ASC Market Position Statement FINAL

Adult Social Care Market Position Statement 2019 -2022



Market Position Statement Our ambition In Somerset we want people to live healthy and independent lives, supported by thriving and connected communities with timely and easy access to high-quality and efficient support when they need it. Our Market Position Statement is designed to help set out: • How we see Somerset changing, how we are ambitious in responding to that change, and what it means for our customers and for our market • How we are changing our approach in responding to both opportunities and challenges, and what you can expect from us and our partners • What we will want more of, less of, what different things we will want, and what we expect from you • How we can continue to connect and involve the people of Somerset in all we say and do, now and into the future

Promoting Independence Maintaining independence makes people happier and healthier. Evidence shows that people themselves are best placed to determine what help they need and what goals they wish to achieve. Our strategy for promoting independence sets out key areas of work we are focused on in order to achieve improved outcomes for people we support. In practice, our strategy is about: • Maximising independence to support people to remain in their own homes and communities without formal social care support wherever possible • A solution-focused and productive relationship with the public, where expectations are managed and we are realistic about what we can do and what we expect from individuals, families and communities • Promoting community solutions that enable people to access information, advice and support in a timely and effective way that increases the ability to self-manage by connecting people to local assets and support networks • Asking staff to think, communicate and practice in ways that individuals understand, are empowering and motivating. We want our staff and partners to be ambitious in setting goals for people and to have good conversations that start with asking ‘what matters to you’ • Ensuring we have the right people to achieve our ambitions

Key messages to our providers We will: • Focus on the people of Somerset, not on organisational boundaries • Help people to live a ‘good life’, remaining well and independent for as long as possible • Invest more in prevention, with locally provided care and support wherever feasible • Move away from traditional bed-based models of care • Embrace innovation and technology to enable significant transformation in the care is delivered • Enable conversations that focus on people’s strengths • Promote greater self-involvement and management to ensure people remain in control of their own care and support, and are ambitious in setting their own goals • Work collaboratively with local communities, the voluntary sector, our health partners and care providers to pool collective resources and develop solutions together that enhance quality of life and promote independence • Prioritise specialist care for those with the most complex needs when other options are no longer appropriate • Commission new forms of accommodation and support to reduce reliance on traditional residential care



Contents Page Improving and maintaining quality of provision 10-11 Our workforce 12 Demographic challenges 13 Part one: Where people live 14-15 Home Care 16-17 Home First and Community Reablement 18-19 Residential and Nursing Care 20-21 Residential and Nursing Placements 22 Supporting housing 23 Extra Care housing 24-25 Part two: How people are supported 26-27 Community provision 28-29 Unpaid carers 30-31 Adults with LD & complex needs 32-33 Adults with Dementia 34-35 Adults with autism 36-37 Support to live fulfilled lives 38-39 Assistive technology 40-41

Improving and maintaining quality of provision By finding ways to care for people in a more joined up way and preventing their condition from deteriorating or escalating as frequently, we can dramatically improve outcomes. This enables greater proportions of our money to be spent on prevention and services supporting people within their own neighbourhoods. Our Home First approach from hospitals is one great example of how system-wide pressures can be managed in a person-centred way and delivers improved outcomes. Somerset County Council is committed to working with providers on continual improvement in quality standards. We celebrate the fact that providers in Somerset are above national benchmarks but will continue to support further improvement through our quality assurance and nursing home support teams.



Our workforce We want and need a vibrant and flexible workforce. As demand for health and care increases, more trained staff are needed, but we are facing shortages of allied health and care professionals, social workers, doctors, nurses and midwives. At the same time as the older population is growing in Somerset, the working age population (15-64) is projected to fall by two per cent. Our ambition is to make Somerset an attractive place to work with an agile and digitally connected workforce able to work in new ways and locations. We are very proud of our workforce and committed to raising the profile of professions right across the health and care system, as well as addressing the recruitment and retention challenges. Somerset County Council is committed to a multi-agency approach to this issue through the workforce development board, which includes providers sector representation, and is taking a proactive approach on this. Our Proud to Care Somerset campaign was developed in response to the anticipated need for an additional 90,000 care workers by 2030 across the region. And, our nurturing of the micro-enterprise market has helped make our market more vibrant and varied. This is an exciting time to be a part of Somerset’s care industry – help us shape it and make it!

Demographic challenges At least 25 per cent of Somerset’s population is projected to be over 65 by 2033. The number of people aged 75 or older is projected to almost double by 2041. People will be LA or self-funding and we need to acknowledge that it is our responsibility to consider the market overall and work with providers on that basis.



1. Where people live We want to support people in Somerset to: • be able to remain in their own homes for as long as is possible • to enable people to recover and return home from hospital quickly • reduce our use of out of county placements by ensuring we have a sufficient range of mixed economy provision. We want people and tthoetier lclaurserwshtaotb‘geoaobdle’ loaonkds hlieklepfdoerstihgenm their support.

Home Care We know that: The emergence of assistive technology, the role of mind as well as physical exercise, diet, and the support of reablement-focused care can all help sustain people within their own homes. There are some areas of Somerset where we continue to struggle to source domiciliary care, due to geography and insufficient coverage of homecare provision. Over 35 home care providers bid for care on our two-tiered commissioning system. This is open for new provider applications at any time. Our commissioning intentions: • To secure sufficient, high quality, personalised care and support, delivered where and when the service user needs it • To enhance what service users, carers and families can do themselves to promote independence, while remaining outcome-focused • To contribute to the reduction of inappropriate hospital admissions, where the patient would prefer to be cared for in their own home, and to support people to return home from hospital as quickly as they are fit and able to do so • To increase the emphasis on access to universal community services, shared services and care technology

Home Care in Somerset Home care hours sourced by area (Sept 2017-Jan 2019) A third of all home care hours requested stemmed from the South Somerset District area. Top 10 areas in Somerset of ‘unmet’ homecare need (Apr-Dec 2018) There are some areas of Somerset where we continue to struggle to source domiciliary care due to geography or insufficient coverage of home care provision. The map highlights the main areas of Somerset where we have experienced ‘unmet need’ over a nine-month period from April 2018.

Home First and Community Reablement We know that: Large numbers of older people referred from acute hospitals are likely to require a service or some help from social care, if only for a short-period. The services available at the point of discharge should, in most cases, offer short-term help focused on supporting recovery and recuperation. Many important aspects of an assessment are better if they take place outside hospital, preferably in a person’s own home. Evidence suggests one in five people leaving hospital are over-prescribed the level of care they need, and a third of direct permanent admissions to residential care from hospital beds are avoidable.

Our commissioning intentions: • To reduce overall system pressures • To continue to innovate and provide more services in the community rather than within hospitals • To work with people and providers on place-based commissioning models to take into account local links with housing, transport and leisure • To assess people in the most appropriate settings to enable recovery and set meaningful goals • To support people to maximise their independence, and reduce or overcome the need for longer-term funded support by working with therapists, social workers and community agents to support successful reablement and help in the assessment of the right support at the right time

Residential and Nursing Care We know that: Somerset has a large and established market for residential and nursing provision. It is anticipated that the use of long-term residential care will reduce and nursing care will be for those with the most complex needs. The quality of our local provision is high and exceeds regional and national averages (Care Quality Commission). People are choosing to remain at home for as long as they are able to do so. This is impacting on demand for residential and nursing care with a corresponding growing number of bed vacancies across Somerset.

Our commissioning intentions: • To continue to monitor the cost of care and ensure the Council pays a fair price through transparent commissioning and contract arrangements • To increasingly commission outcome-focused, time-limited placements to enable people to move into supported living • To work with providers to ensure people are supported to be as independent as possible • To ensure nursing homes are able to meet the needs of residents with dementia and complex needs, and develop provision able to meet the clinical demands to prevent avoidable hospital admission • To reduce delayed transfers of care from hospitals by ensuring sufficient places are available This shows the number of residential and nursing care home beds for the population of Somerset LA as of March 2019.

RReessiiddeennttiiaall aanndd NNuurrssiinngg PPllaacceemmeennttss Somerset County Council is committing to support the RCPA and providers to develop new models and business plans where required.

Supporting housing We know that: Approximately 70 per cent of all supported living accommodation is provided in shared houses. This does not work well for people with more complex needs, and can lead to individuals being given notice and having to leave their home. There is increasing demand for good quality self-contained accommodation with support from a quality provider. Accommodation in larger towns, such as Taunton, tends to be more popular. Data suggests we have a shortage of provision in Yeovil and West Somerset. Our commissioning intentions: • To ensure people with mental health support needs and/or with learning disabilities are able to use mainstream routes to access appropriate housing options, giving them control over where they live, who they live with and how they are supported • To work proactively with providers to ensure we are aware of all new or existing supported living provision across Somerset • To support providers to develop appropriate accommodation in advance of occupation • To increase community placement options for people with complex needs, including the provision of Keyring and Shared Lives schemes

Extra Care housing: We know that: Currently there are 19 Extra Care Housing schemes in Somerset supporting 720 people. The Council commissions 24 hour care and support in each of these schemes to enable people to maintain and improve their independence and wellbeing, while maintaining their tenancy and preventing admission into more acute social care and health services. Data tells us there are a number of schemes where there are a very low number of people in receipt of a care package. This means that the numbers of Extra Care schemes will reduce during 2019, so we are left with a geographical spread with good support models.

Our commissioning intentions: • We want to have vibrant, busy Extra Care schemes that have a community presence, with people from outside coming into the scheme, as well as being valued members of society • To commission integrated care and support services that are outcome based and assist people to maximise their potential for independence • To help prevent inappropriate hospital admissions • To be responsive and flexible to changing needs • To help people with care and support needs to be involved in their local community • To work in partnership with other providers to reduce duplication and improve opportunities for people living in Extra Care Housing • We want to commission at least one new Extra Care scheme in each of the districts over the next two to five years. This will create around 55 new units, which will offer greater choice to people that might need or want to move out of their homes.



2. How people are supported We want all Somerset residents to be able to have equal access to mainstream support within their local community, and tailored assistance to support where they need it. We want to promote enabling conversations that focus on people’s strengths and to offer informed choice. We want people to be able to tell us what good looks like for them and help design the support. We want to ensure that people’s happiness, aspirations and achievements are never limited due to a disability.

Community provision We know that: We want people to have a great choice of local, flexible, high quality services and support to help them live a good life. We are committed to a community development approach to commissioning, which nurtures community care and responds to identified need. The drive for ‘bottom up’ initiatives will develop alongside more strategic drivers towards ‘place-based’ approaches, and will facilitate the growth of social capital within local communities. This approach has, to date, supported the development of 223 brand new, and 56 established community enterprises, and will need to continue.

Our commissioning intentions: • To build caring and resilient local networks and solutions that reflects people’s needs and aspirations • To stimulate the market and support enterprises across the county • To nurture entrepreneurialism and help get new ideas off the ground, exploring new ways of working and imaginative models of support to maximise the community and its resources • To promote and support the delivery of independent living, choice and control • To develop effective ways to demonstrate quality and value of provision • To align micro provision within broader core provision of care at home to ensure vibrancy of the overall marketplace and workforce

Unpaid carers We know that: A carer spends a significant proportion of their life providing unpaid support to family or friends. This could be caring for a relative, partner or friend who is ill, frail, disabled or has mental health or substance misuse problems. There are approximately six million unpaid carers nationally. In Somerset 58,000 people identified themselves as carers, of which 15,491 were 65 or over, 3,306 were 25 or under, and it is estimated more than 1,000 were under 16. 12,300 people provide over 50 hours of care a week, and many have long-term conditions themselves.

Our commissioning intentions: • To enable and support unpaid carers to be resilient in their role by focusing on their health and wellbeing • To ensure they have good support networks and know where they can get good quality advice, information and assistance when they need it through a single point of contact (irrespective of age or need) • To collaborate with carers to ensure solutions are tailored to recognise the expertise, knowledge and importance of the carers role in a timely and compassionate way to prevent escalation of issues • To listen and value carers’ views when decisions are made about the person they care for • To work with partners, employers and specialist organisations (including the VCSE) to ensure solutions are routed within local communities, relevant to the carer and sustainable

Adults with LD & complex needs We know that: The need for trained staff continues to grow as the population of adults with LD and complex needs also grows. There has been a culture of dependency created through paternalistic, risk averse approaches that are not aspirational for adults with LD and other complex needs. This has led to people being excluded from local communities and from opportunities to develop skills that integrate and support people to live as independently as possible. There are inconsistencies in ensuring people get the right health and care, at the right time and in the right setting. There is a lack of opportunity for living independently and gaining employment.

Our commissioning intentions: Our promoting independence strategy applies equally for all people. We want: • To have support for people that is focused on helping them improve or recover, as well as live good lives. This will mean changing the infrastructure and way that we help people. For example, making communities more inclusive for people with learning disabilities and complex needs and promoting peer support options and models • To commission flexible, responsive services that respond to people with complex needs, but are also able to de-escalate and withdraw as appropriate, utilising stepping back to community related support • To enable those with complex needs to be supported in securing mainstream accommodation options under a Housing First approach • To support landlords, district councils and housing associations to have the confidence to provide long-term tenancies for those with complex needs • To ensure people that come into contact with Adult Social Care are supported to understand their level of need and to maximise their skills and independence

Adults with dementia We know that: Around two in three people aged 65 or over with dementia are diagnosed – although diagnosis rates in Somerset are slightly below the national benchmark of 66.7 per cent. Excess weight, alcohol, depression and diabetes are known risk factors for dementia. While we have refocused available budgets into community and grass roots organisations, many services are unable to support people with complex needs or later stage dementia. There is growing demand for good quality respite opportunities and activities for people with dementia who wish to live fulfilled lives.

Our commissioning intentions: • To enable carers to have respite from their caring role and reduce carer crisis referrals to social care, allowing people to live at home longer • To boast a colourful array of services, from the arts to gardening, social clubs to reminiscence sessions, from active living to specialist support, with development directed by the communities they serve • To encourage the market to use available grants creatively to upskill staff, make adaptations to buildings, provide buddies or one to one support to access services, and pump prime new projects. To also increase the participation of older people with mental health support needs accessing local community services and activities, and offer a better choice of services, which are flexible • To ensure home care providers are able to manage dementia needs to avoid placements into care homes, wherever possible • To ensure all care homes are able to support residents with dementia for as long as possible to prevent people from having to move • To provide specialist 24 hour support for those with challenging behavior and dementia without needing intrusive one-to-one care home, and based on stimulation and family care models

Adults with autism We know that: The joint LA/CCG autism needs assessment identifies gaps in provision for adults with autism. Too often support goes through LD or MH workstreams and can fail to focus on specific autism needs. The current Somerset Autism Strategy expired at the end of 2018. Somerset Couny Council are working with the CCG on a refreshed version. There needs to be better information, about support and services and it must be easily accessible to everyone – people with autism, their carers and families and professionals.

Our commissioning intentions: • To ensure young people and adults with autistic spectrum conditions (ASCs) are able to live fulfilling and rewarding lives within a society that accepts and understands them • To address the gaps identified by the autism self audit and redefine the autism strategy • To improve autism services across health, childrens and adults provision • To ensure people with ASCs can depend on mainstream public services to treat them equally and fairly as individuals • To develop and increase employment and supported employment opportunities to encourage people with ASCs into paid work or purposeful, meaningful voluntary roles

Support to live fulfilled lives We know that: People thrive if they are able to develop skills and participate in activities that matter to them, including having opportunities for meaningful employment. People do not thrive in traditional day service provision, being secluded away from the wider community and having access to univeral options. There is a need for the development of peer and community-leg meaningful activities, that are not cost-based. These could be either grant funded, or better yet, universally accessible, that better suit what our local populations need now and into the future. Personalisation needs to be at the heart of service transformation.

Our commissioning intentions: • To improve access to personal budgets in a timely way • To support community providers to become more inclusive • To enable social workers to be more creative with care planning • To encourage the market to develop more meaningful activities, including evening and weekends support, types of day opportunities, build universal community assets, improve and monitor quality and develop an enablement culture • To focus building-based support for those wiht the most complex physcial or behavioural needs, that has access to specialist equipment, stimulation and support. • To ensure day services promote people’s independence and develop people’s life skills • Any support will have an absolute focus on promoting people’s independence, developing life skills and have outcomes with measure at the heart of everything they do

Assistive technology We know that: Assistive technology can enable and support a wide range of needs to support and assist people to live independently and to enhance their quality of life. Assistive technology can also offer greater confidence and reassurance to carers and family members. It can provide a cost effective and less intrusive form of care and support, and supplement (if not replace) the need for alternative care provision.

Our commissioning intentions: • To adopt assistive technology as a core component of our social care offer, and lead the way in developing and testing innovative solutions in order to provide people with greater choice and control over their care and support • To ensure people, their carers and families are able to access good quality and evidence-based information and advice on appropriate assistive technology and, where appropriate, purchase or access it themselves • To support people and providers to find suitable assistive technology that meets their needs, enables greater self-management and, where appropriate, reduces or delays the need for more restrictive or costly care • To ensure solutions are personalised, proportionate and strengths-based, enabling outcomes that promote independence