  • Ensure effective and efficient assessment of needs that offers fair access to services

  • Maintain a market for care and support that offers services at an affordable price

  • Ensure best use of resources, people, data and technology

Specifically for commissioning care in the home, our strategic objectives are:

  • Ensuring timely access to care in the home when required – including in response to rapid changes in their care needs, or following a hospital discharge

  • Improving access to step-up reablement services and developing a stronger reablement ethos across our community-based services

  • Developing models of home care and commissioning processes that are outcomes-focused and more able to respond to fluctuating needs, building on the role of care providers as trusted assessors

Answer:

What we know – People drawing on care and support:

  • Would prefer to choose their own provider and delivery times.

  • Want care to be delivered in a way that meets their needs rather than a prescriptive approach.

  • Only want to pay for the actual care that is delivered.

  • Want continuity of care in terms of the same carers to build up a rapport, and at the same times.

  • Sometime want a choice over the gender of their carers.

  • Want their carers to stay for the full duration of their visit.

  • Want to be able to contact the provider of their care in a timely and convenient fashion.

  • Want to be treated with respect and dignity.

  • Want good quality care from an agency that is registered ‘good’ or better.

  • Want a timely assessment and fairer charging so that the cost of care is known.

  • Want a single point of contact and to know how to make a compliment or complaint.

 While we understand what people drawing on care and support are asking for:

  • We cannot always guarantee a choice of times, however we would work with the provider to enable them to have the time of their choice later wherever possible.

  • We cannot always guarantee a choice of provider, however if the provider is not delivering a satisfactory service we work with providers and service users to improve the situation or agree a change to another provider.

  • We work with providers to support them to improve their quality if they are not rated as at least “Good” by CQC.

  • We take complaints seriously and investigate fully,communicating the outcome of these investigations to all parties concerned. There is an expectation that the provider gets the opportunity to respond to the complaint first, as part of their CQC registration. We ensure that lessons learned areincorporated into processes and services. 

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 Downloadable PDF version (1.76 MB)

Further Contact

Should you wish to make contact following review of this document please email oppdcommissioning@staffordshire.gov.uk

 

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