Ensuring sufficient capacity in local services to meet demand
Our market
We know that the social care marketplace in West Sussex is pressured and there is not always sufficiency in all service provisions to meet levels of current demand. This is most acutely being experienced in services for people with learning disabilities, autism and mental health issues. A piece of work is underway to ensure we have adequate oversight of people who are placed out of the county.
Our strategic ambition is to support a greater proportion of people at ‘home’ rather than a residential-based service. To support this, we have begun the delivery of a programme of work called market development commissioning, with increased resource investment, which is looking at working in partnership with service providers to examine the current mix of services and explore opportunities to develop existing services or create new ones. Through market development a number of providers are working in partnership with the Council to look at existing models of service, whilst reviewing the individual needs of customers. This programme is showing positive outcomes with productive market engagement, interest from developers and active and positive change for individuals. Since the start of the programme we have developed a strategic outline business case focusing on developing land and assets in West Sussex to increase adult care provision, increased the number of providers on our supported living framework by 20%, we are working with 7 current residential homes to re-model to provide supported living schemes and we have 22 supported living/residential new services open or in mobilisation.
We also provide residential, day care and Shared Lives opportunities through our Directly Provided Services (DPS). It is planned to use DHSC Accelerating Reform Fund monies to expand the Shared Lives Carers Scheme across Sussex. A review of the DPS has been undertaken to ensure that we are effectively using our resources and addressing gaps in service provision. We will be looking at recommissioning our Supported Living Framework to address shortfalls and gaps in current commissioning arrangements to support the market to develop the services that are required.
In January 2024 the council launched a tender to change the way in which Day Opportunities are experienced in West Sussex. The tender included an evaluation question that was scored by people with lived experience of attending day opportunities for people with a learning disability. The new services went live on 1st July 2024 and focus on strengths-based approaches to supporting people to be part of their local community and to be supported into volunteering and work opportunities where appropriate. The new service is outcome focused, and providers are being asked to demonstrate the value of the service and the extent to which support is accessible to diverse communities across the county, improve the lives of people by providing safe, accessible services that support people to stay mentally and physically well. The outcome framework has been co-produced with the service providers such as Aldingbourne Country Centre to ensure we are able to accurately understand and demonstrate customers achievements.
The services that are commissioned under this contract will have demonstrated that they are able to deliver a responsive and strengths-based support offer focused on individual need and deliver a diverse range of support options to meet the varied needs of people. There is a focus on promoting independence and enabling people who use the service to increase their levels of social inclusion. The new offer will incorporate what is available to support people in the communities they are part of, and providers will develop and maintain effective working relationships with, families/carers, partner services, commissioners and the communities they are part of.
Our recently published Extra Care MPS details the Council’s ambition to further develop Extra Care services as a key mechanism to supporting all adults (including those with a learning disability, mental health need, or older people) to retain and maintain levels of independence and avoid or delay the need for residential based care. The Council currently supports 17 Extra Care schemes (749 units) in West Sussex but has the strategic ambition of supporting up to 20 new schemes (1,215 units) to allow a greater proportion of people to be supported by these services.
The market for older people’s services is more stable in comparison and we are more able to secure appropriate services for people in a timely manner. The numbers of older people waiting for a non-residential service to be sourced fell by 67%, from ninety-six in August 2022 to thirty-two in August 2023, and has remained fairly stable since, with providers responding well to requests. This is not to say that there are not challenges in specific geographical areas, particularly the remote rural locations of the county. The Care and Support at Home tender has recently been completed and is in the final stages of evaluation with a model which reflects the market in West Sussex and supports and encourages the market to respond to the needs of residents across the county.
The Older Persons Residential and Nursing MPS has indicated that based on a range of information we anticipate that apart from a potential small shortfall in Horsham, there will be sufficiency in the market for demand over the next 10 years with no net growth needed for standard residential and instead a focus on diversifying and developing services for those with the most complex needs, including nursing and nursing dementia.
We hold a large, long-term contract for the operation and management of 12 council care homes with Shaw Healthcare which provide five hundred and ninety beds and are working on a programme of work to review this provision in light of current demand, market supply and our strategic direction. This is a crucial contract for managing our demand as around 20% of all older people with eligible social care needs that are funded by the council in a residential or nursing home are supported within these services. The work is focusing, for example on introducing more complexity and flexibility to the services and contract and exploring use of space in all of the services to meet our anticipated future demand.
The contract has a 30-year term and has been in place for nineteen years. The requirements at the outset of the contract were very different to what is needed now and what we will need in the future. Changes have been made over the years to adapt the services, including changing bed types to meet nursing and dementia needs and the cessation of day services within these properties which had low levels of utilisation, and the latest programme will be the next step in working together with Shaw Healthcare to ensure that the services continue to meet the needs of our residents.
Our approach to fees and annual uplifts over the last three years (8% is 2022/23, 9% in 2023/24 and 8% in 2024/25) have responded to market pressures and learning from our work, including the Cost of Care exercise and Market Sustainability Plan (MSP) and the market development commissioning. A task and finish group was established last year to ensure partnership working with the market to strengthen this further supporting our decision making for 2024/25. We also recognise that more is needed in this regard and alongside future approaches to uplifts, we will be planning to procure a new Care Homes Framework in the future with the impact on the market being a central consideration on commissioning decisions. In some circumstances, particularly when new residential placements are made, payments to providers are currently happening with a delay. There are a number of reasons which explain this, most of which relate to processing issues. A programme of action has been put into place to address this. It includes the introduction of a provider portal and process improvements aimed at giving greater visibility to areas of potential risk and increasing the efficiency of existing arrangements.
A project was introduced in September 2023 to digitise the invoicing process for providers. We are implementing a payment portal where providers will input the actual services they delivered against purchases raised in a web-based portal. This automation of process will help reduce the delays in payments to them, give transparency for providers as they will be able to see how and when approvals for invoices occur and also reduce risk of data protection breaches and data errors with reduced hand-off between officers as the provider will input their own requests for payment on services they have delivered. The first phase is for all non-residential domiciliary care providers and Extra Care services to be moved over to the provider payment portal by 2025. The second phase of this work is to move payments for residential services over to the portal. As with the non-residential services, this will assist with transparency for our providers so they can see when purchases are created and confirm actual services delivered. If there are delays with purchases being set-up the providers will be able to monitor and contact the team that arrange the placement for an update, rather than waiting to see if their payment has been received in their accounts.