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Whole life market sustainability plan (LD/MH/A)

Section 2: Assessment of the impact of future market changes between now and October 2025, for each of the service markets

Supported Living, Self-Directed Support and Care Home provision

In 2018, Wiltshire Council commissioned Glenesk to undertake a needs analysis around accommodation-based care and support, to inform our commission intentions. The needs analysis found that:

  • Over 70% of providers who responded to a survey said they did not feel confident in supporting people with complex learning disabilities; and nearly two thirds of providers reported that they have limited or no ability to support customers with autism spectrum conditions.
  • There is likely to be an overall 25% increase in commissioning spend over the following five years if Wiltshire's care market does not change significantly. 72% of this increased spend will be on supported living and residential care for adults with learning disabilities and older adults.
  • Wiltshire makes relatively high levels of out-of-County placements, which are often more expensive and lead to poorer outcomes than in-County. We need to both reduce the number of new out-of-County placements, and support people returning to Wiltshire where appropriate
  • An audit of placements found that for adults with learning disabilities, there is potential for 74% of future demand to shift from residential to other settings.
  • For adults with mental health needs, we are seeing increasing complexity, but people's experiences of having their needs met and aspirations supported are sometimes poor. We need additional supported living in the north of Wiltshire.
  • Wiltshire makes insufficient use of Shared Lives provision.

The above data analysis has informed the Independent Living Strategy and action plans, Market Position Statement, program of work for accommodation and the work under Transformation of Adult Social Care to review processes to improve the outcome of the areas above.

Key strategic risks

The following key strategic risks have been cited by Wiltshire's providers, ICB colleagues and Council Brokerage, Operational and Commissioning teams.

Workforce

  • Providers are competing for the same workforce.
  • There are increasing numbers of care staff choosing to leave the sector.
  • Significant staff shortages are the biggest threat to sufficiency. This will further impact not only on customer / staff experience but also on service provider performance. The following range of factors has been shared by providers that can drive social care staff to leave, including:
    • pay and terms and conditions
    • career progression
    • training opportunities
    • work-life balance
    • motivation and morale
    • flexibility at work
    • organisational culture
    • leadership

Inflation

Annual contractual uplifts will be applied in April 2024 for framework providers only. Uplift mechanisms take into account current inflationary pressures and market factors. We believe this will work towards maintaining the sustainability of the market. Inflation fell by the end of 2023 therefore we don't see this as a significant strategic risk going forward.

Insurance

Care providers have told us that a lack of choice in care sector insurance is causing instability. Insurers are requiring more assurance and demanding a higher premium which could result in providers exiting the market.

New CQC assessment process

Providers are concerned that the new CQC single assessment process implemented in 2023 may be time consuming and an additional burden. There is a risk that the rating landscape is changing.

Payment to providers

Our current payment processes are a disincentive to current and prospective providers when offering capacity to the council. The Council is working on moving from Net to Gross payments.

Further actions Wiltshire Council plans to take to support market sustainability

During the recommissioning of the Good Lives Alliance 2023, we held a number of joint workshops with providers who delivered or wanted to deliver services to Wiltshire residents, operational staff, Bath and North East Somerset, Swindon and Wiltshire Integrated Care Board (BSW ICB), Wiltshire Centre for Independent Living and Wiltshire Parent Carer Council who represent the customer and family voice, came together to look at best practice, value for money and to continue with a consistent method to pricing to support a more sustainable provider market. Wiltshire Council will continue to prioritise the purchase all new business through the GLA 2023 framework.

Fee Setting - CareCubed - GLA Framework

We will continue to engage with the market through our work on Market Sustainability to better understand what the Fair Cost of Care should be on the basis of what is a suitable rate for providers to cover the cost of delivery and make a reasonable return on operations and what is affordable for the local authority, recognising our responsibility to steward public money and it will be influenced by the amount of funding made available by government and its conditions.

We want to work towards a fair cost of care that is built on sound judgement, evidence and negotiation and critically one that is affordable through the funding provided by Government to implement and manage the Adult Social Care reforms, which have now been delayed until October 2025.

Through the framework, supported living rates have been fixed for both tier 1 and 2 providers. We have tried to introduce bed rates for residential services based on the types of support being delivered and the size of the care home.

For those services purchased on a spot contract, CareCubed, a nationally accepted tool for benchmarking care costs against assessed needs, is used to support negotiation of costs.

The Council is working on moving from Net to Gross payments to providers.

Recruitment and retention

The Council, in conjunction with other Southwest ADASS authorities will relaunch its Proud to Care initiative. Working with Health Education England and our providers, we will focus on making social care careers more attractive, rewarding and sustainable.

  • We will work with the ICB to develop training opportunities for care sector workers across BANES, Swindon & Wiltshire Councils
  • We will promote the BSW Academy, an inclusive initiative that will help to unite and develop the BSW Partnership's entire 34,000 strong workforce by investing in leadership, learning, innovation, improvement, and inclusion across the ICS.
  • We will continue to promote and support the Joint Wiltshire Care Partnership and BSW Care Workforce recruitment and retention scheme.
  • We will continue to promote the Bath and North East Somerset, Swindon & Wiltshire Care Skills Partnership (BSWCSP) to
    • Support Independent, Voluntary and Private sector (IVP) adult care employers and Registered Managers (RMs) to access learning and development for RMs and their staff.
    • Provide advice and support on adult training courses with regard to grants and funding which may be available to staff.
    • Provide advice and support to anyone who would like a career in adult social care regarding traineeships and apprenticeships

Working together with Providers

  • We will continue effective, regular and transparent dialogue with our providers, especially in challenging times.
  • We will work with providers to develop value-based commissioning models and continue to embed the Quality Assurance Framework (QAF) in partnership with them to allow regional quality assurance.
  • We will move from paying net to gross and implement a new provider payment portal to ensure timely and accurate payments.
  • We will continue to deliver our Trusted Assessor Model which is managed by Wiltshire Care Partnership and look at its possible expansion with support from providers.
  • We will continue to develop our information services and integrated brokerage service to include a service for self-funded customers to support section 18(3) of the Care Act 2014

Strategic plans

Accommodation Strategy

We have developed an Accommodation Strategy which outlines Wiltshire Council's adults' of working age who may present with mental health needs, learning disability (with or without dementia), autistic spectrum condition, physical or sensory needs, social, emotional, and behavioral needs, speech, language and communication needs. It details our future accommodation aspirations, our future approach, demand and gaps in the market. The strategy was co-produced by the people we support with the assistance of our service user engagement provider.

Carers Strategy

We have developed a draft strategy which addresses the needs all age carers.

Dementia Strategy

We have developed a joint dementia strategy, which will outline how we will ensure we will have high-quality and equitable services to support people with dementia and carers of all ages through their dementia journey.

Technology Enabled Care Strategy

We have developed this strategy with carers, housing and operational teams, with a strong emphasis on prevention and early intervention. 

Autism Strategy

We have developed an all-age autism strategy guided by a vision of an inclusive, vibrant, well-connected Wiltshire, in which children and young people with autism and autistic adults fulfil their potential, be actively involved and included in their communities, make informed decisions, have control over their lives, and be valued and included within society.

LD Strategy

We are developing a draft strategy which aims to set the commissioning intentions of the Whole Life Commissioning Team regarding Wiltshire residents with learning disabilities (LD)

BSW MH Strategy

We are inputting into the BSW led MH strategy. 

WL Statement (MPS)

We have refreshed the Whole Life Market Position Statement since the 2021 Census data has been released and the Council has published its Business Plan and a suite of new strategies setting out Wiltshire's direction of travel. It will be reviewed and updated regularly as our knowledge and understanding grows and our shared thinking around commissioning intentions develops.

GLA Framework

We recommissioned our Good Lives Alliance in September 2023, using an outcome-focused approach to focus on people's strengths, assets and potential, to have a positive and meaningful impact on people's lives, increase choice and control and develop people's life skills. It includes the role of friends, families, broader community, and technology enabled care in promoting independence and resilience to supplement or replace the support provided and funded by Wiltshire Council.

The Alliance encompasses support services for adults of working age who may present with mental health needs, learning disability (with or without dementia), autistic spectrum condition, physical or sensory needs, social, emotional, and behavioural needs, speech, language and communication needs. 

The Alliance gives stability in the marketplace, and to co-produce a long-term vision and delivery model to support people to live as independently as possible in their own homes and communities. We work with residents in Wiltshire, as well as with providers and professionals, to co-design care and support which meets people's needs in an empowering and dignified way. We expect any provider that successfully joins the GLA Framework will embrace the ethos of co-production and participate fully in listening to and learning from the diverse voices of people in Wiltshire. 

Living My Life Framework

This commenced in August 2022 for a term of 4 years. The key objectives are customers are able to make an informed choice about the opportunities they wish to take up. There is increased focus on enablement, with day opportunities being focused on a clear purpose and specific, person-centred goals.

Payments to providers

A high-level project group has been established which will continue to develop timely, consistent processes to improve payments. Good progress has already been made, and the Council continues to work with providers on this important issue.

Community and Voluntary Sector (CVS)

  • We are mapping out the services that Wiltshire's VCS provide which could potentially reduce the volume of non-regulated care and support that our current home care providers are delivering to free up capacity within the home care market.
  • We are looking to micro providers and small enterprises to offer a more diverse range of care and support in the community in order to maximise capacity and increase choice and control.
  • We are piloting a strengths-based approach that will take a different approach to how we review people's care and support.
  • We continuously review our use of Direct Payments and PAs to give people more choice and personalisation and will seek to pilot things such as Individual Service Funds (ISF) and Prepayment cards to provide people with greater choice.
  • We are exploring alternative models of care and support. By utilising Technology Enabled Care (TEC) services and through existing pilots, we may seek to replace elements of POCs through the use of TECs, and in turn reduce demand on more traditional services, such as home care and residential placements to promote independence and enabling us to target our workforce resources more effectively over the coming years.

Incentives and new delivery models

The Council and ICB are currently exploring several incentives and options for new delivery models that could help alleviate pressures on the supported living market.

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