18. We currently commission the following services for people with mental health conditions:
- Services that help people to have a voice: Integrated Advocacy.
- Services for people who wish to live at home: Supported Living.
- 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 Shared Lives.
- Services that support carers to have a break from their caring role: bed-based respite care, home based respite care.
- A service that provides low level enablement support: Social Inclusion and Recovery Service delivered by Midlands Partnership Foundation Trust (MPFT).
Integrated Advocacy Service
19. From 1 April 2022 we have commissioned a statutory Integrated Advocacy Service with ASIST Advocacy 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.
20. This service supports and enables people with a range of care and support needs (including learning and physical disabilities, autism, mental health conditions), 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.
21. The current contract is due to expire on 31 March 2024 and has the option for two 12-month extension periods.
Supported living
22. Supported living services provide care and support for adults with disabilities in dedicated housing schemes. In October 2021, the Council had 416 placements in supported living schemes, of which 43 were “out of county” including 18 in Stoke-on-Trent. In addition to these the Council also had 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.
23. 84% of supported living placements are for people with a learning disability, 14% are for people with mental health conditions and 2% for people with a physical disability. They support people with different levels of need - figure 2 shows placements broken down by complexity:
- Highly complex individuals have behavioural or physical needs that require very intensive support, some have a forensic history.
- Complex individuals require 24-hour care; and
- Less complex individuals do not require 24-hour care.
Figure 1: Supported living placements by complexity (October 2021)
24. 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. More specifically there is a need for:
- a specific Housing with Care and Support Strategy for Staffordshire which includes supported living;
- 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;
- an increase in placements suitable for individuals with highly complex forensic needs to support their discharge from hospital or other secure settings;
- more supported living opportunities in Lichfield, Newcastle under Lyme and Tamworth;
- a variety of different and appropriate supported housing. This should be in line with identified local needs and Supported housing: national statement of expectations and and strategic conversations with commissioners;
- 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;
- more services with a reablement focus; and
- an increase in local 'step down' accommodation and associated support that focuses on improving life skills and building independence.
25. 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 electronic tendering system Proactis to receive invitations to tender for individual placements. The DPS is due to expire on 01 July 2024.
26. 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.
27. 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.
28. Supported living providers are actively invited to join our regular supported living provider forums which commenced in November 2022. To find out more information about the forums please email us at mailto:wholelifedisability@staffordshire.gov.uk
Day opportunities
29. These are activities and support services provided outside of an individual’s home, typically on a group basis, that focus on social inclusion into local communities by developing skills, building relationships and support networks to enable individuals to achieve their goals and live rich, fulfilling lives. Because they are not registered with CQC, these services are not able to support individuals in their own home with specific care and support tasks (regulated support).
30. These services are for individuals aged 18 and over with learning disabilities, autistic spectrum conditions, mental health conditions, 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.
31. In June 2022 approximately 23 adults with mental health conditions were accessing independent day opportunities. All individuals accessed either via a direct payment or through an historic invoice led arrangement.
32. Day opportunities are contracted through a DPS arrangement which went live in July 2021. The current contract is due to expire on 8 March 2023 and has the option for two 12-month extension periods, up to 8 March 2025. We currently have 50 day opportunities providers registered on the DPS. Payments are now based on bandings of need, with transport needs costed separately if applicable.
33. 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 some day opportunity services are uncontracted and paid by invoice we intend to move away from these arrangements in the future.
34. 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
35. This service, which was recently recommissioned, involves a carer who shares a home, family and community life with an individual with care and support needs who is otherwise unable to live on their own. The service offers support during the day through to helping an individual meet their longer-term care and support needs.
36. This service is accessed by a range of eligible individuals aged 16 and above, including older people, people with mental health conditions, those with a physical or sensory impairment, learning disabilities, autistic spectrum conditions, younger people in transition to adult services and people with complex needs.
37. In March 2022 approximately 80 individuals were using the Shared Lives Service. 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 however workforce supply is currently a limiting factor. We are working with the provider to see how we can jointly address this issue. The current contract is due to expire on 31 March 2024 and will be re-tendered during 2023.
Live in care
38. 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:
- Personal care (including care at night if required)
- Supporting an individual to access their local community (where required)
- Supporting an individual to meet their nutritional needs
- Companionship and support
39. Additional medical care may also be provided in care 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 opens periodically to new entrants.
40. This service is for individuals with learning disabilities, physical disabilities, autism, mental health conditions, 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.
41. As of May 2022, there were 14 placements for live in care. None of these had needs primarily driven by mental health conditions although this is an option in the future. Respite care
42. The Council facilitates respite care for people with assessed eligible care and support needs through two types of services:
- Residential respite care
- Home-based respite care.
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. In 2021/21 70 people used the service. These were predominantly older people and adults with physical disabilities due to the skill set of the providers that have signed, however it is also intended to be accessible by adults with mental health conditions. 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. Following an options appraisal and period of public engagement with we intend to develop 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 replacement care services throughout 2023/24.
Social Inclusion and Recovery Service
45. In October 2020, the Council commissioned Midlands Partnership NHS Foundation Trust to provide a floating support service to provide support to adults with mental health conditions. This service facilitates access to the community and health-based resources for people with a key focus to prevent, reduce and delay their needs escalating and enable them to develop the skills to live independently in the community.
Section 117 aftercare
46. If someone has been detained in hospital under Section 3, 37, 45a, 47 or 48 of the Mental Health Act (MHA) 1983, they are entitled to Section 117 aftercare upon discharge. This is a joint legal duty for the Council and the NHS. Section 117 aftercare is free and should meet people’s care and support needs and help them develop the skills to live independently in the community and avoid readmission. It does not include funding their food, utilities and other living costs.