Newport Adult Services: Market Position Statement
SOCIAL SERVICES DEPARTMENT
NEWPORT ADULT SERVICES
MARKET POSITION STATEMENT
2014 – 2019
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Newport Adult Services: Market Position Statement
1. INTRODUCTION
This document is aimed at existing and potential providers of adult social care. It represents rt of a dialogue between the Council, people who use services, carers, providers and others, about the vision for the future of local social care markets. We are committed to stimulating a diverse, active market where innovation and energy is encouraged and rewarded and where poor practice is actively discouraged. This is an important role for the Council, and a key part of shaping what kind of place Newport is, namely a place where people with care and support needs, their families and carers, are included and involved in community, economic and social life.
This Market Position Statement (MPS) is designed to be a document containing intelligence, information and analysis of benefit to existing and potential providers of adult social care and support in Newport. It aims to describe current and potential future demand and supply; the funding that we will have available as commissioners; potential demand from people funding their own services; and begins to describe how we would like to work with the social care market going forward.
Providers of adult social care can learn about the council’s intentions as a purchaser of services, and our vision for how services might respond to the personalisation / citizen direction of adult social care and support.
Voluntary and community organisations can learn about future opportunities and what would enable you to build on your knowledge of local needs in order to develop new activities and services.
People interested in local business development and social enterprise can read about new opportunities in the market and tell us what would help them to come into social care markets and offer innovative services. Social care providers and organisations not currently active in Newport could find opportunities to use your strengths and skills to benefit local people and develop your business
Importantly, this Market Position Statement seeks to balance three priorities:
• Stimulate the market to provide a wide choice of innovative flexible services, meeting the Personalisation / Citizen Directed agenda and increasing service user satisfaction.
• Engaging with local, regional and national providers to promote the local economy.
• Delivering efficiencies whilst improving quality.
KEY MESSAGES
Demand for services is increasing People need more from the services they receive People are living longer There are fewer resources to provide meet service user needs
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Newport Adult Services: Market Position Statement
2. DEMAND FOR SERVICES
Using information from Daffodil Needs Projection System, we have summarised some of the key messages relating to the current and likely future of community support needs of adults in Newport.
The population projections for Newport over the next five years are in line with the rest of Wales; it is anticipated that the number of people aged over 65 will increase over the next 5 year, with more people expected to live longer.
In 2013 Newport’s total population aged 18+ was 114,160 (Census 2011). This figure is expected to rise to 119,760 by 2020 (5%).
a) Learning Disability
The number of people estimated to have a learning disability (aged 18+) in 2012 was 2568. This figure is predicted to slightly rise over the next 5 years by around 3%
For the age group 18-24, it is predicted that people with a learning disability will reduce from 382 in 2012 to 338 in 2020 (11%)
It is predicted that there will be an increase in the numbers of people with learning difficulties aged 25-44 and those over 55.
Newport Adults aged 18+ with a learning disability, predicted to display challenging behaviour remains the same.
It is estimated that in 2014, there are 1074 adults aged 18+ with a learning disability and who have an autistic spectrum disorder. This figure is predicted to increase by just under 3% over the next 5 years. b) Disabled People
The number of people aged 35+ who have received treatment for a stroke in 2013 was 2,635. This figure is expected to increase by 9% over the next 5 years.
There are an estimated 58 people aged 18-64 with a severe visual impairment. This figure is expected to increase by 3% over the next 5 years. 753 people are estimated to have a moderate or severe visual impairment in the 65-74 age group which is estimated to increase by 4% over the next 5 years.1,443 people aged 75 and above are estimated to have a moderate or severe visual impairment. This figure is estimated to rise by 12% over the next 5 years.
The number of people, aged 18+, predicted to have moderate to severe hearing impairment in 2013 was 13,854. This figure is expected to increase by 9% over the next 5 years.
The number of people, aged 18+, predicted to have a profound hearing impairment in 2013 was 304. This figure is expected to increase by 11% over the next 5 years.
The number of people aged 65 and over unable to manage at least one mobility activity on their own in 2013 was 4,542. This figure is expected to increase by11% over the next 5 years. Unable to manage at least one activity in this context includes ‘going out of doors and walking down the road, getting up and down stairs, getting around the house on a level area, getting to the toilet, getting in and out of bed.’ The number of people aged 65-69 unable to manage at least one activity is expected to fall by 10% over the next 5 years. The expected increase for people aged 70+ is just under 15% over the next 5 years. c) Adult Mental Health
The number of people (aged 16+) estimated to have any mental health problem in 2013 was 19,125. This figure is expected to increase by 4% over the next 5 years.
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Newport Adult Services: Market Position Statement
It is estimated that there are 35 people with early onset dementia aged 30-64. This figure is expected to increase by over 11% over the next 5 years.
It is estimated that that 12,994 people aged 16-59 currently misuse drugs. This figure is expected to increase by 5% over the next 5 years.
It is estimated that 31,225 people aged 16+ currently binge drink. This figure is expected to increase by just over 3% over the next 5 years. d) Carers
There are 16,212 people providing unpaid care in Newport, representing 14% of Newport’s total population aged 18+ (Census 2011).
As at 2013, 9,248 carers in Newport provide 1-19 hours of unpaid care per week and 2,500 carers in Newport provide 20–49 hours of unpaid care per week.
As at 2013, 4,464 carers in Newport provide 50+ hours of unpaid care per week. Across all age groups.
The number of carers aged 65 and over is predicted to rise by 7% over the next 5 years. e) Older People and Older Mental Health (65+)
There are an estimated 1,707 people aged 65+ with dementia. This figure is predicted to rise by 13% over the next 5 years.
The number of people aged 65 and over who will receive treatment for a stroke is predicted to rise by 10% over the next 5 years.
The number of people aged 65 and over receiving community based services is predicted to rise by 12% over the next 5 years. (Community Based Services refers to homecare, day services, respite, meals on wheels, direct payments, equipment and adaptations and supported accommodation).
The number of people aged 65 and over receiving residential based services is predicted to rise by 14% over the next 5 years.
KEY CHANGES OVER THE NEXT 5 YEARS
The number of people with a Learning Disability in Newport is expected to increase by 3% The number of older people with a severe visual impairment is predicted to increase The number of people predicted to have a profound hearing impairment is predicted to increase The number of people expected to be unable to manage at least one mobility activity is expected to increase, particularly for people aged 70+. The number of people who misuse drugs and binge drink is expected to increase The number of people aged 16+ estimated to have any mental health problem is expected to increase The number of carers aged 65 and over is predicted to rise The number of older people receiving a community based or residential service is expected to significantly increase. The demand for services to older people will increase as the shape of the local and national population changes as a result of advances in medical science meaning more people are living longer. There is predicted to be an increase in chronic conditions based not only on an increasing older population but also on life style choices
This rise in demand will not be matched by Government funding meaning a new approach is needed to how social care and support is delivered.
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Newport Adult Services: Market Position Statement
3. CURRENT AND FUTURE EXPECTATIONS (POLICY CONTEXT)
The key strategic messages from local and national strategies that underpin this Market Position Statement are:
Following consultation with the public, staff, stakeholders and Scrutiny Committee’s improvement objectives in Newport one of the key objectives for Newport is to be a caring city. This includes: • Improving independent living for older people - The council will work with the health service and other partners to develop and deliver preventative models of care and support within the community. • Supporting older people leaving hospital - We want to ensure that people who require social care support do not stay in hospital any longer than is necessary. • Ensuring people have the right social services to meet their needs - By developing more integrated approaches to the management of care and support packages, we aim for more multi-professional involvement in reviewing care plans. (Newport Council’s Improvement Plan 2014/15)
Use clear and accessible information when communicating with people and talk and listen to carers more (Carers Strategies (Wales) Measure 2012)
More resources need to be made available to support people with dementia (Integrated Mental Health Strategy 2011-2016)
Greater collaboration to deliver services and a stronger voice for service users and carers and greater accountability on commissioners and providers (Sustainable Social Services for Wales: A Framework for Action)
Greater use of direct payments, greater collaboration, move to an outcomes approach to regulation and inspection (Social Services and Wellbeing Act)
Changing attitudes, expectation and paying for care
Demand for care and support services in the future will rise but will not be matched by a similar commitment in public spending.
The expectations of people who will reach older age in the next 10 to 20 years will be different to older people now. People are used to expressing far greater choice and control over their needs and aspirations and will expect more from their local authority and care providers in terms of the range and quality of services on offer.
To meet this rising demand and expectation in the social care market, providers will need to respond in ways it might traditionally not have thought of. Demand and funding for long term residential and day care will reduce over time and many older people will want to stay at home for as long as possible.
Prevention and early intervention are well recognised to help people stay well, live independently and remain healthy for longer. It is important to ensure that a wide range of preventative services are available to support people across the spectrum of need, including those who do not approach the Council for support or meet its eligibility criteria. This will ensure that people do not go without the support which could prevent critical needs developing in the future.
Providers will need to consider how to maintain people at home, remaining healthy and with a sense of wellbeing for longer. This means considering how to help people maintain good physical, mental, social, emotional and spiritual wellbeing in order to remain healthy and active now and in the future. People are more likely to be funding elements of their own care and will enter the marketplace requesting information and advice as well as a broad range of services without approaching the local authority.
Therefore there are real opportunities for providers to build the link between involving people in the design of services, offering people the information they need to make informed decisions and offering customers new and diversified products and services to help them remain well at home.
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Newport Adult Services: Market Position Statement
4. CURRENT SUPPLY OF SERVICE
Care homes for Older People
There are 20 cares homes for older persons in Newport in the independent sector and the Local Authority runs 4 residential care homes.
The table below shows the number of care home beds available in Newport by category of care provision.
Residential Nursing EMI Residential EMI Nursing
Number of Beds 247 359 85 38 2009 Number of Beds 229 330 125 133 2014
Difference -18 -29 +40 +95
Demand Down Variable Up Up
The number of residential and nursing beds available in Newport since 2009 has decreased whilst the number of EMI residential and EMI nursing beds has increased. When these figures are compared with the Newport bed vacancy trends, the following conclusions can be drawn:
The number of residential and nursing beds available have decreased over the last 5 years. During the same period the number of vacancies for general nursing care has seen a downward trend with average monthly vacancies being 21. Within the residential category, we have seen fluctuations in vacancies, although the overall trend is that vacancies are increasing with a monthly average of 16 across the period. This suggests that there was previously more supply than demand and this continues to be the case although to a lesser extent.
The number of EMI residential and EMI nursing beds available has increased over the 5 year period 2009 to 2014. This is as a result of some homes increasing their supply of EMI bed provision and a number of new homes opening that offer EMI care provision.
The number of EMI nursing beds have increased significantly (+250%); despite this, the vacancy trend has decreased over this period with average vacancies being around 5 monthly. This suggests that there is still an extremely high demand for this type of category and that more supply is needed within the market.
The number of EMI residential beds available has increased by 47% over the 5 year period. Vacancies for this care category have remained consistent with average monthly vacancies of 3 beds. This suggests relatively high demand for EMI residential provision with current numbers of beds being sufficient, although it is expected that demand will continue to increase.
Newport has pre-purchase arrangements in place with 20 privately owned care homes (offering a total potential of 693 available beds) which allows the Council to purchase nursing and residential beds on an individual spot contract basis, with no guarantee of business to these providers. Other purchasers (such as the NHS, other local authorities or people funding their own care) are able to obtain beds in these care homes, which can have implications for the availability of care home beds to the authority.
In addition, Newport runs 3 residential care homes which offer a total of 99 beds.
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Newport Adult Services: Market Position Statement
The breakdown of beds available is shown below:
EMI Residential Nursing EMI Nursing TOTAL Residential
Independent Sector 160 330 70 133 693
Local Authority 54 0 45 0 99
TOTAL 214 330 115 133 792
Until December 2011, Newport commissioned 2 residential respite beds for older persons as a block contract. This service was decommissioned due to lack of demand for the service. Throughout 2014, particularly the summer period, there has been increasing demand for residential respite for older persons.
The Council currently commission 221 (39%) of available care beds in Newport, in both the independent sector and internal homes. 10% of available beds are currently vacant, with the remaining beds either commissioned by Aneurin Bevan University Health Board - for people with Continuing Healthcare Need, other local authorities or are purchased privately by individuals (self-funders).
In addition to older persons beds purchased by the Council within the Newport area, a further 51 beds are purchased across the greater Gwent area and 8 beds outside of Gwent but still in Wales. A further 20 beds are purchased in England and 1 bed in Scotland.
Two homes have closed since 2009; one being as a result of the Council and ABUHB terminating its pre purchase contract due to poor performance, the other home has since re-opened. In addition, one EMI residential home has opened in the Newport area.
Placements for Adults with Learning Disabilities
This service is provided by the private sector. There are 13 providers supporting adults with learning disabilities in a residential support setting across Newport. These 13 providers offer a mix of residential and housing with support. There are 128 placements of this type available with the majority of service users being in a long term placement.
Newport City Council currently has 2 block contracts in place for adults with learning disabilities providing specialist autistic accommodation and support.
Short Breaks / Respite
There are currently 2 residential respite facilities, for people with learning disabilities, within Newport, one provided in-house and one where support is provided by an independent sector provider.
The Council is currently undertaking a review of respite provision and proposals/options for alternative service delivery and will be undertaking a benchmarking exercise, using internal and external data, both financial and non-financial. It is proposed to establish a framework of providers who are able to provide short breaks and holidays.
The Council is considering longer term options for children in transition to adult services; there are more people with physical disabilities and there will be a need for accessible spaces for more people in the future. The main drivers are improving options and flexibility for service users and the council is working through options for a specifically designed new build.
The respite/ short break services need to be modernised and new tenders are being proposed with a framework of holiday provisions and different service models for respite. A redesigned respite service will need to act as a hub for holidays and short breaks. The service will need to know service users well in order to help facilitate opportunities whether they be traditional respite, holidays or short breaks. This will enable
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Newport Adult Services: Market Position Statement better outcomes for service users and meet developing aspirations and the support provider(s) will be key to this.
Domiciliary Care Provision
In 2011, Newport completed a tendering process where block contracts were set up with five domiciliary care providers. Each block contract is for a total of 8% of the total domiciliary care market (40% overall total). The remaining 60% of the market is commissioned on a spot purchase arrangement with seven approved providers plus four of the block contract providers. Under this arrangement, no provider should be providing for more than 16% of the total market.
There is an additional block contract with one provider, providing domiciliary support across three sheltered care schemes.
As well as those providers on the approved providers list, the council also spot contracts with six Tier 4 providers who have been vetted but are not on the approved list as they came into the market after the tendering process had been completed. Tier 4 providers are used where there is no capacity within the approved providers list.
The allocation of domiciliary support hours is managed by our in- house brokerage system.
Domiciliary care in extra care schemes is provided by the Council in-house service and is shown here as a discrete area of business.
The table below provides an illustration of domiciliary care activity in the independent sector within Newport comparing the calendar years 2006, 2009, 2012 and 2014.
2006 2009 2012 2014
No. of Service Users 573 695 717 777
Hours per week 4689 5628 6526 9047
Average weekly Hours per Service User 8.2 8.1 9.1 11.6
% increase % increase % increase 2006 to 2014 2009 to 2014 2012 to 2014 No. of Service Users 36% 12% 8%
Hours per week 93% 61% 39%
Average weekly Hours per Service User 41% 43% 27%
The number of people using domiciliary care services have increased by 36% from 2006 until 2014
The number of hours of domiciliary care has increased by 93% from 2006 until 2014.
The average number of hours delivered to service users across domiciliary care services has increased from 8.2 weekly hours in 2006 to 11.6 weekly hours in 2014, indicative of the higher needs and greater complexity of care packages of people receiving domiciliary care services within the community.
People living in Lliswerry (500+ weekly hours) and Rogerstone (400+ weekly hours) have the highest number of hours per week of domiciliary care delivered with Victoria ( <100 weekly hours) and Marshfield (<50 weekly hours) having the lowest number.
The demand for domiciliary care remains very high and is increasing. This is likely to remain the case in the medium and longer term, reflecting people’s preferences to remain in their own homes.
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Newport Adult Services: Market Position Statement
Services in the Community
Whilst there has been some development such as the Frailty model, the majority of services are the more traditional and often building based. Domiciliary care, while being of a good standard, still needs to move to a universal programme of reablement and day care needs to move from building based to a more community based and inclusive day service. There are good examples of day services in the community, one being is a coffee shop in Belle Vue Park which is run by people with learning disabilities.
Extra Care Provision
There are 4 Extra Care schemes which are owned and managed by Linc Cymru Housing Association. Supporting People provide funding for housing related support and domiciliary care is provided by Newport City Council.
The provision of care within the Extra Care schemes will remain within Newport City Council and staff providing this service will continue to be employed by the Council. We will be working to update the management agreement with Linc Cymru and to ensure that the constructive partnership that has existed between us since the launch of Wales’ first Extra Care scheme continues. We will also be seeking to establish regular communication between the Council, Linc Cymru and the tenants.
The Council is also considering how we develop the ‘community’ team so that we can support people to continue to live independently within their own homes. Throughout 2014, we will set out the structure for the future homecare service that will promote reablement. In doing this we will review the staffing structure of the remaining community, CIT and PILS Teams, seeking to create one joined up team.
Telecare
Telecare helps people, especially older and more vulnerable individuals, to live independently and safely in their own home. It includes services that incorporate personal and environmental sensors in the home, and remotely, that enable people to remain safe and independent in their own home for longer (DOH 2012). The equipment can sense risks such as smoke, floods and gas, can remind a person to take medication and assists in calling for help after a fall. It provides reassurance to carers and families as well as the person maintaining their independence.
For those assessed by a social care assessor, telecare will be considered for every care package including those already in place. As of May 2013, there were 410 recipients of telecare with a target of doubling this number in 2013/14.
Equipment
Equipment or aids to daily living are issued by health and social services staff, with the supply managed by Vision Products which is based in Newport and is a joint venture between 6 local authorities and the Aneurin Bevan Health Board.
There are also a variety of local businesses, including Vision products, which give advice and sell equipment to people who do not meet the eligibility criteria. Use of the criteria is inconsistent at the moment but this will be rectified to provide an equitable service regardless of point of entry.
GWICES (Gwent Wide Integrated Community Equipment Service) provides a community equipment service across the five ‘greater Gwent’ local authority areas and the ABHB.
Frailty
Frailty is a joint venture between Health, Adult Services and Voluntary agencies; it was launched in April 2011 to provide a service to “frail” people of all ages so that they can retain or regain life skills to maintain their independence, health and wellbeing.
Currently referrals are received from GP’s, therapists within the hospital and social workers. They have access to a range of medical interventions, physiotherapy, occupational therapy, social work assessment and reablement.
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Newport Adult Services: Market Position Statement
The service is available for up to 6 weeks to maximise a person’s independence so that ideally no on-going support is needed. However, at times, long term care and support may be needed following a period of reablement but the level of care has been reduced. There is no charge for up to the first 6 weeks but care and support from then on is subject to the charging policy.
Frailty helps prevent hospital admissions and facilitates timely discharges from hospital.
We would like providers to support us in this reablement model.
Working with a reablement ethos to enable independence Consistency of carers and care Flexible and integrated care and support provision to achieve service user outcomes Workforce development, including contribution to assessments and reviews in order to better respond to service user needs Connecting service users with wider community opportunities Staff training and development of services to respond to the increasing numbers of people with dementia Transport and simple pricing structure
Older People (Community Based Care)
Care and repair deliver a care and Safety at home and the Rapid Response Adaptations programme (RRAP). The service enables small adaptations to be carried out to prevent admission to hospital and the RRAP scheme deals with early discharge from hospital. The service is funded by a variety of sources including the Welsh Government with the objective of enabling independence. The organisation has seen an increase in the number of service requests in the last three years by approximately 20%. It was noted that the average age of services users is somewhere between 75 and 78 years old and the trend is that service users are getting older.
Respite Care – Older Persons
Until December 2011, Newport commissioned 7 residential respite beds for older persons as a block contract. This service was decommissioned due to lack of demand for the service. Throughout 2014, particularly the summer period, there has been increasing demand for residential respite for older persons.
Two of the Council’s own homes offer residential respite beds for older persons.
Respite care is currently spot purchased within the independent sector.
Direct Payments
Throughout 2012/13, the direct payments support service provided support to 133 individuals. As at June 2014, 160 people were in receipt of a direct payment; this shows an increase of 20% of Direct Payment service users
The number of people accessing a direct payment can be seen in the graph below:
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Newport Adult Services: Market Position Statement
60 Number of People Accessing Direct Payments 55 52 49 50 47
43 2012/13
40 2013/14
30 30
20
10 8 7
1 1 0 Older People Children & Families Learning Disability Mental Health - Mental Health - Adults Older Persons
Physical Disability
1. Sight Support are commissioned to employ a Rehab worker to support visually impaired people to enable them to maintain or develop independence in the community and improve their quality of life by, the assessment for and provision of rehabilitation training for mobility, communication and independent living skills for visually impaired people, provision of aids and other associated support in order to enable service users to be as independent as possible.
2. Sight support are also commissioned to provide a range of community based services to people with a visual impairment including a social club, walking club and younger persons group. Demand for these services remains constant. In addition, Sight Support provides a range of support services including a ring-a-round club, contact service for newly registered blind people and a part time welfare benefits advisor.
3. The Council provides a small amount of funding to and Vision in Wales and Wales Council for the Deaf to promote the welfare of those people with a visual impairment and /or who have hearing disabilities.
Learning Disability
The Strategic Review of Placements for Adults with Learning Disabilities led to an Accommodation Strategy, which has developed a step-down model of accommodation for people with learning disabilities. The model envisages that those with the most complex needs and / or behaviour that challenges will be accommodated in specialist residential provision.
The next tier of service user need will be met by specialist supported living provision, with a further tier of support need leading into independent living.
This model recognises that we want to commission services that are flexible, that will promote independence and that are not necessarily for life. To achieve this, we need providers who can demonstrate a flexible and innovative approach and who can work with service users to help them reach targeted outcomes.
Newport City Council currently has 3 block contracts in place for adults with learning disabilities. Two of these are for specialist autistic accommodation and support, with the other service being residential respite.
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Newport Adult Services: Market Position Statement
At present, the Council is unlikely to commit to any additional block contracts, due to the inflexibility that can be a feature of them.
The Council is committed to regional collaboration and to the work of the SEWIC brokerage process. We will also look for opportunities for regional collaboration where appropriate, particularly if there are specific niche areas where we and other authorities are struggling to meet need. More work needs to be done at a regional level to identify where there are such areas of mutual needs arising from deficits in service levels.
The reliance of residential respite for people with learning disability is obvious; there are opportunities here to develop more innovative forms of respite that will meet the needs of the person as well as the carers.
Deputyships / Appointeeships
Newport City Council provides an in-house appointeeship service for 117 people with mental health or learning disabilities who are unable to manage their benefits. There are also approx. 20 people on the waiting list for the service.
The Appointeeships are split into:
45 Adults under 65 years of age who have mental health problems, this includes the Community Mental Health Team, Assertive Outreach Team and the Forensic team. Within that figure there are a number of Vulnerable adult referrals from the Review team. The majority of the more recent cases have in the majority been POVA related, involving financial abuse /Exploitation of vulnerable adults.
26 Adults over the age of 65 with mental health problems, usually dementia.
46 Adults with Learning Disabilities.
At the moment this is not a chargeable service.
The Welfare Reform Act will have an impact on the team, the full extent is not clear as yet.
Services for Carers
1. Crossroads provides a carers information and advice service which is based in Newport market. The service aims to ensure that unpaid carers in Newport have access to accurate, appropriate information about their rights and entitlements and the support that is available to them and to assist them in exercising their rights. The number of service users supported doubled throughout 2013/14.
2. There are a number of commissioned services within the voluntary sector providing respite service for carers, including drop in facilities and outreach support.
3. Crossroads provide respite to unpaid carers where the cared-for require additional supervision due to their frailty or disability. Throughout 2012/13, crossroads provided 8,400 hours of respite and 725 hours of respite to people with a mental health problem. In addition to planned respite, Crossroads also provides an emergency response service; there are currently 217 people registered for the emergency response service and the service provides around 1,100 hours of care annually.
4. Age Cymru provide a range of services including respite for carers. Throughout 2013/14, Age Cymru provided 2,443 hours of respite and 1871 hours of respite to people with a mental health problem.
5. Age Cymru provides a domestic support service for around 34 carers. Although the service average is 40 hours weekly, the service is currently at capacity with 42 hours allocated to service users and there is a small waiting list.
Mental Health and Older Mental Health
1. The Alzheimer’s Society provides a befriending service across the Gwent area, supporting around 200 individuals in 2013/13 with 6,282 hours of support. There is on average 47 people on the waiting list for a befriender, some of whom receive other community based services.
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Newport Adult Services: Market Position Statement
2. Newport Mind are commissioned to provide a drop in service 7 days per week; the service offers a women’s group, Asian women's group, activity groups/courses, wellbeing Groups, welfare benefits advice service; specialist support. Women in Mind with an average of 40 active service users weekly over 3 days and the wellbeing group supports an average of 70 active service users per week with demand is increasing. Mind also provides an outreach support service with around 13 service users on average being seen per week.
3. Hafal provides a resource centre for carers of people with serious mental health problems, offering 20 hours of support weekly to an average of 25 services users per month. Hafal also provide an outreach support service offering 21 hours of support weekly to an average of 12 service users per month. Demand for the service remains consistent.
4. Crossroads and Age Cymru are commissioned to provide respite services to people with a mental health problem. Demand for both services remains consistent.
5. Growing Space are commissioned to provide a day service to rehabilitate people with mental health difficulties and enhance the quality of their lives through accredited training opportunities in horticulture, woodwork and vocational routes, therapeutic support, volunteering opportunities, and meaningful work experience. The service provides a garden clearance and maintenance scheme for Newport City Council tenants who are elderly and disabled. Staff also provide informal support and advice including benefits as part of the rehabilitative process. The number of service users entering the service has increased by approximately 8% over the last twelve months; new referrals have increased by 10% over the last twelve months.
Advocacy
There are 2 commissioned advocacy services for adults in Newport:
A learning disability advocacy service is commissioned with Dewis, CIL, a third sector organisation. Over the last 18 months the number of service users in receipt of an advocacy service has increased significantly. Currently there is an average caseload of 30 service users receiving advocacy support. Where advocacy support exceeds hours expected under the contract, additional support will be spot purchased. This arrangement will remain in place until further work on a Gwent wide advocacy service for people with a learning disability is developed.
Age Cymru Gwent is commissioned to provide 30 hours of advocacy support hours per week to older persons over the age of 50 years who have experienced a significant change in their circumstances. Currently there are 2 caseworkers supporting approximately 10 service users each at any one time. The service has developed strong links with the all Wales Advocacy Network reporting key information which is cascaded to Welsh Government and has worked closely with the Older Persons Commissioner. Support over the last year has included instructed and non-instructed advocacy to enable service users to make informed choices relating to their housing/accommodation needs, hospital discharge, care planning, finances, divorce, power of attorney and residential/nursing care placement.
Newport People First provide advocacy support by raising awareness of and campaigning for the rights of people with learning disabilities and to support self-advocacy groups.
Demand for Advocacy support relating to safeguarding and POVA issues has significantly increased over the last 6 months due to the current economic climate and the welfare reform act. This has had a considerable impact on the capacity of the service increasing case support hours by approximately 30%. Newport council is committed to provide independent advocacy support for vulnerable people in line with the Older Persons Commission Framework for Action 2013-17.
Day Services
Day care is predominantly building based with community alternatives being developed with people with learning disabilities but is open to development for all other categories.
Newport City Council has identified day and respite services as an area for a strategic review into promoting independence and choice which will lead to the transformation of day and respite opportunities.
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Newport Adult Services: Market Position Statement
The Council is reviewing the way it provides services and the approved list of Day Care Services suppliers established through this exercise may be used to determine a framework, dynamic purchasing system or contract in the future.
KEY CHANGES OVER THE NEXT 5 YEARS
The number of residential and nursing beds available in Newport since 2009 have decreased, whilst the number of EMI residential and EMI nursing beds have increased. The number of hours of domiciliary care commissioned in the independent sector has increased by 93% between 2006 and 20014 while the number of service users has increased by 36% over the same period. This demonstrates higher needs and increasing complexity of care packages which require more support. Referrals for minor home adaptations have increased by 20% over the last 3 years. It is anticipated that demand for telecare services will increase. The number of services users receiving a direct payment is increasing year on year. Demand for respite services for carers has remained constant. Demand for mental health drop in services and older mental health befriender services remains consistent. Whilst demand for day services remains strong, there is an emphasis to support people access community based activities.
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Newport Adult Services: Market Position Statement
5. QUALITY OF CURRENT PROVISION
Contract Compliance, Complaints and POVA referrals
Commissioned services undergo a contract compliance process on an annual basis to ensure that services meet people’s needs. During the period 2013/2014 the Commissioning and Contracts Team undertook 72 contract compliance visits to domiciliary care providers, supported living schemes and care homes.
In this period 156 complaints were investigated with improvement actions being taken in some cases. Of the total number of complaints received there were 49 identified as Protection of Vulnerable Adult cases and investigated in co-operation with the POVA team.
Domiciliary Care
The majority of domiciliary care in Newport is provided by the independent sector. During 2013/2014 there were 19 contract compliance visits carried out to domiciliary care providers. Using contract compliance as an indicator of the quality the 2013/2014 process highlighted that there were shortfalls in the range of contract areas that were tested, in particular improvements were required in training, quality assurance, continuity of care and timekeeping.
The Commissioning and Contracts Team received 94 provider issues regarding domiciliary care services during the 2013/2014 period. The issues raised were mainly regarding timekeeping, continuity of staff and calls being missed.
The Commissioning and Contracts Team also undertook a domiciliary care survey on behalf of the Carers Forum. A questionnaire was distributed to each service user; the results were analysed and showed that generally, responses were very positive, although there are a few areas of concern which will be taken forward with providers during routine contract compliance visits.
In particular areas which will be taken forward include that all service users should receive a copy of the Service User Guide and that they should explain exactly what documents are left with service users for their information, training will be explored with providers, particularly around use of personal aids, the completion of accurate daily records, how providers can improve continuity of care staff, introduction of new staff to service users prior to them providing care and support, ensuring providers effectively communicate with service users regarding the planned rota and any changes to the rota, provision of rotas be provided where requested, staff to be reminded the dangers of cross infection and of the need to change PPE between care tasks, ensuring that an appropriate dress code is followed at all times particularly the wearing of jewellery, ensuring that providers conduct an audit of their policies regarding financial processes and ensure that staff are aware of these and adhere to them at all times, ensure that spot checks of staff are carried out on a regular basis as part of their quality assurance programme, providers ensure a copy of their complaints procedure is given to ALL services users and that service users are kept informed of their complaint throughout the entire process.
Care Homes
Most care home provision in Newport is provided by the independent sector, with three residential homes being owned and managed by the authority.
There were 18 contract compliance visits to homes owned by the independent sector and a contract compliance visit undertaken to each of the authority’s owned homes during the 2013/2014 period. Where possible, contract compliance visits to nursing homes were carried out in partnership with ABUHB health professionals. Using contract compliance as an indicator of quality for the 2013/2014 period for residential and nursing homes provided by the independent sector, the process highlighted that improvements were required in the following areas that were tested: policies and procedures, induction, supervision and annual appraisals, accident and incident reporting and quality assurance.
There were examples of good practice found in many of the establishments reviewed which included: the interaction and knowledge of staff with residents and care planning which reflects the authority’s assessed care plan.
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Newport Adult Services: Market Position Statement
Supported Living
Supported living is provided by a mix of private and public sector provision.
The Commissioning and Contracts Team undertook 31 contract compliance visits to supported living schemes, and where appropriate their registered office, during the 2013/2014 period.
Using contract compliance as an indicator this provider group performed to a good standard but with additional improvement required to increase compliance in the areas service user file documentation, risk assessments, accident recording, policy review, business continuity, internal quality reviews and staff supervision. There were examples of good practice identified in the interaction between support staff and service users, activity programming to suit individual needs and individual wishes and goals.
KEY POINTS
The majority of concerns regarding domiciliary care providers relate to issues regarding timekeeping, continuity of staff and calls being missed. the process highlighted that improvements were required in the following areas that were tested: policies and The main issues for residential and nursing homes were around procedures; induction, supervision and annual appraisals; accident & incident reporting and quality assurance. Generally supported living providers were of a good standard.
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Newport Adult Services: Market Position Statement
6. LOCAL AUTHORITY FUNDING
Whilst most social care in Wales is provided by private and voluntary sector organisation, it is generally funded from the public purse. As it is a public service for Wales, we expect it to be based on Welsh public service values (Sustainable Social Services: A Framework for Action 2013). The June 2013 spending review by the UK Government changed the entire basis of future financial planning, meaning that additional austerity measures will likely remain a long term feature of public services.
Breakdown of our expenditure in 2013/2014
5% 3%1% 8%
Physical Disabilities Mental Health Needs Learning Disability
37% Older Persons 46% Other Adults Voluntary Sector
Over the next 4 years, Newport City Council needs to make savings of around £25 million including nearly £10 million in 2014/15. Newport City Council has published its proposals to address the shortfall from its 2014/15 budget as it faces up to the pressures of government funding cuts.
The bulk of the savings are to come from reductions to services, increases to fees and charges, reduction in staffing and changes to the way some services are delivered. In social Care we expect the following changes/ developments:
Commissioning on a collaborative basis Continued work with providers to reduce costs/fees Further review of learning disability packages Review eligibility of services Managed demand on residential and nursing placements Review of voluntary sector contracts, ensuring they are fit for the future and offer value for money Review of respite and short break services Review of double handed calls and reablement service
Fee Modelling We have previously undertaken a Fees Project with Care Home providers for older persons, in conjunction with Torfaen County Borough Council. The purpose of the project was to better understand care home provider costs and to improve quality across the sector. This work remains ongoing with further consideration given to improving quality and looking at ways to remodel care home provision to account for the increasing demand for short term reablement and respite care.
KEY FINANCE POINTS
There is going to be less funding available for services over the next 5 years. At the same time demand for services is increasing. More services are likely to be commissioned on a collaborative basis The majority of the social care budget is spent on older people and people with a learning disability
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Newport Adult Services: Market Position Statement
7. FUTURE MARKET OPPORTUNITIES
a) Commissioning – Commercial Arrangements
The Council will be introducing a range of commercial processes and contract types to deliver services using different supply models. Everything the Council does will be transparent, competitive and auditable. We will improve the way we performance manage providers and our providers must be willing and enthusiastic participants in the continuous improvement agenda.
By 2017 we will use the developed council wide commissioning framework to guide activity across the organisation and we will demonstrate impact on market development.
Change Programmes
• Commissioning Strategy – we will set out clearly how far the city-council intends to commission services externally and/or provide services through its own workforce.
• Commissioning framework – drawing from national guidance we will develop a council wide approach to commissioning with clear guidance for setting outcomes, analysing need, and strategies for analysing and managing the market, designing service specifications, de-commissioning and procuring new services.
• Identify and evaluate alternative arrangements to council provision this will include considerations around, Trusts, Trading companies, joint ventures, community based ownership, social enterprises and outsourcing.
As the role of the Council becomes increasingly that of a commissioner, rather than provider of services, it will be vital for providers to: Understand commissioning and procurement Have a working knowledge of contract law, or have connections with qualified/appropriate support agencies Understand the benefits and risks of bidding as part of a consortium and other types of provider groups Be conversant with the tender process - understand what the local authority is evaluating Understand outcome based specifications Understand the implications of different forms of contract.
It will be vital for providers, including voluntary sector organisations, to consider sharing back office facilities and other skills to reduce avoidable costs.
In response to Government cuts and policy change, Newport City Council is likely to buy less of some services and more of others. Providers need to keep up to date with changes in their market and respond to these.
Newport City Council will signal what information it can but much of the change in demand is expected to be driven by the Personalisation / Citizen Directed Agenda, that is, directly by customers.
In summary providers will need to be flexible and adapt to changing demands.
b) Collaboration/Regionalisation
In 2013 we have begun to make steps towards collaboration with other public bodies, mainly with our neighbouring local authorities and health. Regionalisation is being discussed at a national level and we want to put Newport City Council in a prime position to lead service delivery across Gwent where appropriate.
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Newport Adult Services: Market Position Statement
By 2017 collaboration across the public sector will be our accepted way of doing things with our key strategic partners and our preferred operating model for all service delivery. Regionalisation will be firmly established through the outcomes of the public services commission and we will be working to put the newly established local government footprint into place.
We will need to take full account of all other methods of service delivery and establish those which represent the best outcomes for the council
Adult Services
Current Situation
Adult Services provide a statutory assessment function and provide services to safeguard adults who have eligible needs. We currently provide services to 3033 adults (2% of the population) and have an annual spend of £42m delivered by 570 FTE staff.
Services provided to adults in need include home care, day services, respite and residential services. Currently the Council directly delivers 22% of services and purchases the remaining support from the private and voluntary sector.
Position by 2017
By 2017 demand for services will significantly increase as a result of demographic and social changes, along with advances in healthcare which will mean that there will be more individuals living with more complex needs in our community. In addition, The Social Services and Wellbeing Bill will impact towards 2017 by increasing the number and range of people eligible for services.
In order to meet these increasing demands we will need to develop a broader range of services that prevents or delays the need for ‘formal’ care and support services by promoting wellbeing and strengthening the capacity of individuals, families and communities to care for themselves.
How we get there?
The service plans two key change programmes:
A programme of strategic commissioning service reviews
− Developing a joint commissioning strategy − Decommissioning acute provision and commissioning new outcome focussed and evidence based early intervention and prevention services. − Increasing use of technological solutions − Commissioning and procuring for outcomes.
Building community capacity
− Developing capacity for supporting community led solutions to promote citizen wellbeing − Information, advice and assistance for people with moderate needs − Offering people greater choice about how their needs are met, with new types of providers delivering new types of services. Empowering individuals to manage their own support needs and reduce reliance on ‘formal’ services.
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Newport Adult Services: Market Position Statement
8. FACILITATIING THE MARKET
Reviewing the evidence Delivering change People have higher expectations and want care NCC will seek to do business with providers who can provided flexibly in a way that supports their family demonstrate their ability to offer high quality care and and social life, rather than having to organise their support, underpinned by person-centred values and life around care services. approaches whilst offering value for money.
We also know that satisfaction with good quality, Service users report that what matters most is the skilled and appropriately trained staff as well as quality and consistency of the individual providing consistency of care / care worker wherever possible the care and support. is important. NCC will want to work collaboratively with providers to diversify the level of competence and range of duties that care / support workers can provide to meet the rising demand for home-based services and ensure a reablement approach.
Demographic growth means that the current pattern The market will need to be ready to respond to of services and investment is unsustainable and will budgetary pressures that are being faced nationally. not be matched by public funding. This may mean providers being able to offer sustainable value for money and quality services at a lower cost regardless of whether service users are spending their own or allocated funding.
NCC will be keen to do business with flexible providers who can demonstrate that their services are able to diversify into related area of provision.
The number of people requiring home support is NCC will want to do business with providers that increasing, however we see this rising demand will encourage people to become independent again or be met by people being supported by short term require less intensive methods of support and who reablement / intervention rather than relying on put people in touch with local organisations to help longer term support. them maintain that independence.
Support planning and brokerage will take a new shape as both in-house and independent organisations will take on this role for Service Users.
The aim will be to broker short term packages of care and support, with the focus on reablement rather than setting up longer term packages of care.
The Council in its commissioning approach will move towards a model of outcome based commissioning and performance management that can deliver greater flexibility rather than the former block contracting of services.
Higher eligibility thresholds for local authority funding People who do not require the local authority to fund could lead to an increased number of people funding their care should still benefit from improved health their own care. and social care information and expertise regarding, e.g., the alternatives to care homes, in assessing needs, maximising independence, managing risks and supporting Carers.
People want more choice and flexibility over how NCC will want to develop Citizen Directed Support / their needs are met, regardless of who is funding the Direct Payments so that people can manage their
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Newport Adult Services: Market Position Statement
Reviewing the evidence Delivering change support. own care and have more choice in provision, e.g. shopping service, handy person and transport.
The number of people with a moderate to severe We will work with providers to ensure that the needs hearing impairment is predicted to increase is of people are met within existing services by expected to increase substantially. Numbers of ensuring appropriate training for staff around sensory people with a profound hearing impairment are also disabilities. expected to increase/
The number of older people receiving a community* We will continue to work with the independent sector based or residential service is expected to increase: care home providers to promote the need for additional EMI residential and nursing beds. *home care, day services, respite, direct payments, equipment and adaptations and supported We will also review domiciliary care services and accommodation look to consolidate block and spot contracting purchasing arrangements under a dynamic purchasing system.
We will continue to review short break provision with the aim to increase service user choice.
Some service users who are currently eligible for internal Day Care services will not be and the Council will provide support by signposting these service users to approved suppliers on their website and through consultation. Therefore, the Council wishes to commission an approved list of suppliers who can provide Day Care Services to adults (aged 18 plus) i.e. older people, those with Learning Disabilities and Mental Health issues; for signposting.
The number of carers aged 65 and over is predicted The projections indicate that we will see increasing to increase. Surveys indicate that service users and numbers of carers aged 65 and over, however at the carers want a wider range of alternatives to the moment the number of referrals received by the existing, often building based, forms of care, respite Authority has decreased. We will continue to work or intervention. with the voluntary sector to meet demands and to access grant funding to help provide services to carers.
There is recognition of the need to support carers. With increasing numbers of older people, there are clear social and economic benefits to enabling carers to continue in their caring role. We will continue to work with the voluntary sector to meet demands and support those people providing a caring role.
We will be looking for providers to work flexibly to provide a range of options for e.g., day opportunities for working age adults, respite and alternatives for young adults coming through transition.
The number of people who are estimated to misuse We would see most peoples’ needs continuing to be drugs and binge drink are expected to increase. met within existing services.
The number of people expected to be unable to To enable this group to continue to live at home for manage at least one mobility activity is expected to as long as possible we will work with the increase, particularly for people aged 70+. independent sector care home providers to provide an enabling domiciliary support service.
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Newport Adult Services: Market Position Statement
Reviewing the evidence Delivering change We will also review domiciliary care services and look to consolidate block and spot contracting purchasing arrangements under a dynamic purchasing system.
The number of people aged 16+ estimated to have We will look to support more people at the primary any mental health problem is expected to increase, care level, developing the non-statutory front end with a strong demand continuing for community services. In partnership with ABUHB, the other based mental health services. Gwent local authorities and the voluntary sector. We will be reviewing our current services in order to improve the co-ordination and best value of services.
There is predicted to be an increase in chronic We will work with ABUHB and providers to ensure conditions based not only on an increasing older that the needs of people are met within existing population but also on life style choices. services by ensuring appropriate training for staff around chronic conditions.
We will embrace the use of telemedicine to enhance the lives of people with chronic conditions in partnership with the ABUHB.
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Newport Adult Services: Market Position Statement
9. CONCLUSION
Local authorities across Wales will continue to shift away from providing services and move towards a role which focuses more on assessing overall need within a locality and ensuring there is sufficient and appropriate care available to meet these needs. Individuals will increasingly have control over purchasing their own services, using direct payments. There will likely be a steady decrease in block contracting arrangements over the next 5 years.
We are facing an unprecedented challenge – significantly reducing resources combined with increasing demand for, and expectations of public services. Over the next 5 years and beyond, the Council will find itself facing the challenges of reductions in the availability of funding, increasing asset depreciation and liabilities, the impact of increasing deprivation, new legislation, increases in population and environmental sustainability. However, there are also opportunities for greater collaboration with our partners. A key challenge will be to work with practitioners and the public in a co-productive way whereby public services will be delivered in an equal and reciprocal relationship between professionals, people using services and their families. This will help the Council to continue to deliver services for the most vulnerable people within an increasingly difficult financial climate.
There has been an impact on local social care providers who have had to face budget restrictions and re- design services to meet new priorities, the modernisation agenda and increased demand for services.
In line with the Welsh Government’s policy, Newport’s direction will be to continue to deliver enabling support with the intention to reduce the long term input of social care by promoting independence and community living and enabling people to live safe and fulfilled lives.
Dedicated work continues to focus on high cost placements in Adult Services. We have ensured that independence is better promoted and have amended support packages to reflect this. Contract rates have been re-negotiated and this work is ongoing. Efficiencies are being examined by ensuring that needs are being reviewed in a way that maximises independence. This has been achieved through partnership working with our service users, their families, front line operational staff and service providers.
The pressures facing Adult Services are increasing; there is ever increasing demand for support together with diminishing budgets which will focus our efforts in looking for creative solutions, working in collaboration where this adds value. We recognise that we may have to reduce our aspirations during the difficult financial climate and austerity measures being imposed by central government. However, the primary focus will be to safeguard and support the most vulnerable in our community whilst improving independent living.
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