Our commissioning approach for adults, children and families in Gateshead - commissioning priorities 2024-2025
Introduction
This document sits alongside Our Commissioning Approach and will be reviewed on an annual basis.
A number of key user groups and service areas have been identified as priorities for the Commissioning Service in the forthcoming year:
- Home Care for older and disabled people
- residential and nursing care for adults
- a Gateshead System approach to meeting the needs of children and adults with autism
- SEND and alternative education provision
- local, high quality registered residential care for children
- sustainable homes and support for adults and children with complex behaviour related needs with a focus on transition
- Foster Care sufficiency
- sufficiency in relation to working age adults with enduring Mental Health Needs
This does not represent an exhaustive list of planned activity during the course of the year but provides a focus on some of the more significant areas of commissioning work to be undertaken.
A number of key themes have also been identified, that will influence our commissioning activity:
- community based solutions, reducing demand for formal care for adults
- information, advice and signposting
- Self Directed Support
- caregivers including young carers
- technology enabled care and communities
- regional collaboration and engagement
- engagement and co-production
- community based, low intensity and free services
- placement sufficiency for children and young people in the care of Gateshead Local Authority
- sufficiency of short break provision for Disabled Children
1. Home Care for older and disabled people
Home Care is essential in supporting the independence of many hundreds of older and disabled people in Gateshead to continue to live independently in their own home. It is intended to sustain the current capacity of local home care provision and extend it by approximately 2,000 hours weekly or 18%. This will provide much needed support at home for people who might otherwise be admitted to residential care, so losing their independence and sense of belonging to their local community.
The biggest challenge to home care provision nationally is workforce recruitment and retention, although Gateshead and the Northeast is somewhat less vulnerable to this than other parts of the UK. The council has managed to retain good supply during difficult times, including managing demand from hospital discharge and reducing delays for people in the community awaiting packages of care. Nonetheless there are risks particularly in the rural West of the Borough and the regional market remains vulnerable to sudden shifts in demand and a growing reliance on overseas workers.
There are economic and practical issues arising from the current configuration of the market and the services it provides. The proliferation of short or very short calls of less than 30 minutes is part of a historical "time and task" approach to home care. Whilst proposed changes will reduce them to some degree it would be impracticable and uneconomic to eradicate them at this stage. The current dispersed, multi-lateral approach to call scheduling and monitoring software also raises issues and administrative challenges.
Home Care is being fully recommissioned for the first time for many years, along with a reset of contractual terms and the promotion of an outcome focused model of support and contracting. The new Home Care Framework will be in place in early Autumn 2024. This is a very substantial undertaking and requires the support of many services across the council.
2. Residential and nursing care for adults
There is significant demand for and diverse provision of care homes in Gateshead. These provide essential care and support to very vulnerable adults, very often towards the end of people's lives. It has been identified that a higher proportion of older and disabled people are admitted to care homes in Gateshead than nationally or regionally. It is therefore a key priority to reduce the rate of admission and overall numbers of Gateshead residents living in care homes. A key element of this approach involves more people taking up commissioned home care and other alternatives to enable them to remain in their own home.
Gateshead has generally enjoyed a stable care home market with good standards of care, adjudged by CQC and the council's own commissioning function. The council has fostered positive relationships with the sector, aligned with a proactive, robust approach to quality assurance. The sector has generally enabled consistent and effective discharge from hospital, withstanding the considerable challenges of the Covid19 pandemic, with dynamic support from Commissioning.
The current re-procurement of the framework for residential and nursing care incorporates a review of fees, refreshed and updated terms and conditions and a streamlined iteration of Gateshead's innovative Quality Excellence Framework. It is to be confirmed whether the ICB will join with the council to enable the framework and terms and conditions to encompass placements funded through Continuing Healthcare (CHC) The council will continue to work with regional partners in monitoring the capacity, quality and resilience of the care home sector, including around any reliance on overseas workers.
3. A Gateshead system approach to Autism
Gateshead Council is working with NHS and voluntary sector partners to refresh and strengthen the strategic approach to Autism, including a new multi-agency strategic group and a renewed commitment to the participation and representation of people of all ages with lived experience. This participation and representation will depend on support from expert voluntary organisations locally and regionally.
The council has identified funding to secure expert engagement, development and writing of a new whole system all age autism strategy for Gateshead. This project commences in early 2024, with a final draft strategy expected in the Autumn. This strategy will draw heavily on ideas and experiences of local children and adults with autism and wider communities, whilst also reflecting on national policy on Autism. The strategy will be all age in scope and have a planned life of 5 years, with a mid-term review.
4. SEND and alternative education provision
It is proposed to develop and implement a new commissioning plan for SEND and Alternative Education Provision during 2024 and beyond. This will enhance the range and choice of educational provision for children and young people who need an alternative to a mainstream education. The commissioning plan will include a review of the current alternative provision and SEND provision in Gateshead and will respond to the national policy drivers to develop a local alternative education strategy.
An alternative provision may be required due to a child or young person being permanently excluded, or at risk of being permanently excluded, from their chosen school. The need for alternative provision may also be due to a child or young person's medical needs, mental health, trauma experience or due to a special educational need which requires an intensive assessment period or a more specialist provision to a mainstream school to meet the identified need.
The plan will address priorities and challenges relating to education and support for children and young people with Special Education Needs and Disability (SEND) and those whose needs are best met through alternative education provision.
The commissioning approach will guide the review and redesign of models of learning and support and the consequent re-configuration and/or re-procurement of services including:
- dedicated local provision for young people excluded from or temporarily unable to attend mainstream schools
- the introduction of Assessment Hub provisions for the Early Years, Primary and Secondary phases to support schools in meeting the needs of children and young people who require intensive assessment, support and intervention in a time measured placement to be successfully reintegrated into their 'home' school
- additional Resourced Mainstream Provisions - review of the current ARMs provisions based in our primary and secondary schools to identify gaps in provision and areas of need
- dedicated local provision for our most complex young people who currently access 1+ banding funding or out of area placements
- improving Local Area systems for the allocation of placements/provisions out of area (currently an NE12 portal which will cease in May 2024 with the need for local authorities to develop their own systems)
- improving access to and waiting times for NHS therapy and clinical services for children with SEND needs, as part of Education, Health and Care Plans (ECHPs)
Implementation of the commissioning Plan will incorporate:
- review of delivery models and performance of existing contracted services including the costs/price uplifts for independent SEND Schools
- review of the Service Level Agreements for the existing ARMs provisions including the funding arrangements in comparison to other local authorities
- review of the Service Level Agreements for all contracts with independent SEND provisions including the associated costs
- review of the Service Level Agreements for our current alternative provisions to ensure that they are fit for purpose and that they address the current needs of the children who attend
- review of the arrangements for Home and Hospital provision and commission new arrangements to ensure that the service is cost effective and high quality
- review of models of best practice in SEND and alternative education provision regionally and nationally
- engagement with young people, families, communities and local stakeholders
- make or buy options for the re-provision of education and support, with re-procurement where appropriate. eg SEND Support Services and outreach funding models
A new full time Commissioning Officer post has been established to lead and co-ordinate this priority area.
5. Local, high quality registered residential care for children
In common with most local authorities, Gateshead faces huge challenges in securing appropriate residential care for children and young people. Even though residential placements are required only for a small proportion of young people and demand is generally stable, these cases involve significant risks and consume extensive staff time and huge resources. These challenges are widespread nationally and in addressing this priority, the focus for Gateshead is on:
- securing more commissioned provision in the Borough and in neighbouring areas close to Gateshead
- avoiding the use of unregistered placements, so far as possible
- assuring the quality of residential care for young people
- exerting some control over price to progress towards more affordable care which offers some value for money.
In seeking more local provision, commissioning will support Children's Services in continuing to extend incrementally the council's own in-house residential care for children, where appropriate. This would also contribute to assuring the quality of provision and controlling price. Such development will be gradual and on a modest scale, conferring with Ofsted and with council members and local stakeholders.
The primary focus in securing more local provision is engaging with existing registered providers which operate already in Gateshead or neighbouring areas. Particular care is required in consideration of appropriate locations for children's residential settings, with engagement with local communities by providers.
Price control is very challenging in the residential market as demand greatly exceeds supply, the market composition is volatile, with transient providers and frequent mergers. Attempts nationally and regionally to constrain prices have generally failed. The Northeast regional framework encompassing residential care is to close in March 2024 and Gateshead has seldom been able to find homes for children through it. The council will establish its own very light touch dynamic purchasing system (DPS) but until extensive market engagement with providers has begun to be successful, this process is unlikely to exert much control over placements.
Market engagement is the main hope for change in provision of residential care and this is a major priority for Gateshead's children's commissioners. Engagement will be with the most local providers first, explore different procurement and financial models and promote the reputation of Gateshead for education and wider support for children.
6. Sustainable homes and support for adults and children with complex behaviour related needs
The needs of these individuals of all ages offer a consistent and growing challenge for Gateshead and all local authorities and NHS partners. Behaviour challenge manifests in different ways including self-harm, suicide risk, physical violence to others, aggressive or disturbed behaviour, significant distress or manipulation of others to cause harm. Behaviour needs can be associated with a range of trauma, different diagnoses or with none. Behaviour needs which challenge commonly cause the breakdown of family or other supportive relationships including unpaid care, as well as that of formal care arrangements.
The challenge of this area of need for the council and its partners is seen in:
- problems in finding appropriate accommodation and support
- frequent breakdown of services
- the imperative to avoid hospital admissions wherever possible and expedite discharge from hospital
- the very high prices often charged for services and accommodation by providers, often arising more from commercial opportunity and assumption of risk, rather than direct costs involved
Various strategic approaches instigated or co-ordinated by the council are expected to have a positive impact on responding to the challenges related to supporting people with complex behaviour needs. These include:
- complex Housing Programme for adult social care
- strategic housing needs assessment and strategy for supported housing approved by Cabinet in 2023
- continued development of in-house residential provision for children
- proposed development and expansion of in-house council accommodation and support for adults with complex needs, including supported living for young disabled people transitioning to adulthood and residential respite for adults with complex needs, including those funded through Continuing Health Care (CHC)
- extended commissioning engagement with providers of residential care for children and young adults with complex behaviour needs
7. Sufficient family based care via fostering
Children's Services are committed to supporting as many children in care as possible to live in local, family based care. This may be with extended family members and family networks , or through the care of Local Authority foster carers or through the provision of fostering via Independent Fostering agencies. As a result of high numbers of children in care, there is a priority to encourage more local families to foster as well as ensuring that services are available to provide wrap around support. There is potential to build longer term consolidated arrangements with the most often used local and regional providers, to establish more cost-effective dependable provision. It remains challenging to find homes for children and young people with complex behaviour needs. Gateshead can promote its wider offer of wrap around education and support services to give confidence to providers.
8. Working age adults with enduring mental health needs
There are many gaps or frailties in the provision for this population locally which reflect a much wider national position. Whilst the population overall is of manageable size, in practice, needs separate into fairly small cohorts of people requiring different service types, including nursing, supported living, residential, community support and crisis response. Small numbers undermine the cost modelling and viability of some types of service locally, prompting the need for innovation or regional collaboration. There are opportunities for joint investment with the ICB, utilising CHC and s117 funding.
9. Community based solutions, reducing demand for formal care for adults
These are essential for delivering the benefits of a strengths based social work model and potentially achieving significant preventative value. The volunteer led services in the community will be central to the major partnership project with the National Development Team for Inclusion (NDTi). There will be key roles for commissioning in developing the capacity and infrastructure within communities, in collaboration with Public Health and other partners. The NDTi initiative and strengths-based working is aligned to the Medium Term Financial Strategy (MTFS) trajectory for reductions in spending on Adult Social Care over the next five years.
10. Information, advice and signposting
These services are the focus of statutory obligations under the Care Act. Information and signposting are key components of effective prevention and are often used in conjunction with social prescribing, strengths-based practice and population health initiatives.
In Gateshead there are no commissioned IAS services particularly for adult social care or demand management and the council's own signposting at the ASC front door is not specifically focused on community based, prevention services. Any databases supporting such an approach are very limited at present. The council does not operate an information and signposting or wellbeing focused website directly. There is a local website operated in the voluntary sector fulfilling some the information and signposting role around preventative community services.
The new expansion of community based, volunteer led opportunities and activities arising from the NDTi programme will depend on comprehensive and accessible information and signposting. This area is also likely to be in focus during an upcoming CQC assurance visit.
11. Self directed support
Direct payments have been part of statutory expectations and good practice in social care for adults and children for many years. In adult social care the 18% take up of direct payments in Gateshead is very low by national and regional comparisons. This is significant both in relation to the opportunities and outcomes for individuals and for diverting demand away from higher intensity formal care services. Direct Payments will also attract significant attention during CQC assurance visits.
Recent engagement with Gateshead's Jewish community has illuminated opportunities for social care services to think beyond direct payments, and instead promote the concept of self directed support more widely and flexibly in meeting the needs of children and adults. There is potential to use direct payments and also Individual Service Funds (ISFs) for larger numbers of people and families to enable them to meet needs more directly and effectively. This will require service development, training and awareness raising across the council and with a range of different communities.
The role of commissioning in addressing these challenges and expanding the deployment of direct payments will be directed towards:
- designing and developing a more substantial, flexible series of support service for people opting for a direct payment. This will consider options for procurement and in-house delivery and encompass management of payments and support with recruitment, employment and payroll
- establishing approved lists of providers for key services susceptible for use of direct payments, including daytime services for adults. Such lists will promote diversity of opportunity and support decision making by customers through an appropriate level of basic assurance about providers
- promoting and facilitating the use of ISFs where appropriate to enable families or customers to pool their resources to meet needs in conjunction with local providers
12. Caregivers
Caregivers provide vital unpaid and irreplaceable support for loved ones and enable the balancing of a fragile care and support economy. They have rights to participate in decision making about the cared for person's services and to have their own needs identified and addressed. These rights were consolidated in the Care Act 2014 and the Children and Families Act 2014. Gateshead Council and the local NHS has commissioned and funded a significant suite of services for unpaid carers over many years.
A full review of existing commissioned services for caregivers has been undertaken during 2023, preparatory to a redesign and recommissioning of services, by way of an open procurement. This will lead to new contracts mobilising on 1st September 2024. The process is led by the council, in conjunction with the ICB and there will be confirmation of the resource plan for funding to 2029, along with the redesigned proposals. In 2023 a revised adults care-givers strategy was produced, providing further context for the recommissioning. A new Gateshead strategy for young caregivers is planned for 2024.
The current level of funding from the NHS for care-givers services is lower than that in 2019, following reduction in NHS funding to joint commissioning of services. However, it is noted that the level of Gateshead system investment in caregivers will remain above that of many other areas in the Northeast and further afield.
The design of new services will draw on intelligence about the impact and use of current provision, feedback from local stakeholders and carers and priorities and best practice nationally. It is likely that priorities for the revised services will include:
- young caregivers
- young adult caregivers
- parent carers
- carers statutory assessments
- information, advice and signposting and carers' wellbeing
- navigating the health and care system
- self-help and mutual support
13. Technology enabled care and communities
When used effectively, technology, through both universal devices and specialist equipment and software, can enable people to stay healthy and independent for longer and prevent or delay need for formal care. Gateshead Council has made effective use of some technologies, mostly delivered and monitored/ supported through its Care Call Service. Technology products and options are continually developing, and different approaches are evolving around the country. There are increasing opportunities to link technology enabled care with tele-health and upstream prevention in communities.
The council will commission a new technology enabled care strategy during 2024, in consultation with partner agencies and benefiting from the expertise of the national professional network. The strategy will guide future investment, product selection and planned outcomes for different cohorts, working in collaboration with health and provider partners.
14. Regional collaboration and engagement
Gateshead has been active in regional commissioning collaboration for many years, including various formal arrangements, for both adults and children's services. These have played a significant role in the way the council procures and assures services in several sectors, until recently. Such regional arrangements have been widespread and multi-faceted in the Northeast, by comparison with other parts of the UK. However, the formal aspects of this culture of regional collaboration are now often dwindling or coming to an end.
Several procurement frameworks and joint contract management arrangements are now expected to end, in some cases because they are felt to be ineffective or because no local authority is prepared to carry the burden of leading the work. The loss or risk to Gateshead occasioned by these changes will generally be limited. The council has gained from regional collaboration around quality assurance, particularly for user groups/sectors where Gateshead relies on placements out of area.
Northeast councils are still keen to work together to share information, manage risk and provide mutual support, particularly in adults social care. Recent examples include major safeguarding concerns and issues relating to overseas workers. There are clearly benefits for Gateshead in remaining active partners in regional collaboration, including through ADASS and ADCS networks. It may even lead or instigate in collaboration around certain issues.
15. Engagement and co-production
These are fundamental to commissioning good practice and will be a key feature of the future commissioning programme in Gateshead. Effective engagement and co-production take time and traditionally there are challenges for local authorities in building them into the scheduling of commissioning and recommissioning projects. The future approach in Gateshead will be managed within the staffing resources available in Commissioning.
The IASCS Directorate is finalising a new "framework" for co-production, promoting best practice across social work operations, direct service delivery and commissioning. The framework has drawn upon models of practice around the country and will be published via the council's website. Commissioning is reviewing and developing its engagement and co-production work through workshop methodology involving staff across the service. This work will result in a new co-production plan for commissioning, as part of the IASCS framework and will link to wider corporate engagement practice and intelligence data to support it.
The commissioning plan for co-production and engagement will address:
- long term development of representation of lived experience around priority themes and user groups
- use of short-term focus groups for commissioning projects
- engagement with communities in Gateshead, whether of geographical localities, minority ethnic/ cultural communities or communities of interest
- structured participation of people with lived experience including carers in service reviews and procurement
- more comprehensive embedding of service user and carer feedback and experience within quality assurance and contract management