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Market Position StatementAutumn 2010
2
Contents
Chapter Title Page
➊ Whothisdocumentisfor 3
➋ FutureDemand 4
➌ CurrentSupply 12
➍ Quality 16
➎ FinanceandFunding 18
➏ ReviewingtheEvidence-DeliveringChange 20
➐ FacilitatingtheMarket 23
3
Thisdocumentisaimedatexistingandpotentialprovidersofadultsocialcareandsupport.Itrepresentsthestartofadialogue,betweentheCouncil,peoplewhouseservices,carers,providersandothersaboutthevisionforthefutureoflocalsocialcaremarkets.Wearecommittedtostimulatingadiverse,activemarketwhereinnovationandenergyisencouragedandrewardedandwherepoorpracticeisactivelydiscouraged.ProvidersofadultsocialcarecanlearnabouttheCouncil’sintentionsasapurchaserofservices,anditsvisionforhowservicesmightrespondtothepersonalisationofadultsocialcareandsupport.
Voluntaryandcommunityorganisationscanlearnaboutfutureopportunitiesandwhatwouldenableyoutobuildonyourknowledgeoflocalneedstodevelopnewactivitiesandservices.
Peopleinterestedinlocalbusinessdevelopmentandsocialenterprisecanreadaboutnewopportunitiesinthemarketandtelluswhatwouldhelpyoutocomeintosocialcaremarketsandofferinnovativeservices.
SocialcareprovidersandorganisationsnotcurrentlyactiveintheBradfordDistrictcouldfindopportunitiestouseyourstrengthsandskillstobenefitlocalpeopleanddevelopyourbusiness.
Who this document is for ➊
4
Future DemandKey messageslDemandforcareandsupportserviceswill risebutwillnotbematchedbyasimilar commitmentinpublicspendingl Individualaccountswillincreasinglyallow peopletochoosefromawidermenuof activities,optionsanddemandis expectedtodecreasefortraditionalmodels suchasdaycare.Peoplewillbeableto choosetouseamixoftraditionaland mainstreamserviceslThepartnershipbetweenhousing,support andcarewillbestrengthened;withprovisions suchastelecareandequipmentenabling peopletocontinuelivingathomelSpendingonresidentialandnursingcare willcontinuetodecreaseasaproportionof spendingonolderpeople;thereforestaying wellandindependentforlongermustbe integraltomainstreamserviceslTherewillbeopportunitiestoofferaneven widerandmorevariedmenuofoptionsfor peopletomeettheirsocialcareandsupport needslLifeexpectancyisincreasingandentryinto servicesislikelytobelaterinpeople’slives
Opportunities for business changelCommunityactivities-youmaywantto considerofferingrecreational,educational, socialandsupportactivitiesinthelocal community.lDayopportunities–peoplewithcash personalbudgetsaswellasthosefunding theirownsupportmaynolongerwantto usetraditionaldayservices.Youcould considersettingupacluboractivity.
lCommunitymeals–youmaywantto considerofferinghotmealsforpeoplein yourlocalareaortosetupalunchclubl Information,brokerageandadvocacy–you maywishtoofferawiderrangeofsupportto helppeoplefindthehelptheyneed,arrange theirsupportandexpresstheirviewslBackofficeservices–ifpeoplearerecruiting theirownpersonalassistantstheymayneed supportwithadvertising,recruitment,payroll, CriminalRecordsBureauchecksortraininglDomesticservices–youcouldconsider settingupdomestichelp,gardeningor shoppingservices,forexamplehelping peopletoshopratherthandoingitforthemlEquipmentprovision–peoplecanspend theirpersonalbudgetsonequipmentand thereisarangeofitemssuchasrails, stairliftsandriserchairs
Thefutureofadultsocialcareisgoingtoseesignificantdemographicchange.InBradford,thenumberofpeopleovertheageof65isforecasttoincreaseby10%in2015,by20%in2020andby33%in2025.1Thedemandforservicestoolderpeoplewillincreaseastheshapeofthelocalandnationalpopulationchangesasaresultofadvancesinmedicalsciencemeaningmorepeoplearelivinglonger.ThisriseindemandwillnotbematchedbyGovernmentfundingmeaninganewapproachisneededtohowsocialcareandsupportisdelivered.Highereligibilitythresholdsforlocalauthorityfundinghave,inpart,ledtotheincreasednumberofpeoplefundingtheirowncare.Regardlessoffunding,peoplewantmorechoiceandflexibilityoverhowthoseneedsaremet.
➋
1 Projecting Older People Population Information System www.poppi.org.uk
5
Key messageTheNHSWhitePaper‘EquityandExcellence;LiberatingtheNHS’willseecloserintegrationofHealthandSocialCare2
Table 2. Key factors that may influence potential changes in demand for health and social care in people aged 65 and over living in Bradford
2 Department of Health www.dh.gov.uk/en/Publicationsandstatistics/index.htm
2010 current figure
68,800
9,400
2015 figures and % increase
75,90010%
10,80015%
2020 figures and % increase
82,40020%
12,50033%
2025 figures and % increase
91,20033%
15,00060%
Allpeopleaged65andover
Peopleaged85andover
2010 current figure
4,970
33,417
23,564
28,782
1,161
2015 figures and % increase
5,4279%
36,76110%
25,6899%
31,2849%
1,231
2020 figures and % increase
6,02221%
39,86419%
28,03519%
34,15919%
1,307
2025 figures and % increase
6,87238%
44,42933%
31,42433%
38,33033%
1,542
Peoplelivingwithdementia
Peoplewithalimitinglong-termillness
Peopleunabletomanageatleastonepersonalcaretask
Peopleunabletomanageatleastonedomesticcaretask
Peopleaged75andoverprovidingmorethan50hourscareperweek
Table 1. Potential population growth of older people in Bradford
Thetablesbelowshowtheriseisevensharperaftertheinitialfiveyearsfortheoldestoldpopulationandthosemostlikelytobeinneedofsocialcareservices:
6
Table3showsthenumberofpeopleinBradfordaged18-64isalsoforecasttoincreaseby5%by2015,9%by2020and13%by2025,allsignificantlyhigherthantheaverageforEngland3
Table 3. Predicted population in Bradford of people age 18-64 with a disability or a mental health problem 4
ThehighestnumbersofolderpeopleinBradford5liveintheKeighley6andShipley7localities.Theseareasarethoughttohaveahigherlikelyprevalenceofdementia,mobilityissuesandfunctionalimpairment.BingleyandBingleyRuralwards
makeup37.5%oftheelderlypopulation.Thereislikelytobecontinuedgrowthintheolderpopulationofthesewards,asitisapopularlocationforretirement.Figures1and2showthedistributionoftheolderpeople’spopulationinBradfordin2008.
2010 current figure
1,715
23,172
6,635
13,589
50,446
2015 figures and % increase
1,8106%
24,1024%
6,8313%
14,1034%
52,7665%
2020 figures and % increase
1,90611%
25,2229%
7,2129%
14,8669%
54,7188%
2025 figures and % increase
2,01317%
26,11113%
7,53013%
15,43214%
56,64412%
Peoplewithamoderateorseverelearningdisability
Peoplewithmoderatephysicaldisability
Peoplewithaseverephysicaldisability
Peoplewithamoderateorseverepersonalcaredisability
Peoplewithamentalhealthproblem
3. Projecting Adults Needs and Service Information www.pansi.org.uk 4 Projecting Adults Needs and Service Information www.pansi.org.uk5OfficeforNationalStatistics2007www.statistics.gov.uk/hub/index.html
6Craven,Ilkley,KeighleyCentral,KeighleyEast,KeighleyWestandWorthValleywards7Baildon,Bingley,BingleyRural,Shipley,Wharfedale&WindhillandWrosewards
7
Figure 1. Proportion of population estimates per ward of people age 65+
Figure 2. Proportion of population estimates per ward of people age 85+
12
34
5
67
8
9
10
11
12
13
14
15 16
17
18
19
2021
22
2324
25
26
27
2829
30
12
34
5
67
8
9
10
11
12
13
14
15 16
17
18
19
2021
22
2324
25
26
27
2829
30
Key to maps 1Baildon 2Bingley 3BingleyRural 4Bolton&Undercliffe 5Bowling&Barkerend 6 BradfordMoor 7 City 8 Clayton&FairweatherGreen 9 Craven 10Eccleshill 11GreatHorton 12Heaton 13 Idle&Thackley 14 Ilkley 15KeighleyCentral 16KeighleyEast 17KeighleyWest 18 LittleHorton 19Manningham20Queensbury 21Royds 22Shipley 23Thornton&Allerton 24Toller 25Tong 26Wharfedale 27Wibsey 28Windhill&Wrose 29WorthValley 30Wyke
8
Attitudesandexpectationsarealsochanging.Theexpectationsofpeoplewhowillreacholderageinthenext10to20yearswillbedifferenttoolderpeoplenow.Peopleareusedtoexpressingfargreaterchoiceandcontrolovertheirneedsandaspirations.Currently,peoplearemuchmoresociallymobilethanbeforeandhavegenerallyexperiencedawiderexposuretodifferentgoodsandservicesthaneverbefore.Peoplenowandinthefuturewillexpectmorefromtheirlocalauthorityandcareprovidersintermsoftherangeandqualityofservicesonoffer.
Tomeetthisrisingdemandandexpectationthesocialcaremarket,includinghowthelocalauthoritybehaves,providerswillneedtorespondinwaysitmighttraditionallynothavethoughtof.Demandandfundingforlongtermresidentialanddaycarewillreduceovertimeandmanyolderpeoplewillwanttostayathomeforaslongaspossible.Providerswillneedtoconsiderhowtomaintainpeopleathome,remaininghealthyandwithasenseofwellbeingforlonger.Thismeansconsideringhowtohelppeoplemaintaingoodphysical,mental,social,emotionalandspiritualwellbeinginordertoremainhealthy,activecitizensnowandinthefuture.
Peoplewillalsofundtheircareinagreaternumberofways,forexample,insurancepolicies,savings,pensionsandinvestments.Significantly,tenurewillplayapartinshapingthemarketasagrowingnumberofolderpeoplewilloptforhomeownership.Thiswillincreasethenumbersofpeoplefundingtheirowncare.Olderpeoplewillenterthemarketplacerequestinginformationandadviceaswellasabroadrangeofserviceswithoutapproachingthelocalauthority.AlthoughtheCouncilseesthisserviceasanimportant,centralisedrole;therewillneverthelessbeagrowingneedtoofferpeopletherightkindofinformationandservicesasthiswillbeacorecustomerbasewantingtopurchaseservicesdirectlyfromprovidersinthefuture.Thereforetherearerealopportunitiesfor
providerstobuildthelinkbetweeninvolvingpeopleinthedesignofservices,offeringpeopletheinformationtheyneedtomakeinformeddecisionsandofferingcustomersnewanddiversifiedproductsandservicestohelpthemremainwellathome.
Arecentsurveyofcouncilstaffandpartnerorganisations8highlightedtheexpectationsofpeoplewithinthedistrictandtheirfuturehousingandfundingoptionsforretirement.23%of50-59yearoldssaidtheywouldprefertoliveinaretirementdevelopment,shelteredhousingoranextracarefacility.Whenaskedabouthowtheyexpectedtofundtheirretirement,73%of50-59yearoldsstatedthatanemployersorprivatepensionwouldbeusedand29%statedthattheywouldusetheirsavings.Althoughthisgivesalocalsnapshotofopinion,itisneverthelessaninterestingindicationastohowsomelocalpeopleapproachingretirementagearethinkingabouthowtofundtheirfuturecareandhousingneeds.Wherethereareapossiblegrowingnumberofpeoplepreparedtoselffundsomeoralloftheircareandsupportneeds,themarketneedstobeabletorespondtothisanddealwithpeopleselfreferringorwantinginformationandsupporttomakechoicesabouttheirneeds.
The importance of prevention and early interventionPreventionandearlyinterventionarewellrecognisedtohelppeoplestaywell,liveindependentlyandremainhealthyforlonger.Itisimportanttoensurethatawiderangeofpreventativeservicesareavailabletosupportpeopleacrossthespectrumofneed,includingthosewhodonotapproachtheCouncilforsupportormeetitseligibilitycriteria.Thiswillensurethatpeopledonotgowithoutthesupportwhichcouldpreventcriticalneedsdevelopinginthefuture.Table4outlinesthedifferenttypesofpreventativeservicesthathelpolderandvulnerablepeople:
Changing attitudes, expectation and paying for care
8 Ridley-Ellis W, Thinking Ahead: Your Housing Options for the Future Bradford. www.bradford.gov.uk
9
Table 4. The three types of preventative services
Primary
Involvingolderandvulnerablepeopleintheplanningandoperatingofservices.
Consultation,membershipofcommittees,boardsandworkinggroups.Offeringautonomytorunactivities,groupsorservicesthemselves.
Bybeinginclusiveandinvolvingpeopletheaimistopreventisolationandlonelinessandencourageparticipationandasenseofbelonging.Improvesconfidenceandindependence.
Secondary
Servicesdeliveredtopeopleinthecommunity.
Housingrelatedsupport,telecare,supporttocarers,fallspreventionandreablementservices.Befriendingschemes,sittingservices,providingequipmentoradaptations,wellbeingcafes,lunchclubsandhotmeals.
Tomaximiseindependence,preventfurtherdeteriorationandmaintainagoodlevelofhealthandwellbeing.
Tertiary
Specialistservicesdeliveredtopeopleathomeorinhospitaltoofferaseamlesstransitionofcareortopreventanadmission.
Facilitateddischargefromhospital.Intensivesupportdeliveredathomeorinextracarehousing.Intermediatecarefacilities.
Tospendnolongerthannecessaryinhospitalandtoreturnsafelyhome.
Purpose
Suggestions
Desired outcome
10
Table5givessomefiguresonthedistributionofpopulationforthetoptenwardsinBradford.
Table 5. Distribution of older people by top ten wards as compared to those in receipt of council support
Ward by total population 2006/7 ONS
City(16,714)
Bingley(13,838)
BingleyRural(13,625)
Tong(13,570)
Bowling&Barkerend(13,268)
Craven(13,079)
BradfordMoor(12,768)
LittleHorton(12,755)
Toller(12,722)
Royds(12,718)
Ward by population aged over 65
Ilkley(3,589)
Craven(3,308)
BingleyRural(3,073)
Bingley(2,908)
Idle&Thackley(2,536)
Shipley(2,530)
KeighleyEast(2,484)
KeighleyWest(2,439)
Bolton&Undercliffe(2,392)
Royds(2,364)
Ward by number of council funded packages of day care (2009/9 RAP return)
KeighleyWest110
Craven101
KeighleyCentral88
BingleyRural82
KeighleyEast78
Ilkley65
Wharfedale62
WorthValley62
WindhillandWrose56
Bingley55
Ward by number of council funded packages of domiciliary care (2009/9 RAP return)
Craven230
Clayton&FairweatherGreen214
KeighleyWest197
Bingley189
Bowling&Barkerend185
BingleyRural183
Windhill&Wrose182
Ilkley181
KeighleyCentral179
IdleandThackley176
Ranking
1
2
3
4
5
6
7
8
9
10
11
Thenumberofpeoplewithalearningdisabilityinthedistrictisexpectedtorise.Currentlythereare1,660LDserviceusersinreceiptofacare/supportpackagewithinthedistrict.ThehighestconcentrationofLDusersisinBradfordWest.9ThisislinkedtotheconcentrationofpeoplefromBMEbackgroundslivinginBradfordWestandthehigherthanaverageincidenceofpeoplelivingwithalearningdisabilityfromblackandminorityethnic(BME)backgroundsinBradford.Thelocalsituationwillfollowthenationaltrendofpeoplewithalearningdisabilitylivinglongerduetoadvancesinmedicaltreatmentgivinglongerlifeexpectancy.
Peoplewithalearningdisabilityaremorelikelytobelivingwithanelderlyparentastheirmaincareprovider.Societywillalsoseethiscarerolereversingasthepersonwithalearningdisabilitywillstarttotakeonthemaincaringroleforelderlyparents.TheCouncilanticipatesthatthesupportrequiredforthisgroupofserviceuserswillgrowandthatnewtypesofsocialandpracticalsupportwillberequired.Bradford’slowweightbirthrateandpre-termbirthrateishigherthanthenationalaverageandthisincreasestheriskofillhealthanddisabilitythroughoutaperson’slife.10MoredisabledchildrenliveinBradfordWestlocality.HowevereachareainBradfordhasasimilarpercentageofdisabledchildrencomparedtotheirtotalchildpopulation.Theprevalenceofcerebralpalsyis3.87per1000childreninBradfordcomparedto2.08per1,000inEurope.Thereareadisproportionatenumberofchildrenwithneurodegenerativeconditions.Thereisasignificantlyincreasedprevalenceofotherseriousmedicalconditionswhichcanalsobecategorisedasconferringadisability.ThiswillhaveanimpactonAdultServicesasthenumbersofyoungpeoplegrowingintoadulthoodwithaphysicaland/orlearningdisabilitycontinuestogrow.
Anincidenceof17.2%ofcommonmentalhealthproblemscanbeexpectedacrossBradford.Demandonmentalhealthservicesisexpectedtoincreaseinlinewiththepopulationgrowthoverthe
nextfewyears.ThemajorityofsocialcareexpenditureonmentalhealthprovisionisthroughtheBradford&DistrictCareTrust.However,thereissomesmallerinvestmentwithinlocalcommunityandvoluntaryorganisations.AdultMentalHealthDayServiceprovisionhasgonethroughastrategicreviewandisnowenteringtheimplementationstage.AllprovidersworkingwiththeCouncilareexpectedtoofferindividualchoiceandcontrol,anddiversifyfromtraditionalmodelsofcare.Anemphasishasbeenplacedontheimportanceofserviceswhichpromotesocialinclusion,includingaccesstowork,skillsandeducation.
Thenumberofpeoplewithphysicaldisabilitiesandsensoryimpairmentsinthedistrictisexpectedtorise.Thisisbecausechildrenwithcomplexneedsandrecessivegeneticconditionsincludingcerebralpalsy,physicaldefects,deafnessandblindnessareexpectedtolivelongerduetomedicaladvancesandgreatersurvivalrates.Currentlythereareover1700peoplefundedtoaccessservicesinthedistrictwiththenumberofpeopleclaimingdisabilitylivingallowance(oneindicatorofdisabilityprevalence)at14970.Thoseclaimingthisallowanceandthoserecordedaspermanentlyunabletoworkareoftenusedasindicatorsofneed.Bothmeasuresseearisingpatternoverthemediumtolongterm.
Agrowingolderpopulationwillalsoincreasethenumbersofacquiredsensoryimpairmentsinthedistrictaswellasmoreolderpeoplewhoarefrailandwhosemobilityisimpairedbyphysicaldisability.Peoplewithphysicaldisabilitiesandsensoryneedsoftenwishtoaccessuniversalservicesandlocationsbutfindbarriersincludingphysicalaccessandalackofaccessibleinformation,somerequireonetoonesupporttoaccessthisinformationandtheservicesoffered.Morewidelydifficultiesarisewithgainingandsustainingmeaningfulemploymentandasaresultthisclientgrouppopulationprofilecanbelinkedtoindicatorsofdeprivationandareasacrossthecitythatexperiencesmultipledeprivations.
10DisabledChildreninBradfordNeedsAnalysis2010
9Heaton,ThorntonandAllerton,Toller,ClaytonandFairweatherGreenandLittleHortonwards
12
Current SupplyKey messages:
l Thecurrentsupplyofresidentialanddaycare servicesisnotsustainabletomeetthelonger termchangingdemandinBradfordlCurrentcostsofserviceswillreduceinresponse tothediminutioninGovernmentspendinglAlternativemodelsofhousingthatoffer integratedcareandsupportserviceswillneed toenterthemarketplacelFocuswillshiftmoreontoshorterterm placementsprovidingrehabilitationanda returnhomelAwiderrangeofhomebasedserviceswillbe neededtomaintainpeoplestayinghealthyand withasenseofwellbeingathomeforlongerlProviderswillneedtooffermoreservicesthat offeraccesstoinformation,advice,advocacy andbrokeragetodemonstrateconfidenceto customersandgenerateinterestandbusinesslServicestomeettheneedsofpeoplewith learningdisabilitieswillneedtodiversifyand offerabroadrangeofstimulatingandrewarding experiencesfortheserviceuserandcarerlEntryintoworkwillbeseenasthenormrather thantheexception
Opportunities for business changelNewtypesofhousingprovision–youmaywish toconsiderdiversifyingintoextracarehousing, assistedlivingenvironmentsandbuilding relationshipswithkeycouncildepartmentsto achievethislHomebasedservices–youmaywantto considersettingupdomesticservices,shopping services,sittingservicesaswellasliveinornight timecarelAccesstoinformation–youmaywishtooffer moreassistancetopeopleseekinginformation andadvice.Morepeoplewillhavepersonal budgetsortheirownmoneytospendthiswill beakeysourceofnewbusinesslSpecialistservices–youmaywishtoconsider reablementorrapidresponseservicesaswell associal,educationalandwellbeingopportunities forpeoplewithalearningdisability
Residential CareTheDistricthas152residentialcareestablishmentsthatprovideatotalof4617beds.11
Older People’s Residential Care Thereare108homesproviding2803bedsregisteredforelderlycareorelderlycarewithnursing.Ofthesethereare61residentialhomesregisteredforelderlycarewith1805bedsand47homesregisteredtoprovidecarewithnursingwith2352beds.Thereare11Counciloperatedhomesproviding354bedsforelderlyresidentialcare.TheCouncil operatedhomesbedspaceiscomprisesof203longstaybeds,116shortstaybedsand46intermediatecarebedspaces.12Inthedistrictthisequatesto26residentialcarebedsper1000peopleaged65andoverand34nursinghomebedsper1000peopleaged65andover.
11Basedonoperationalfiguresfortheweekbeginning20.9.10fromCityofBradfordMDCCommissioningTeam
12Comprisingofrehabilitationbeds,assessmentbedsandinterimbeds
➌
13
Younger Disabled Adults (<65 years old)Thereare33homesproviding454bedsregisteredtoprovidecaretothisusergroup.Ofthesethereare21residentialhomesregisteredtoprovidecareforlearningdisabilities,mentalhealthandphysicaldisabilitieswithatotalof249beds.Thereare12homesregisteredtoprovideresidentialandnursingcareproviding205beds.Thisequatesto2.83residentialbedsper1000and2.33nursinghomebedsper1000peopleinthisusergroup.
Thereare34outofdistrictLDplacementsand172withindistrictplacements(residentialandnursing).
Respite Care14
TheCounciloperatesavoucherschemeforrespiteandhasissuedthemto585serviceusersforrespitecarehavingspentonaverage£22,670perweekinredeemedvouchers.
ThePrimaryCareTrusthasissuedrespitevouchersto99serviceusersforrespitecarehavingspentonaverage£16,875perweekinredeemedvouchers.
Intermediate Care and Nurse Led CareIntermediatecareisprovidedwithintheCounciloperatedandprivatesectorcarehomes.TheCounciloperatedhomeshavecapacityfor30rehabilitationbeds,10assessmentbedsand6interimbedsavailable15forusewithinitsowncarehomesforolderpeople.Bedspaceisalsoavailableinsomeprivatecarehomeshowevercapacityvariesaccordingtodemand,proximityofaGPandthetherapeuticinterventionneedsoftheserviceuser.
Therearefourcommunityhospitalsinthedistrictproviding72bedsofferingnurseledcare.Theseofferrehabilitationwithamultidisciplinaryinputwherethereisadefinedsetofnursing/medicalneedsinadditiontothetherapyneeds.Inadditiontothisthereare16bedsofferingasimilartype ofcarewithintwonursinghomes.
ArecentsurveycarriedoutbytheCouncil’sAdultsandCommunityServicesCommissioningTeam foundthatapproximately60-65%ofresidentialandnursinghomebedsareoccupiedbypeople fundingallorpartoftheirowncare.
At17thSeptember2010theCouncilhadatotalof1,993contractedbedsintheBradfordArea(residentialandnursing-allclientgroups).
13Singleroomwithensuitefacilities,figureincludesqualitypremiumspaidtogoodandexcellentestablishments.NursingcarebedincludesFNCpremium.CommunityCareMarketNewsJune2010
14Figuresfrom10.4.10to17.9.10–i.e.financialyeartodate
15Intermediatecarebed:fulltherapyinput6weeksfreeofcharge.Assessmentbed:notherapyinputbutusedforconfidencebuilding,timetoassessandplan,riskmanagementandhomevisits.Interimbed:careplanagreedbutwaitingforelementsofprovisionorrehousing
Cost of Residential care bed
Cost of Nursing care bed
Bradford
£365.26
£534.80
Calderdale
£384.29
£507.80
Kirklees
£376.62
£503.16
Leeds
£385
£535.70
Wakefield
£402
£510.70
The table below shows how Bradford compares to its neighbours in terms of minimum baseline fees for a contracted bed for older people13
14
Extra Care Housing / Housing with Care Thereare8purposebuiltextracareschemesthatprovideatotalof474apartmentsforrentorpurchase.
16Basedonfiguresforweekcommencing8thMarch201017ThevastmajorityofLDservicesareprivateprovision
18Basedonsoftmarkettestingfiguresfor201019Basedonfiguresfrom22ndFebruary–22ndMarch2010
Domiciliary Care – Older People and Adults with Physical DisabilitiesThetotalnumberofcarehourspurchasedbytheCouncilacrossthedistrictis30,146hoursperweektoatotalof3130serviceusers,16or1.57millionhoursperyear.ThenumberofhourspurchasedbytheCouncilfromregisteredprivate/voluntaryproviders(OP,PDandLD)istypically20752hoursperweekequatingto69%oftheCouncilpurchasedmarket.17Thenumberofhourssuppliedbythe‘inhouse’serviceistypically8555hoursperweek,equatingto28%ofthismarket.The‘TimeOut’(sittingservice)supplies839hoursperweekequatingto3%ofthismarket.TheaveragecostofdomiciliarycareacrosstheWestYorkshireareaappearstobeintheregion £12.50to£12.80.18TheNationalaveragehourlyrateis£14.34;takenfromapapercommissioned bytheDHin2005witha2.5%increaseeachsubsequentyearto2010.Atpresentthecostofprovidingcareandsupportvariesamongstprovidersandclientgroups.TheCouncilwillwanttomovetowardsafairpricingsystemwherethetruecostsofservicesareshown.
TheCouncilintendstomovetowardsworkingwithinframeworkagreementswhereafairpricewillbesetandpaidforprovidingcareandsupportthatrepresentsgoodqualityandvalueformoney.Thein-househomecareservicealsoprovidesashort-termreablementserviceforpeoplereceivingcareforthefirsttime,withtheaimofmaximisingindependence.Thisformspartoftheassessmentprocess,whichremainsthecouncil’sresponsibility.Thispartoftheworkcurrentlyaccountsforaround11%ofitsbusiness.89%ofitsworkremainsintraditionalhomecare.
Domiciliary Care – Adults with Learning DisabilitiesDuringtheweekbeginning8thMarch2010,theCouncilpurchasedprovided5443hoursofcare andsupporttopeoplewithlearningdisabilities.
Housing Related SupportInatypicalweektheCouncilpurchasescareandsupportfrom60providerssupportingupto13,000serviceusers.Itspendsapproximately£370,000onthisserviceperweek19andthisexpenditureisbrokendownasshownintable6:
Table 6 Proportion of spend per client group on housing related support
Client Group
MentalHealthOlderPeopleLearningDisabilitiesYoungPeopleatRiskGenericsupportDomesticViolenceSingleHomelessOffendersHomelessFamiliesComplexNeedsAllotherclientgroups
Proportion of annual spend
20.1%16.1%15.5%7.1%6.7%6.1%5.7%5.3%4.7%2.4%10.3%
15
Grant-funding for older people’s preventive support
TheCouncilallocatesjustover£2mtosupportvoluntaryandcommunitysector(VCS)groupsacrosstheDistrictworkingwitholderpeople.Thisisallocatedinthreefundingprogrammesshownintable7below:
Table 7. Allocation of social care grant funding in Bradford
Evaluating outcomes of grant funding
Theolderpeople’swell-beingteamvisitfundedgroups(twiceayearforthe3-yearprogramme) andrequiresthesegroupstocompletemonitoringdocuments.TheWBAFandWBCprogrammeshaveledthewayinimprovingthewaythatgrant-fundedactivitiesshowtheirsuccessandtheUniversityofBradfordhasevaluatedtheHealthinMindprogramme.
1) Individualstorygathering:Eachfundedgroupis askedtoprovidetheseateachsix-monthly monitoringvisit.
2) Individualquestionnaires:Theteamhas workedtosimplifytheUniversityofBradford questionnaires,astherewereconcernsat the‘monitoringburden’.FromApril2011,the newversionwillbeusedforeveryscheme receivingWell-BeingActivityFund.
3) Outcomes:Reviewsbasedonthesevenadult socialcareoutcomes.Eachgrouphastoshow howtheirschemeisintendedtoachievethese outcomes,andhowtheywillknowthatthisis thecase.Initialevidenceisthatthisis stimulatinggroupstousequestionnaires, photosandothermeanstogivetheevidence.
Programme
Older people’s 3-year VCS commissioning
Well-being activity fund (WBAF)
Well-Being Cafés (WBCs)
Age Concern ‘Helping Hands’
Anchor Housing Staying Put
Age Concern Trades Register
Age Concern ‘Starting Point’
Description
61groupssupportedbygrantswhichareguaranteedfor3yearperiods;currentlyrangefrom£520-£80,000pa.
Short-termgrantsofupto£5,000todeveloppilotandinnovate.Approx.20groupsatanyonetime.
Meetmonthlyforolderpeoplewithdementiaandothermentalhealthneeds,andcarers.Currently16cafés,funded£4,800pa.
HandypersonforOlderPeople(minorrepairs,minoradaptations,smalldomesticmaintenancework).
HomeImprovementAgency–adviceandprofessionalsupportforpeoplewishingtoadapttheirhomes.
Helptofindreliableandtrustworthytradespeople
Informationandsignpostingforolderpeople
£ per annum
£1.35m
£200K
£76.8K
£100K
£170K
£34K
£100K
16
QualityKey messages:l Thedemandforarangeofhighqualityservices willrisecreatingnewopportunitiesforbusiness changeanddevelopmentl TheCouncilwillcontinuewithitsstatutorydutyto measureandassurequalityforallitsresidentslQualityassurancewillremainacoreareaof businessfortheCouncil.l Providinghighqualityserviceswillbekeytolong termbusinesssuccessandconfidenceinthe marketl Increasinglypeoplewillmeettheirpersonal needsusingtheirownbudgets
Opportunities for business change:l Focussingonquality–youmayneedtoconsult orreviewwhatyourcustomersthinkofyou; asmorepeoplemanagetheirowncare, recommendationsbywordofmouthanduser feedbackwillbeanimportantmarketingtooll Staffsatisfaction–beingabletoofferahigh qualityservicehelpstorecruitgoodstaffand improvesmotivationandstaffretentionlCompetition–youmayneedtobeawareofwho youarecompetingwithasthemarketwidensout asmorepeoplestarttomaketheirownchoices
lCommunication–youmayneedtoconsiderhow yourorganisationcommunicateswithits customerstocreateapersonalised,customer focussedexperiencelReviewingandmonitoring–youmayneedto thinkabouthowyougoaboutmaintainingquality throughoutyournormaldailybusinessl Involvingpeople–customersvalueinputintothe designanddevelopmentofservices
The Council places great importance on quality assurance and sees its role within this area increasing over time as the uptake of personalisation increases. It aims to deliver this through a number of approaches:l Integratedqualityassuranceframework: TheCouncilisdevelopinganevidencebased approachtoqualityassurancethatwillbe consistentandtailoredtothetypeofservice beingmonitored.l Providerframeworks:Thisisalistofproviders, setbyclientgroup,whohavedemonstrated throughatenderingprocessthattheymeethigh standardsforqualityandvalueformoney.lApprovedListofContractors:Providersof housingrelatedsupportwhorequiredfunding fromtheauthorityarerequiredtobeonthe Council’sapprovedlistofcontractorslStandardspecifications:TheCouncilandlocal NHSaredevelopingastandardspecification fornursingandresidentialhomes,whichwill includequalityrequirementsandperformance managementlinkedtothem.lRegistrationschemes:TheCouncilisalso lookingintoanapprovedregisterforpersonal assistants.lLow-levelsupportaccreditation:TheCouncil commissionsAgeConcerntoruna‘Traders Register’whichfollowinganinitialaccreditation process,addstradespeopletoalist.
TheseprocessescomplementrequirementstoregisterwiththeCareQualityCommissionfora widerangeofhealthandsocialcareservices.TheCouncilseesitsroleinbothprotectingtheinterestsofallresidentswithcareorsupportneeds,regardlessofhowtheyareprovidedorfundedandcontinuingtoworkwithproviderstoimproveandmaintainhighqualityservices.
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17
Quality – facts and figures
20AllstarratingsareBasedonCareQualityCommissionratingsJuly/August2009
Residential Care
TheaverageCareQualityCommission(CQC)starratingofthe152listedprivately/voluntaryoperatedcarehomesinthedistrictwas2.02.20Fourhomeswereratedaspoor(0stars)and33asexcellent(3stars).Ninehomeshadnotyetbeenrated.Theaveragestarratingofthe11Counciloperatedcarehomeswas2.33.TheaveragestarratingforallcarehomesinEnglandwas2.0stars.
TheCouncilalsomeasuresqualityanditsownperformanceviathe’CapturingRegulatoryInformationataLocalLevel’(CRILL)andthe‘LocalAreaMarketAnalyser’(LAMA).For2009/10,initialfindingsshowthattheCouncilisperformingslightlybelowtheEnglandaverageforallplacesingoodandexcellenthomesexceptolderpeoplepersonalcarewhereweareperforminginline.
Forolderpeopleinresidentialcarehomes(nursing),thecouncilpurchased79%ofitsplacementsingoodandexcellentplacements,inlinewiththenationalaverageandhasimprovedonlastyearsfigures.Forolderpeopleinresidentialcarehomes(personalcare),thenumberofplacementspurchasedfrombothwithinandtheauthorityandthoseoutsidetheauthority,ingoodorexcellenthomesisgreaterthannationalpurchasingandourpositionhasimprovedfromlastyear.Therewerenoplacementsmadetohomesratedaspoor.
Foradults(learningdisabilities,mentalhealthandphysicaldisabilities)inresidentialcarehomes(nursing)withintheauthorityarea,theCouncilpurchasesfewernumbersofplacementsingoodorexcellenthomesthannationalaverage,buthasreducedthenumberofplacementspurchasedinpoorhomesfrom9%to0%.Outoftheauthorityarea,thecouncilonlypurchasesplacementsingoodorexcellentratedhomes.Foradultsinresidentialhomes(personalcare),theCouncilpurchases48%ofplacementsintheauthorityinpoororadequateratedhomesagainstanationalaverageof15%.TheCouncil’sperformanceinthisareahasdecreasedfromlastyearandissignificantlybelowthenationalaverage.Outoftheauthorityarea,theCouncilisperformingabovethenationalaverage.
Domiciliary Care
TheaveragestarratingfordomiciliarycareprovidersregisteredinBradfordis2.05starsandforEngland2.1stars.Theaveragestarratingforinhouseserviceswas2.0starsandforthe41listedprivateproviderswasalso2.0stars(8ofthesehadnotbeenrated).
At30.9.09,theCouncilwaspurchasing91%ofitsdomiciliarycarehoursviagoodorexcellentratedcareagencies,3%fromadequateratedagenciesand6%fromagenciesthathadnotyetbeenCQCrated.Thisishigherthanthenational.
Complaints
Duringthesameperiod,atotalof47complaintsreceivedbytheCouncilrelatedto15homecareproviders.Thenatureofthesecomplaintswere8allegationsagainststaff,15complaintsaboutpunctuality,21complaintsaboutthequalityofcareand4complaintsaboutmedication.
18
Finance and Funding
Inthelastfinancialyear(2009/10)theCouncilspent£172.2moncareandsupport.Thisfigurerepresentsgrossexpenditureandcomprisesofspecificgrants(£32.1m)andincomefromchargesandotheragencies(£28.3m).AbreakdownofthisgrossexpenditureisprovidedinTable8andfigure3.In2008-9,theCouncilspent54%ofitsoverallspendforolderpeople’scare
servicesonresidentialandnursingcarerepresentingadecreasefrom56%thepreviousyear;amajoritysharebutadecreasingone.PublicspendingwillstarttobereducedandtheCouncilwillneedtoconsiderhowitallocatesfundingtousersandservices.TheCouncil’scommissioningapproachwillbetoseekoutqualityservicesthatoffervalueformoneyandmaintainhighlevelsofusersatisfaction.
Figure 9.
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ServicesforPeoplewithPhysicalDisabilitiesServicesforPeoplewithMentalHealthNeedsServicesforPeoplewithLearningDifficultiesServicesforOlderPeopleOtherAdultsSupportingPeopleAsylumSeekersVoluntarySectorGrants
ItemServicesforPeoplewithPhysicalDisabilitiesServicesforPeoplewithMentalHealthNeedsServicesforPeoplewithLearningDifficultiesServicesforOlderPeopleOtherAdultsAsylumSeekersVoluntarySectorGrantsTotal£m
£15.612.342.580.411.91.28.3172.2
Table 8. Gross Expenditure by Social Care including grants Year 2009/10
19
How do we compare to other West Yorkshire Councils?
ThetablebelowshowshowwecomparetoothercouncilsinWestYorkshireintermsofpercentagedistributionoftotalgrossexpenditureonadultsocialservicesbyclientgroup.21
Table 9. Comparison of total gross adult social care expenditure across West Yorkshire
Self funders of careAsurveywassentouttoprivatedomiciliarycareprovidersinNovember2009askingaboutselffunders.34providersweresurveyed,9respondedstatingthat170oftheircustomersfundedtheirowncarepurchasing1939hoursinagivenweek.Ofthiscare,69%ispersonalcareand31%isdomesticcare.OverallweestimatethattheselffundingmarketinBradfordwillincreaseovertimeorthatpeoplewilloptto‘topup’theirassessedpackagesofcarewithadditionalservices.
ItisestimatedthattherewillbeasignificantproportionofselffunderswithintheBingley,BingleyRural,CravenandIlkleywards.Thesewardsarethehighestrecordedareasforcouncilfundedhomecaresupport22andareexpectedtohaveahighproportionofolderpeoplelivingtherecoupledwiththerelativeaffluenceoftheseareas.Therefore,the
Councilexpectstoseeanincreasingamountofactivityincareandsupportprovisionforelderlypeopleintheseareaswillneedtomatchthislevelofdemand.
ItisexpectedthatthisshareofthemarketwillshiftovertimeandtheCouncilwillwanttoactivelysupportpeoplewhochoosetofundsomeoralloftheircareandsupportneeds.Itwillofferimprovedaccesstoinformation,support,andadvocacytohelpthemdecideonthebestoptionsforthem.TheCouncilwillwishtodobusinesswithproviderswhocansharethiscommitmenttoofferingpeopletherightadvice,helpandsupportwhereappropriate.OptionsforthefuturefundingofsocialcareandsupportarebeingconsideredbytheGovernmentandtheselffundingmarketisexpectedtohaveasignificantinfluenceoverthewaypeopleaccessandpayfortheircareandsupportneeds.
21NASCIS005ExpenditureReport2008/9http://nascis.ic.nhs.uk 22BradfordObservatorywww.bradfordobservatory.com
There are currently 954 people in receipt of direct payments in the District.
England average
57%
24%
10%
7%
2%
16.45%
17.70%
Calderdale
60%
21%
12%
6%
2%
15.86%
17.86%
Kirklees
59%
24%
9%
7%
1%
14.92%
17.71%
Leeds
59%
22%
10%
8%
1%
14.01%
18.38%
Wakefield
63%
21%
9%
6%
1%
16.64%
18.04%
Bradford
60%
18%
9%
8%
6%
13.41%
17.15%
Older People (65+)
Adults with a learning disability
Adults with a physical disability
Adults with mental health needs
Other adults services
Proportion of older people (65+) of total population
Proportion of Younger Disabled Adults of total population
20
Reviewing the Evidence – Delivering ChangeReviewing the evidence
Demographicgrowthmeansthatthecurrentpatternofservicesandinvestmentisunsustainable;agrowthupwardsof30%inolderpeopleandyoungeradultswithdisabilitiesinthenext15yearswillnotbematchedbypublicfunding.
Funding,demandandcapacityfortraditionalmodelsofcareprovisionwillreducei.e.residentialandnursinghomes.Thiswillmeanmorepeoplewillwanttostayathomereceivingthecareandsupporttheyneed.
Thecurrentcareandsupportmarketoffersarangeofprovidersthatsupplygoodqualityservices.Thereissufficientcapacityinthemarketasitstandsandagoodlabourmarkettosupporttheindustry.However,thecurrentprofileofserviceprovisionisunlikelytomatchtheexpectedriseindemandincareandsupportservicesacrossthedistrict.
Anincreasingnumberofpeople(notwithstandinganygovernmentproposalswithregardtothefuturefundingofsocialcare)willbeexpectedtofundtheirowncare.Currentlyweestimatethatapproximately12%ofserviceuserswhoreceivesupportfundingviatheCouncil,alsoaugmenttheircareorpurchaseotherservicesdirectlyfromthesameprovider.Thefigureforthosefundingtheirowncareoutrightisestimatedataround8%ofthetotalmarket.
TheCouncilcurrentlycommitsover£2mperyearforactivitiesandsupportwhicholderpeoplecanaccessdirectlywithoutaformalassessment.Thisincludeshandypersonhelp,informationand‘signposting’(i.e.helpingpeoplefindoutaboutandaccessactivitiesandservices),daycentres,drop-insandlunchclubs,befriendingschemes,well-beingcafés,
Delivering change
Themarketwillneedtobereadytorespondtobudgetarypressuresthatarebeingfacednationally.Thismaymeanprovidersbeingabletooffersustainablevalueformoneyandqualityservicesatalowercostregardlessofwhetherserviceusersarespendingtheirownorallocatedfunding.
TheCouncilwillbekeentodobusinesswithprovidersthatcandemonstratethattheirservicesareabletodiversifyintoareasofprovisiontomaintainpeopleathomelivinghealthylivesforlonger.Thiswillbethecorecustomerbaseinthefutureandtheareathatrepresentsthemostopportunitiesforsuccessandcontinuedbusiness.
AdditionalcapacitymayberequiredtomeettheexpectedriseindemandforcareandsupportserviceshowevertheCouncildoesnotwishtoseeanincreaseinthesametypeofprovision.Itsviewisthatinvestmentandgrowthinpreventionearlyinterventionandsocialcapitalisabsolutelyvital.Thismeansdeliveringarangeofpreventativeservicesfromlowerlevelcommunityplanningandinvolvementtohigherlevelhousingrelatedsupportneedssuchastelecare,fallspreventionandworkingwithcarers.TheCouncilwillworkcloselywithitsNHSpartnerstodeliverthesetypesofservicesandreduceanyduplicationofservicesoverthecomingyears.
Beingabletodeliverarangeofhomeandcommunitybasedpreventativeandearlyinterventionserviceswillbeasignificantshareofthesocialcareandsupportmarketthatwillneedtodevelop.
Peoplewhodonotrequirethelocalauthoritytofundtheircare,shouldstillbenefitgreatlyfromimprovedhealthandsocialcareinformationandexpertiseregardinge.g.thealternativestocarehomes,inassessingneeds,maximisingindependence,managingrisksandsupportingcarers.
Morepeoplewillwanttochoosethesetypesofservicesfromaproviderthattheytrustandthathaveagoodreputation.
TheCouncilwillactivelyseektodobusinesswithprovidersthatcandemonstratecommitmenttoeithermaintainingordevelopingpreventativeservicesaspartoftheircorebusinessorthatarepreparedtoadvise,supportandguidepeopletotheseservicesaswellasdelivermoreregularformsofsocialcareandsupport.
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21
Reviewing the evidence
activitiessuchasusingtheinternet,walkinggroupsandarts&crafts.Mostofthisactivityisgrantfundedvialocalcommunityandfaithgroups,whocontributetheirownresourcessuchasbuildings,volunteersandfundraising.Althoughwecanhighlighttherecentgrowthinthisinvestment,itremainsaverysmallproportionoftotalolderpeople’sspending.
Thenumberofpeoplerequiringhomesupportasincreasinghoweverweseethatthisrisingdemandwillbemetbypeoplebeingsupportedbyshortterminterventionratherthanrelyingonlongertermsupport.
TheCouncilanticipatesthatthenumbersofpeoplerequiringextracarehousingtomeettheirlongertermneedswillincrease.TheDepartmentofHealthhasrecentlyreiteratedtheimportanceofextra-carehousinginfutureplansforolderpeople’saccommodationandcare.VerypositiveviewswereexpressedaboutthemodelaspartofrecentconsultationonthefutureoftheCouncil’sresidentialhomes.HousingprovidersarestillkeentoworkinpartnershipwiththeCounciltodevelopschemesandarestillabletoraisefundsfordevelopment.
Overonemillionpeopleliveinhousingprovidedspecificallyfortheneedsofolderpeopleandnearlytwothirdsoftheseliveinshelteredhousing.23
Weanticipatethatthenumbersofolderpeoplerequiringspecialisthousingandsomeformofsupporttoliveindependentlywillincrease.
Delivering change
Theevidenceshowsthatthesetypesofactivitiesarevaluedbythepeoplethatusethem.Maintaininghealth,wellbeingandindependencewillbevitalintheleanyearstocome.TheCouncilwillwanttoworkwithprovidersthatcanshowcommitmentandunderstandingtothepreventionandearlyinterventionagendas.
TheCouncilwillwanttodobusinesswithprovidersthatencouragepeopletobecomeindependentagainorrequirelessintensivemethodsofsupportandwhoputpeopleintouchwithlocalorganisationstohelpthemmaintainthatindependence.Supportplanningandbrokeragewilltakeanewshapeasbothinhouseandindependentorganisationswilltakeonthisroleforserviceusers.
Theaimwillbetobrokershorttermpackagesofcareandsupportwiththefocusonreablementratherthansettinguplongertermpackagesofcare.
TheCouncilinitscommissioningapproachwillmovetowardsamodelofoutcomebasedcommissioningandperformancemanagementthatcandelivergreaterflexibilityratherthantheformerblockcontractingofservices.ItwillworkwithGPcommissioningcolleaguestoappropriatelyrewardthistypeofapproach.
TheCouncilwishestocontinueworkingwithproviderstodevelopnewextracareschemeswhichcanpromoteindependenceandwell-beingforpeoplewithhousingandsupportneedsandmeethighlevelsofcareneeded,includingovernightcare.Theextentofsuchdevelopmentwilldependonavailablelandandinvestment,continuedstimulusoftheindependentsectorandtheoutcomeoftheCouncil’scurrentreviewofitsin-housecarehomes.
TheCouncildoesnotexpectthedemandforshelteredhousingwillincrease,nordoesitseethatthisareaofprovisionwillbestmeettheneedsofthelocalpopulation.TheCouncilwillwanttoreducethedistinctionbetweenshelteredhousingandextracarehousingandseesthemodelofprovisionitwillwanttocommissionbeingarangeofhighqualityhealth,socialcareandsupportbasedservicesthatareequippedtobedeliveredintoalltypesofspecialisthousing.TheCouncilwillbekeentoworkwithprovidersthatcanrespondtotheincreaseddemandforthesetypesofvariedsupport.23ElectionManifesto2010TheEssentialRoleof
ShelteredHousing.www.shelteredhousing.org
22
Reviewing the evidence
Peoplehavehigherexpectationsandwantcareprovidedflexiblyinawaythatsupportstheirfamilyandsociallife,ratherthanpeoplehavingtoorganisetheirlifearoundcareservices.
Wealsoknowthatsatisfactionwithgoodquality,skilledandappropriatelytrainedstaffaswellasconsistencyofcare/careworkerwhereverpossibleismoreimportantthanwhichagencyisused.
ThereisstillsignificantexpenditureondirectCouncilprovision(‘in-house’services),despiteofsignificantshiftstowardspurchasingfromtheprivatesectorinthepastdecade.In-houseservicesaremoreexpensiveandsignificantlyforpersonalisation,commitresourcesinadvanceinthesamewaythatblockcontractsdo.Althoughtraditionallytheinhouseservicehasheldasignificantplaceandshareofthelocalcareandsupportmarket,itwillneedtorespondtocurrentfinancialpressuresbyreducingcosts,drivingoutinefficienciesandofferingvalueformoney.
Carersmakeahugecontributiontothesupportofpeoplewithdisabilities.Wewanttooffersupportdirectlyto.A2009evaluationofschemesfundedforcarersacrosstheDistrict,foundsomeofthebestresultswerefromschemesthatgiverelativelysmallsumsofmoneydirecttocarers,e.g.forholidays,computersandITskills,exerciseoryogaclasses.ACouncilschemetoissue£50‘winterwarmth’paymentstohelpcarersinthesevereweatherinwinter2009-10hasreachedover1,400carers.
Delivering change
TheCouncilwillseektodobusinesswithprovidersthatwanttodeveloptheirservicestohelpkeepolderpeopleathomeandabletofunctionsafelyandindependentlyforaslongaspossible.Thismayinvolvefloatingsupport,particularlyintheprivatehousingmarketandofferingawiderchoiceofsupportiveactivitiesthatrelatetomaintainingagoodqualityoflifeinone’sownhome.TheCouncilwillalsowanttodobusinesswithprovidersthatcandemonstrateamorepersonalisedandintegratedapproachtosocialcareandhousingdelivery,recognisingthataonesizeapproachisnolongersuitable.
TheCouncilwillseektodobusinesswithproviderswhocandemonstratetheirabilitytoofferhighqualitycareandsupport,underpinnedbyperson-centredvaluesandapproacheswhilstofferingvalueformoney.
Serviceusersoftensaythatwhatmattersmostisthequalityoftheindividualprovidingthecareandsupportandtheirpunctualityandflexibilitytogotheextramile.TheCouncilwillwanttoworkcollaborativelywithproviderstodiversifythelevelofcompetencyandrangeofdutiesthatcare/supportworkerscanprovidetomeettherisingdemandforhomebasedservices.
TheCouncilwillreviewthefunctionandcorebusinessofthein-houseservices.Forexample,thein-houseresidentialanddayservicesarecurrentlyunderreviewandanextensiveperiodofconsultationtookplacein2009.ElectedmemberswillconsidertheoutcomesandrecommendationsfromthatworkthroughareporttotheExecutiveCommitteelaterintheyear.
TheCouncilintendstodevelopindividualaccountsforcarers,whichwillleadtoopportunitiesforprovidersofawiderangeofgoodsandservicestopromotewell-being,educationandskills,socialandeconomicinvolvement.
Asimple,easytoaccessschemeisplannedtoenablecarerstoreceivearelativelysmallcashsum;withtheoptiontohaveamoredetailedcarers’assessmentandresourceallocationifthecarers’needsrequireit.
23
Facilitating the Market
NewmethodsofdevelopingandfacilitatingthesocialcaremarketarerequiredwhichcanbuildontheCouncil’suniqueposition.TheCouncilcanbringinformationitknowsaboutpopulationanddemandofitsserviceusersandcarersintoadialoguewithprovidersaboutinvestmentandrisk.Theaimistoencourageandsupportproviderstoshapetheirservicestopersonalisation,demonstrategoodoutcomesandimprovedmodelsofpracticeandexplorewaysinwhichtheycancomplementtheseapproachesandberewardedfordoingso.
TheCouncilrecognisesthattodeliverchangeproviderswillrequireinvestment.Thismightincludeprovidingnewtypesofservice,trainingstafftoimprovequalityorspendingtimewithcustomerstoplanandtailorservices.Ifwewishtoseesmallandmedium-sizeprovidersinthemarketwemustconsidertheircapacitytoinvestmoneyandtakerisks.Largerprovidersshouldnotbeoverlookedeither,butgenerallyhavemorecapacitytotakerisksandtoallowdemandforservicestobuildupovertime.Italsorecognisestheneedtofosterasupportiveenvironmentofsharedrisktakingacrosstheboardfromassessmentandsupportplanning,throughtobrokeringservices,frontlineservicedeliveryandreviews.Sharedrisktakingintermsofthepackagesofsupportthatpeoplearegivenwillreducedependencyandpromoteindependence.Wewanttoworkwithserviceprovidersthatcanprovideeffectiveshortterminterventionsandcollaboratewithusduringthereviewprocesstoreducecosts.
Developmentgrantsarebeingtrialledbyotherlocalauthoritiesintheregionandhavebeenusedwithsomesuccesstosupportthedevelopmentofsocialenterprisestoprovidepracticalsupportforolderpeople.24However,itisimportanttobeclearaboutthenatureandpurposeofsuchgrants,allocatingfundsfairlyandinlinewithrestrictionsonpublicsubsidyandtolinktoeventualsustainabilityofanenterprise.
TheCouncilwantstosupportvoluntarysectorprovidersviainfrastructureorganisationstocometogethertobuildmoresocialcapitalinthedistrict.Italsowantstoreducetherequirementsplacedonproviderstoworkwithincomplexcontractualarrangementsandtomakeiteasierforexistingandnewproviderstoenterthemarketandworkwithus.TheCouncilaimstocontinuetoencouragelocalpeopletohelpinfluencelocalcommissioningdecisionsandwillalwaysconsultwithitsresidentstoshapetheservicestheywantandtodowhatisrightforBradford.TheCouncilalsorecognisesthechallengesofunderstandingandmeasuringoutcomesandwelcomestheinitiativeshownbythelocalHealthandWell-Beingforumforthevoluntaryandcommunitysectortodeliveritsowndevelopmentinitiativestohelpthoseprovidersgettogripswiththeissue.
TheCouncilwouldwelcomedialogueabouthowwecanbestworktogetherandoffersupporttofocusonoutcomes,avoidingperformancemanagementsystemsthatinadvertentlyrewardthewrongthings.TheCounciliscommissioningenhancedsupportfordevelopingsmallproviders,supportingvoluntaryandcommunityorganisationsandgroupstoenablethemtodevelopnewfundingandoperatingmodels.
Thismarketpositionstatementisthestartofaprocess.ItisintendedtoserveasanintroductiontothemanydiscussionsthatneedtobehadbetweenthecouncilandprovidersbutalsoasastartingpointforproviderswithintheBradfordDistricttothinkabouttheircurrentbusinessmodelsandhowtheymayneedtochangeforthefuture.Itdoesnotpreventprovidersseekingacompetitiveadvantagethroughtheirownmarketresearchandotheractivities.Therightkindoffreely-sharedandpublishedintelligencecouldlowerbarrierstomarketentryandpreventprovidersfromwastingresourcesonpoorly-targetedinitiatives.Asastartingpointwewelcomeviewsonwhatkindofmarketinformationwouldbeespeciallyusefulinthefutureormightbedifficulttoobtainindependently.
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24www.keepinghouse.org.uk
24
ThewordinginthispublicationcanbemadeavailableinotherformatssuchaslargeprintandBraille.Pleasecall:01274437957.
FormoreinformationabouttheMarketPositionStatementpleasecontactPaulO’Brienon01274437710oremailpaul.o’[email protected]