Adult Social Care Market Position Statement

Shared Lives

Shared Lives is an alternative to traditional types of care and support available to adults with care and support needs. In Shared Lives, a person lives, or stays with a Shared Lives carer within the local community. The Shared Lives carer provides the care and support in their own family home and as part of their own family and community network.

Current market intelligence 

The Stockton Shared Lives Scheme was brought in-house in January 2022, transferring existing provision from the previous provider.

We currently have 11 active shared lives schemes.

Shared Lives is a fantastic alternative to some of the more traditional services. Providing an opportunity for people who require care and support to live independently in the community and can be an alternative to living in a care home, housing with care or housing with support.

The Shared Lives scheme matches people who need care and support with an approved carer. The carer shares their family and community life and gives care and support to the person with care needs. Some people live with their Shared Lives carer, while others are regular day-time visitors. Some people combine day-time visits with overnight stays.

How we propose to shape the market

We propose to grow the provision by a further 10 Shared Lives placements over the next 3 years.

How we will achieve this

A robust recruitment campaign, targeting different audiences as we want to attract potential new carers into the service, including people who are already employed in the care sector, who may be able to provide a short break or respite support, whilst receiving some additional income.

The service will actively promote the benefits of both working as a Shared Lives carer and for service users utilising the scheme via partners and amongst the general public.  

The service will develop robust training and support package for shared lives carers to enable them to develop and retain them within the sector.

We are working alongside Shared Lives Plus (SL Plus) and Social Finance to look at Shared Lives as a model for respite for informal carers looking after those on the dementia pathway. If successful, Shared Lives could be used as a model to meet the needs of those living with dementia and their carers in an alternative environment to residential care, providing support on a 1:1 basis that is personalised and cost effective, producing positive outcomes for all involved.

Housing with Care

Housing with Care combines accommodation with care and support services. It comes in many forms, from small communities of flats and bungalows to retirement villages. The facilities and care provided will vary, but Housing with Care schemes usually include self-contained adapted flats or bungalows.

Current market intelligence 

In Stockton-on-Tees there are four Housing with Care schemes for older people and two for people with complex care and support needs (which will be part of a future Supported Living framework).

As of April 2023, there were 173 occupied extra care units of accommodation.

There is currently a nominations process managed by our Strategic Housing Team. The current nominations process started in 2021.

In 2021 there were 27 referrals to the waiting list.

In 2022 there were 67 referrals to the waiting list.

In 2023, 63 referrals were received. Five of these were from out of area.

Up to the end of May 2024, we have received 34 referrals. All of these are from in-area.

How we propose to shape the market

We have finalised the model for Housing with Care and a new service will start from October 2024.

We produced an agreed specification, specific to Housing with Care services in conjunction with our clients, their families or carers, and stakeholders. Engagement has taken place with residents regarding what is important to them about living in Housing with Care schemes.

We have a consistent waiting list for Housing with Care placements (36 as of March 2024) with priority always given to those that can demonstrate a local connection to Stockton-on-Tees.

We have growth in the aged population and the current criteria we attach to Housing with Care is over 55 years although this does have some flexibility. We do also recognise a slightly younger cohort of customers who otherwise would be eligible and suitable for Housing with Care provision. We are committed to developing more supported accommodation and we would be interested in looking at options for developing additional Housing with Care Services potentially with flexible approaches to meet the needs of a range of people.

Mental health

Mental health residential care home provides accommodation together with personal care providing 24-hour care and support.

Current market intelligence 

Stockton-on-Tees has six homes offering 81 beds. All of these currently come under the Residential Care for Older People framework and the Specialist Mental Health Accommodation Framework. 

There are also 21 Supported Living Schemes where people with a range of support needs, including mental health support needs and learning disabilities, live as independently as possible.

There are a number of people with long term placements within these Mental Health accommodation settings. In addition, there is a recognised need for additional significant and highly complex mental health residential support for individuals within the Borough.

In 2023 to 2024, 261 Mental Health Placements were made (excluding Discharge Support Services and Respite) which included supported living and care at home. 35 of these were out of Borough placements and 37 placements were made to Mental Health Residential settings in Stockton-on-Tees.

All our Mental Health Registered Care Homes in the Borough were rated as 'Good' by CQC in 2019 to 2020. When comparing this to 2021 to 2022 one home has now been rated as 'Inadequate'.

How we propose to shape the market

Following a review of the current provision for those individuals with significant and highly complex mental health support needs a new specification was produced and agreed and went to the market in March 2024.

The framework is aimed at support provision for people who require significant and highly complex mental health residential support services. The aim of this framework is to support commissioning work with interested suitable providers to deliver small scale schemes set around the agreed specification to meet individual support needs. This work will also link to the Housing LIN Report recommendations.

We will continue to work with our existing Mental Health Residential Care Homes and Older People's Care Homes to ensure the standards are improved and maintained where necessary and to ensure that they are providing the right residential environment for those individuals who live within them.

We will continue to work with providers across the market to design services to meet the needs of people within Stockton-on-Tees.

We work closely with our Strategic Housing, Public Health and Voluntary and Community Sector colleagues to help develop and support mental health initiatives and services including a Stockton-on-Tees Wellbeing Hub which will provide wellbeing support in the community following its launch in summer 2024.

We are looking to bring our Supported Living Schemes under a specific framework to ensure consistency where possible while still maintaining person centred care across these services.

Learning disabilities residential care

Learning disabilities residential care homes provide accommodation together with personal care providing 24-hour care and support.

Current market intelligence

Stockton-on-Tees has 16 homes offering 137 beds, with a total of 84 people accessing support in 2023 to 2024 in the Borough and 49 people accessing support out of Borough.

There will be an estimated 2,827 adults with a learning disability aged 18-64 years living in Stockton-on-Tees. This number is not expected to increase significantly over the next 5 years. Autism is the largest associated condition among children with learning disabilities coming into adult services, followed by physical disability.

The Council has engaged with the market twice in 2022: once across Tees Valley with neighbouring local authorities and the other to engage with providers on the local requirements for 2023 and beyond.

How we propose to shape the market

The Council is looking to use the existing Learning Disabilities Residential Framework to work with existing providers and encourage new entrants to the Stockton-on-Tees market to address needs in:

• settings with dedicated and bespoke support that work to support a person to move to greater independence at all points of the individual's life course
• specialist or autism specific setting for individuals with the most complex needs
• all-female unit for sexual disinhibition or personality disorder or autism with complex behaviours
• option for an all-male forensics' unit
• planned local emergency respite provision

Older people's residential care

A care home is a residential setting where a number of people live, providing care and support 24 hours a day.

Current market intelligence

The market for older people's residential care in Stockton-on-Tees remains one of contrast: whilst older people's care home providers are delivering good quality in the main, the market has too many beds for our local population needs which is impacting on overall occupancy, service improvement and viability of some homes.

There are a total of 30 older people's care homes in Stockton-on-Tees offering 1,577 beds. In 2021 to 2022, 911 people were accessing care and support.

As of April 2022, we had 1,629 beds under contract, with 18% vacancies (although there are some significant outliers across the market with 9 homes with greater than 92% occupancy and 3 homes with 30% or more vacancies). Annual gross spend is circa £21.5m (£13.6m net).

Overall quality, when compared to the national averages for 2022, demonstrates a lower percentage of Stockton-on-Tees residential and nursing homes have been awarded Good or Outstanding rating by CQC.

How we propose to shape the market

We will be retendering for a new Older People's Care Home Framework (2024 to 2028) which will be in place by 31 March 2024.

The scope of the retender will be all current Older People's Care Home Providers currently on the 2020 to 2024 Framework who wish to register their interest including other care homes, registered for over 65 care / dementia care that are operating with Good or better CQC rating who have an interest in tendering for the 2024 to 2028 framework.

We will ensure the new framework reflects the work undertaken through the Fair Cost of Care and is sustainable and affordable.

We will ensure the new framework builds on successes on 2020 to 2024 Framework and acknowledges future challenges.         

We will ensure the new framework is effectively co-produced with input from key stakeholders and partners.

Care at home

Care at home provides support to an individual in their own home and is available to those that require additional support with day-to-day household tasks, personal care or any other activity that allows them to maintain their quality of life and independent living.

Current market intelligence 

In 2022 to 2023 we supported approx. 1,096 people to live independently at home, delivering over 70,240 hours annually at an annual gross cost of £14.1m.

We have 26 providers on the Care at Home Framework (including some providers whose offices are outside Stockton-on-Tees), who deliver home care services for older people, people with dementia, learning disabilities and mental health. Of those providers on the framework, 96% who have a current CQC rating were assessed as Good or Outstanding.

Includes care at home for those in prison via Spectrum CiC. Circa £100k.

Recruitment is a significant challenge facing care at home providers and this can have a direct impact on delivering quality care. Nationally, some providers have adopted innovative approaches to recruitment, aiming to maximise retention looking at different approaches to recruiting the right people.

Using technological innovation to improve current service delivery is something which the Council is continuing to use and explore. This could see a person be better connected to a wider support system to improve quality, increase flexibility, and tackle issues such as social isolation.

How we propose to shape the market

We have finalised the model for Care at Home and a new service will start from October 2024.

We will continue to support recruitment and retention in the care sector using a variety of mechanisms, including development of sector-based Work Academy Programme, direct recruitment via the Employment and Training Hub, use of existing projects (for example the Well Led Programme), and the use of communication channels to promote caring as a career.

Alternative technological solutions such as assisting technology will have more of focus as a preventative tool and we will continue to look at different ways, we can deliver care and support in people's home.

Day opportunities

Day opportunities is a package of community-based day time activities which will engage adults with a learning, physical and/or sensory disability, providing person-centred support and maintaining people's independence.

Current market intelligence

In Stockton-on-Tees, day opportunities for adults are currently provided in three ways: 

• Stockton-on-Tees Borough Council's in-house day services
• Stockton-on-Tees Borough Council's commissioned day services from the independent or voluntary sector
• support purchased directly by individuals from the independent and voluntary sector using a direct payment

Day opportunities can be either building or community-based and offer opportunities for social connections, activities which promote wellbeing, skills development and greater independence, and respite or breaks for informal carers.

Day opportunities are accessed by individuals with a range of needs including older people, people with learning disabilities, autism, physical disabilities, and mental health needs.

The two highest primary support reasons for individuals accessing in-house and commissioned day opportunities are for people with a learning disability (48%) and Support with Personal Care (19%).

How we propose to shape the market

Between Autumn 2021 and Spring 2022 the Adult Social Care and Health Select Committee completed a scrutiny review of day opportunities for adults in Stockton-on-Tees.

The report and recommendations produced by the Committee were agreed by Cabinet in May 2022. The full report can be found on the Performance Review and Audit Select Committee document.

We propose to implement the recommendations from the review and to grow the range of options that are available to people with a particular emphasis on growing the range of community-based opportunities.

Transition into adulthood

Current Market Intelligence

Not all young people will require support from the Council when they turn 18. Upon transitioning to adulthood, what an individual receives will depend on their needs. The Council's aim for all young people is to maximise their independence, build on their strengths and networks of support, promote individual wellbeing, and enable them to maximise choice and control over their own lives. 

The number of children and young people looked after has changed by 15% over the last 5 years from 511 in 2018 to 590 in 2023.

The number of children and young people looked after within the 10 to 15 year age group has changed by 9% over the last 5 years from 211 in 2018 to 229 in 2023.

As a percentage of the total cohort, 10 to 15 year olds has reduced by 5% over the last 5 years from 41% in 2018 to 39% in 2023.

The number of young people looked after within the 16-17 year age group has changed by 84% over the last 5 years from 69 in 2018 to 127 in 2023.

As a percentage of the total cohort, 16 to 17 year olds has increased by 57% over the last 5 years from 14% in 2018 to 22% in 2023.

9.2% of children in need have a recorded disability (as of 31 March 2023) which is slightly lower than the mean for all unitary authorities (12.4%).

Percentage of pupils with an SEN is higher than the mean for all unitary authorities, both in terms of mainstream schools for children with a moderate learning disability (19.5% for Stockton-on-Tees and 17% for unitary authorities) and for special schools (20% for Stockton-on-Tees and 10.6% for unitary authorities).

How we propose to shape the market

Work is underway between Children and Families and Adults, Health and Wellbeing commissioners and social care teams to explore opportunities for young people going through the transition process to have a route into appropriate accommodation and support. 

Following an assessment of the market with the Housing LIN in 2022, we have established working groups to focus on identifying Registered Social Landlords or Housing Providers to provide high quality affordable accommodation for young people transitioning into adult services.

Specialist Housing Needs Assessment (2022) identified:

• up to 10 units of accommodation for vulnerable young people at risk or recovering from homelessness (by 2027)
• there is a need for move on accommodation in the form of one-bedroom flats when care leavers are ready to live independently, these properties need to be located in safe areas where young people will not be at risk of exploitation

The current Tees Complex Care and Support framework is designed to support people transitioning from children's services to adulthood. Commissioned in April 2023, we will continue to work with the market to ensure this delivers the right outcomes and timely support people need.

Reduce or eliminate use of short-term emergency provision, for our young people due to their vulnerabilities.

Have a clear pathway of accommodation options to meet the range of needs for young people 16 plus to assist them into early adulthood with stability and support.

Support providers who are skilled as advocates for young people, promoting their independence and self-care while supporting their journey into adulthood. Support providers who are adept at-risk management during transition.

Technology

Current Market Intelligence

Our current telecare service is One Call. The service includes the lifeline unit and pendant or the enhanced service that includes relevant assistive technology to enable the client to live independently. There are currently 5,141 people (as of 31 January 2023) receiving this support and it includes a mobile response service.

The Council is committed to an ambitious programme that will introduce new and innovative technologies and digital approaches, which enhance the experience and the outcomes the people who use the service.

How we propose to shape the market

Our approach to the provision of technology solutions for care and support needs to reflect the changing requirements in our population and the rapidly evolving market of technology.

The current gaps we believe technology could be an enabler and positive influence for change include:

• improving the consistency of technology enabled care as primary consideration as a means of achieving key outcomes or people through Strengths Based assessment planning
• increase the profile of technology solutions as an integral means of achieving care and support outcomes
• regular reporting to partners detailing the impact of timely and appropriate technology solutions as a means of achieving optimised care and support outcomes
• working with stakeholders to ensure that our catalogue of solutions is both currently appropriate to meet the needs of our client group and that it is sufficiently forward thinking that we will be able to maximise service user and self-funder independence
• supporting local partners to develop and pilot innovative care solutions alongside Stockton-on-Tees Borough Council
• work with our partners to educate stakeholders and the general public of available solutions to home automation, smart homes and care and support technology to ensure that products are well understood and adopted