12. We currently commission the following services for people with a disability:
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Services that help people to have a voice: Integrated Advocacy Service
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Services for people who wish to live at home: supported living placements
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Services that help people to live at home and engage with the local community: day opportunities, live in care, general community support provided in supported living placements and the Shared Lives Service
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Services that support carers to have a break from their caring role: bed-based respite care, home based respite care
Integrated Advocacy Service
13. From 1 April 2022 we have commissioned a statutory Integrated Advocacy Service with Asist advocacy services which includes Independent Care Act Advocacy (including for prisoners), Independent Mental Capacity Advocacy, (including Deprivation of Liberty Safeguards and Relevant Persons Representatives), Independent Mental Health Advocacy and Independent Health Complaints Advocacy.
14. This service supports and enables people with a range of care and support needs (including learning and physical disabilities, autism, mental health issues), and who are otherwise unable to speak up for themselves, to have their voices heard and take more control about decisions over their lives and care.
15. The current contract is due to expire on 31 March 2024 and has the option for two 12-month extension periods
Supported living
16. Supported living services provide care and support for people with disabilities in dedicated housing schemes. In March 2023, the Council had 576 placements in supported living schemes, of which 84 were “out of county” including 43 in Stoke-on-Trent and 16 placements in an in-house learning disability supported living service. Placements are made outside Staffordshire for a variety of reasons including a lack of local providers able to support people with highly complex needs.
17. Of the 576 supported living placements, 78% are for people with a learning disability and / or autistic people, 18% are for people with mental health needs and 4% for people with a physical disability. Further information on mental health services can be found in the market position statement for care providers supporting individuals with mental health conditions.
18. Supported living placements support people with different levels of need. Of the 537 in county supported living placements in March 2023:
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3% have very highly complex needs (behavioural or physical needs that require very intensive support, some have a forensic history)
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83% have high or medium complex needs where 24-hour care is required.
19. In October 2022, there was total market capacity for 578 supported living placements in Staffordshire. Whilst overall there is a good supply of supported living, we have identified gaps which more flexible provision could help fill. We are developing a new Housing with Care Strategy for Staffordshire, which includes supported living. More specifically there is a need for:
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an 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, and who need more short-term support, and potentially more intensive support, to enable them to transition into living more independently in the future;
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an increase in placements suitable for individuals with highly complex forensic needs to support their discharge from hospital or other secure settings;
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more supported living opportunities in Lichfield, Newcastle under Lyme and Tamworth;
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a variety of different and appropriate supported housing. This should be in line with identified local needs, CQC’s Right Support, Right Care, Right Culture Guidance, and Supported housing: national statement of expectations and strategic conversations with commissioners;
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more accommodation and support options where staff have the right set of skills to manage more complex people and to genuinely prioritise their independence, avoiding restrictive practices;
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more services with a reablement focus; and
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an increase in local 'step down' accommodation and associated support that focuses on improving life skills and building independence.
20. From 1 October 2019, we have used a Dynamic Purchasing System (DPS) to source 24/7 and non 24/7 supported living placements to meet the care and support needs of people with learning disability, mental health, autism and / or physical disability. The DPS is an automated sourcing process; providers must register on our e-tendering portal Proactis to receive invitations to tender for individual placements. The DPS is due to expire on 30 June 2024.
21. We are in the process of reviewing how we will commission supported living placements in the future. We want to get the best quality of care from our new contracting arrangements; one that builds on people’s strengths, promotes independence, and allows them to achieve the outcomes they want whilst also ensuring they can be as independent as they wish. It is also important that the services provided offer the best value for money in achieving these outcomes.
22. All new arrangements are intended to be in place by 30 June 2024. For more information on the recommissioning proposals, please refer to the report which went to a meeting of the Council’s Cabinet on 19 October 2022. We will also be using the information gathered during our recent local cost of care exercise to inform our recommissioning approach.
23. Supported living providers are actively invited to join our regular supported living provider forums (north and south Staffordshire). To find out more information about the forums please email us at wholelifedisability@staffordshire.gov.uk.
Day opportunities
24. These are activities and support services provided outside of an individual’s home, typically on a group basis, that focus on developing skills, building relationships and support networks to enable individuals to achieve their goals and live rich, fulfilling lives. These services are not those which provide CQC regulated care and support in people’s own homes.
25. These services are for individuals aged 18 and over with learning disabilities, autistic spectrum conditions, mental ill health, acquired brain injuries, physical disabilities, sensory impairments and / or people with specialist needs or individuals aged 16 and above if referred through the Preparing for Adulthood Assessment and support planning process.
26. In March 2023 approximately 541 people with learning disabilities and autistic people were accessing independent day opportunities. Of these, 418 accessed via a direct payment, 101 attended through a contracted arrangement, and 22 through an invoice led arrangement. In addition to commissioned services, the Council operates five specialist in-house day opportunity services across Staffordshire which are accessed by 54 individuals.
27. Day opportunities for people with a disability are contracted through a DPS arrangement which went live in July 2021. The current contract is due to expire on 8 March 2024 and has the option for a 12-month extension up to 8 March 2025. We currently have fifty-day opportunities providers registered on the DPS; there are a small number of providers not registered on the DPS.
28. Interested providers can register to join the DPS at any time and if a provider does not join the DPS arrangement for whatever reason, an individual will need to have a Direct Payment to buy support from them. Whilst many people are still accessing day services through invoice arrangements, we will not be creating new invoice-led arrangements in the future. Payments are now based on bandings of needs, and transport needs (if applicable) are also costed separately.
29. Further to learning from provider engagement around cost of care in late 2022, we wish to work collaboratively with the market to co-design future procurement models which better enable collaboration across the sector.
Shared Lives
30. This service which has recently been re-commissioned for a new contract to commence in April 2024, involves eligible individuals, otherwise unable to live on their own, sharing the home, family and community life of a specially recruited and trained Shared Lives Carer. The service supports them to reach their potential and live healthy, safe, independent and fulfilling lives in their own communities. The aim is to enable individuals to live their best lives possible.
31. The Service provides long term placements, respite (short breaks), opportunities in the day and evening in four or eight-hour sessions, support carers, emergency placements within the service and a home from hospital service.
32. People who are eligible for this service will be aged 16 and above, older people (aged 65+), people with mental health needs, those with a physical or sensory impairment, learning disabilities, autistic spectrum conditions, younger people in transition to adult services and people with complex needs.
33. In September 2023, 81 individuals were using the Shared Lives Service. Most people accessing the service are people with a learning disability and / or autistic people, and most people were in a long-term placement as well as accessing day opportunities and short breaks. There is potential for this service to offer more step-down and home from hospital support, as well as expanding provision within other areas of needs; however workforce supply is currently a limiting factor. We are working with the provider to see how we can jointly address this issue.
Live in care
34. Live in care involves fully trained carers living with an adult with social care needs in their own home. Live in carers provide specific support to enable an individual to remain comfortable and independent at home, including:
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Personal care (including care at night if required)
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Supporting an individual to access their local community (where required)
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Supporting an individual to meet their nutritional needs
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Companionship and support
35. Additional health care may also be provided only if it is jointly funded by the Council and the Integrated Care Board. Live in care is sourced via the Platform Agreement for Home Care and is a service model we are currently considering potentially using further. The Platform Agreement for Home Care opens periodically to new entrants.
36. This service is for individuals with learning disabilities, physical disabilities, autism, mental ill health, sensory impairments, older people, people with dementia, people with alcohol and/or drug dependencies or if referred through the Preparing for Adulthood assessment and support planning process.
37. As of May 2022, there were 14 placements for live in care, 13 of which are for individuals aged 18–64. In terms of primary support needs, 8 people have a learning disability and 6 people have a physical disability.
Respite care
38. The Council facilitates respite care for people with assessed eligible care and support needs through two types of services:
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Residential respite care
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Home-based respite care.
39. The Council directly provides 13 beds of residential respite care for people with learning disabilities and autism at Douglas Road in Newcastle-Under-Lyme. Due to the increased complexity of people with disabilities, the downstairs of the accommodation is oversubscribed with the upstairs significantly underutilised. This means that the service operates at a maximum capacity of eight beds.
40. In addition, the Council commissions up to 15 beds of residential respite care from an independent provider. These beds are located across two services: Woodland View in Cannock which has 10 beds; and Silverbirch in Burton-on-Trent which offers 5 beds.
41. If a bed cannot be sourced from these services, the Council spot purchases beds individually using the Residential and Nursing Home DPS or people can opt to take a direct payment to buy their own services.
42. In 2021/22 the Council’s bed-based respite care services provided 3,547 nights of respite care to 113 adults with learning disabilities and autism. In addition, 38–40 adults with learning disabilities and/or autistic people accessed bed-based respite care through the Council’s Residential and Nursing Home DPS from April 2021 – March 22,and a further 72 individuals accessed respite care via a direct payment. This is an increase on pre-Covid numbers due to infection control measures reducing capacity at our bed-based services.
43. The Council commissions home based respite care on a spot purchase basis from 48 providers registered on Lot C of our Home Care Platform Agreement which went live on 1 September 2022. Home based respite care services have mainly been used by older people and people with physical disabilities due to the skill set of the providers that have signed up to the DPS, however it is also intended to be accessible by people with a primary need of learning disabilities. The Home Care Platform Agreement will run to 31 August 2025 with the option to extend annually up to 31 August 2028. It opens periodically to new entrants to meet demand. Providers can join the platform agreement by registering on our electronic tendering system Proactis.
44. Of the 70 people who accessed home based respite care in 2021/22, none had a learning disability, 17 people had a physical disability and 1 person had a mental health need. It is noted that the numbers of people accessing home based respite care had reduced in 2021/22 however numbers are gradually increasing again and in July 2022 there were 111 people accessing this service.
45. Following an options appraisal and period of public engagement with people with disabilities, carers, providers, and professionals in 2021, we have developed integrated residential and home-based respite care services serving specified geographical areas. These will operate on a ‘hub and spoke’ basis, with a residential respite care facility offering beds as well as a home-based service. It will allow residential and home-based services to be used flexibly and offer families a single provider with which to develop a relationship, as well as continuity of care to avoid them having to tell their story multiple times. Plans are underway to implement integrated respite care services throughout 2023/24.