Overview
49. The Council will remain predominantly a commissioned of services rather than a direct provider. We will have role in shaping the local market to ensure a range of good quality services at sustainable and cost-effective prices that taxpayers can afford. We will use our influence and resources to encourage collaboration and innovation by providers and to promote choice. We aim to increasingly enable individuals and their families to purchase care and support directly from providers via Individual Service Funds and direct payments. We are prepared to provide services, either in-house or through local authority trading companies, where the market cannot the services that people need.
50. We intend to deliver our strategic objectives for community social care services for adults with mental health conditions working with the provider market. We have refreshed our Mental Health is Everyone's Business strategy which we anticipate will be published by April 2023. We will continue working closely with CQC regarding regulated services and in doing so, we aim to work with providers who can prevent, delay or reduce the development of care and support needs, including carer support needs, and consolidate our asset-based and outcomes-based commissioning, and ensure we measure our performance as commissioners against the principles, ethos and approach detailed in the Commissioning for Better Outcomes route map.
51. In addition, we continue to work in close partnership with Public Health, ensuring the priorities of the Health & Wellbeing Strategy 2022-2027 are reflected in the work we do including:
- prioritising prevention and early intervention
- engaging with communities to co-produce solutions
- recognising the importance of voluntary organisations in improving health and wellbeing
- recognising diversity and responding to inequalities and inequities
- commissioning and delivering high quality services that provide excellent value for money for those who need them most, tailored to people’s needs.
- communicating clearly to make sure we are understood, and that information is accessible to everyone.
- being strengths-based, making the most of existing community assets and insight.
- having a good understanding of data, improving care coordination, and designing proactive models of care
- ensuring that local people have access to the information and support they need to remain independent and stay well
- developing the wider health and care workforce
- embracing digital solutions
52. Figure 1 demonstrates how we want the market to shift over the coming years.
Figure 1: Strategic Direction of Travel
Strength-based approaches
53. We support strength-based approaches to enable people to lead the most independent and fulfilling lives. Strength-based approaches focus on what matters to people, what they can do for themselves, and how their abilities can be complemented by family, friends, neighbours and technologies to achieve their goals. We will continue to develop the assets available in our communities and ensure that the public and professionals know how to access them, and we have embraced strength-based approaches in our Care Act assessments.
54. Through our Supportive Communities programme, we will continue to work with the voluntary sector, NHS, district/borough and parish councils to make communities vibrant, safe and inclusive places for adults with mental health conditions to live. The programme is focused on making better connections between those people that may need additional support and the wider range of voluntary groups and community services that are available locally.
55. We want care providers to have a wider social impact by helping to link people to support in their communities. We want to see improved use of community facilities that empower people to self-help. The Staffordshire Connects portal holds information about a wide range of services including leisure centres, parks and green spaces, support groups, advocacy, direct payments, transport and much more.
56. We also want care providers to adopt strengths-based approaches within their services, maximising people’s independence, taking positive risks, avoiding restrictive practices and achieving personalised outcomes. As we commission services, we will look at opportunities for promoting strengths-based approaches within service specifications, shifting away from ‘time and task’ and towards outcomes-based contracts that offer care providers more flexibility to meet individual needs and achieve their outcomes.
Co-production
57. Co-production means organisations and their staff, communities and individuals working together as equals to improve services and outcomes. It requires a commitment to working collectively and collaboratively and involving people in the whole process of design and delivery of services, from beginning to end, exchanging information and power for mutual benefit. We are strengthening our arrangements for co-production in Staffordshire.
Quality
58. For all services we use a range of information to evaluate quality including Care Quality Commission (CQC) ratings, feedback, compliments and complaints from adults with disabilities, their families and carers, and intelligence from our staff and from other partners in the health social care system.
59. We encourage all care providers to consider and implement national best practice including NICE standards, ‘Making it Real’ from Think Local Act Personal, and CQC quality statements. Where we have concerns about the quality of a service, our Quality Assurance Team will co-ordinate further assessment and support.
60. For regulated services an important view of quality is CQC ratings, although we recognise that there may be a considerable time between inspections. All regulated services should aim to be assessed by CQC as ‘Outstanding’ or ‘Good’, and every service below this level should be enacting a plan to improve. We aim to continue working closely with CQC to improve regulated services.
61. Quality ratings for the 53 supported living providers the Council was working with in September 2022 are shown in figure 3. All of our residential respite care services are rated ‘Good’.
62. Day opportunities are usually a non-regulated service and care quality is not measured by CQC. We will be developing and strengthening our quality assurance arrangements and ensuring that quality requirements are specified in contracts and expectations for the services that people purchase using direct payments.
Figure 2: CQC ratings of supported living services with a Staffordshire placement (including out of county) in September 2022
Source: www.cqc.org.uk
63. Our intention is to strengthen quality assurance arrangements including:
- Involving people who use services in quality assurance and contract monitoring processes.
- Working with supported living providers to meet REACH standards and the real tenancy test.
Accessibility and sufficiency
64. The Council needs to ensure that people have access to a sufficient supply of accessible services in the long term. We intend to strengthen our market intelligence about demand and supply. This includes understanding key life stages such as the needs of older children before they transition to adulthood, as well as end-of-life services. This will allow us to assess expected demand against supply of services and shape the market appropriately.
65. We know that there are immediate shortfalls of supply of services for some groups and in some areas:
- We have a gap in capacity for supported living with reablement that can help people develop life skills, for example for younger people as they transition to adulthood, and people of all ages after hospital admission or a prison term. We welcome conversations with care providers who are willing to develop these models.
- We need more capacity in personal assistants who can offer a full range of support to help adults with disabilities to live independently.
- There is a relative deficit in capacity of supported living in Lichfield, Newcastle-under-Lyme and Tamworth.
- We want to identify and signpost to voluntary sector organisations and social enterprises.
- We want to promote a culture shift away from a medicalised model to take a more holistic approach to care and support for everyone.
- We would like to do more prevention and early intervention to keep people out of services and help manage demand. This includes raising awareness of measures that everyone can take to improve and maintain their mental well-being, including the Five Ways to Wellbeing. We ask care providers to promote these in their services.
- We want to improve in county provision for people with trauma-based experience including those that manifest in risky behaviours.
70. We ask that all care providers, under 'Right support, right care, right culture' guidance, consult the Council prior to submitting any planning applications. This is the ideal time to share innovative ideas and local investment opportunities to improve life for people with disabilities in Staffordshire. Please see the How to Contact Us section at the end of this document for our contact details.
Person centred care and support
71. We are interested in giving adults with disabilities greater control over their personal budgets. We are exploring the development of individual service funds (ISF) to allow adults with disabilities and their families and carers greater choice and the opportunity to directly shape the services they receive from care providers.
72. To support choice and control we want to make sure that adults with disabilities have good access to information, advice and guidance so that they can understand the community assets and care services that are available. We are reviewing the Council’s website to improve content and accessibility. We would like to see more care providers offering information, advice and general signposting, including via social media, to help all adults with disabilities live as independently as possible.
73. The Council and care providers have a duty to be aware of and responsive to the needs of wider vulnerable groups or demographic characteristics for example in respect of protected characteristics (inducing disability, ethnicity, religion, culture, gender, and sexual orientation etc).
Workforce
74. The Council has developed a sector wide Workforce Strategy 2023 – 2025 across adult social care and will continue to support the care provider workforce through 8 key actions:
- Improve the use of updated data and intelligence as a shared resource to support the social care workforce.
- Promote available resources to providers more effectively, and engage with providers who need the most support to use those resources.
- Develop an improved journey into work.
- Implement a co-ordinated partnership approach to learning and development.
- Improve the positive recognition of social care as a valued career.
- Increase the level of capability to use digital and technology innovations.
- Support improved practice across the sector in recruitment and business continuity planning.
- Seek to reduce travel costs where possible across the partnership.
Cost effectiveness and pricing
75. Nationally the financial position of adult social care will continue to be challenging. It is important that the Council and providers work together to ensure that services offer value for money. This will require a commitment to innovation and the continuous development, sharing and testing of new models of care.
76. We have undertaken a local cost of care exercise, in partnership with the market, to help us establish a greater shared understanding of cost pressures facing the Council and care providers.
77. The Council undertakes an annual fee review for all commissioned services which considers a range of economic factors including the cost pressures facing care providers and the funding available to us. Our contracts do not allow care providers to unilaterally increase fees outside of this process.
78. For the Council, cost pressures are driven in part by rising demand from a relatively small number highly complex individuals and we are interested in developing reablement services that can prevent, delay or reduce the development of care and support needs. We also want to understand how we can incentivise care providers to take positive risks and avoiding restrictive practices so that adults with disabilities can enjoy greater independence and a better quality of life.
79. In line with national policy, we intend to work with the market to standardise prices for services, including in supported living and day opportunities. This will ensure that funding for individuals and for care providers is equitable and based on their care and support needs rather than on market forces. As part of this we will be clear about the service specification that is covered by the price.
80. The Council is in the process of implementing a change to all placements to pay providers gross rather than net of client contributions. This change will be effective for some commissioned disability services from August 2022 and will result in providers having greater certainty of income and reduced bureaucracy associated with invoicing individuals. This will be in place for supported living when it is recommissioned.
Technology enabled care
81. Technology is advancing at pace and presents opportunities to for innovative approaches to improve the quality and cost-effectiveness of care, enabling adults with disabilities to be more achieve their individual outcomes. The Council is interested in working with care providers to understand, test and implement relevant technologies in their services, and to develop the appropriate skills in staff.
Partnerships
82. The Council will work with a range of partners to help people with mental health conditions enjoy greater independence and a better quality of life – including:To support carers supported including with flexible respite care in line with the priorities outlined in the Strategy for Carers
- With the voluntary sector and communities to improve access to local support.
- With district and borough councils and the NHS to ensure that people with disabilities can access universal services and general needs accommodation.
- With schools, colleges and employers to improve access to education, training and employment opportunities.
- With housing partners to influence planning opportunities and ensure that there is a sufficient supply of dedicated housing.
- With technology providers to understand, test and implement relevant technologies in care services.
- With the NHS to ensure access to specialist services for people with disabilities.