Adult social care market position statement

What is the Local Authority Vision?

In 2022, we launched our strategy, ‘Living Better Lives – Our Strategy for Adult Social Care’. This describes the council’s approach to adult social care over the next three years. It provides the below strategic context to our future commissioning intentions.

1. Carers

We will enhance our offer to unpaid carers across the district and ensure that they are supported.

2. Market Sustainability Plan

We will work with care providers to achieve the aims of the market sustainability plan.

3. Integrated Community Response

We will work with others to further develop an integrated community response offer. This offer will also meet the outcomes of residents in the Wakefield District.

4. Integration with the Integrated Care Board (ICB)

The Local Authority and ICB have a shared vision. This is a vision of how integrated care and better outcomes will be commissioned and delivered. Organisational and supporting processes will be aligned to ensure value for money, person centred, coordinated care.

5. Co-production

Our approach will involve people who use health and care services and communities. This will engage groups of people at the earliest stages of service design, development and evaluation.

6. Early intervention and prevention

Individuals to have choice and control in a flexible way.   This will happen by giving them the opportunity to use their personal budgets to buy self-directed care and support. Using community assets to meet their outcomes is also important.

Our primary aim is to ensure, where appropriate, people’s care needs are supported closer to home and therefore avoid hospital attendance. At the same time we will also focus on approaches to support people earlier and to diversify our market through use of personal budgets.

The situation in Wakefield - key messages for the market

In the Wakefield district we are seeing

Increasing demand for care and support.

Partly due to an ageing population and people with long term health conditions living longer. Current trends suggest there will be a 21% increase of people aged 65+ receiving longer-term support by 2030. This could be in the community, or in residential or nursing care settings. 

A reduction in the demand for long term residential care.

This could lead to an oversupply in the current market. This is reflected in the decreased spend in residential and nursing care from 2021 – 2022 to 2022 – 2023.

A corresponding overall increase in demand for domiciliary care.

By October 2022, at the end of the previous domiciliary care contract, there was an average of 15,000 hours of domiciliary hours being supplied. This has now increased to 20,000 hours. This is in line with national modelling suggesting that people do not want to move into residential care. People prefer to stay in their own homes for as long as possible. This is in line with the home first approach which is supporting individuals to remain living in their own homes.

A future predicted increase in the demand for dementia and dementia nursing care payments.

There is currently undersupply of this in the market.

A gap in the market for skilled workers in the supported living and domiciliary care providers.

This is reflected in increasing waiting lists for services. Providers tell us is mainly due to them struggling to recruit skilled care workers.

The need to ensure our Adult Care offer is sustainable within the current financial context.

It also needs to continue to meet the eligible needs of our adult population.

That there are challenges throughout the health and social care sector to recruit and keep the right number of staff with the right skills.

This is necessary to meet the increasing needs of people who need care. These challenges are recognised as a pressure for Adult Social Care nationally and in Wakefield. We will continue to work with providers to address workforce challenges and support the development of the market.

Background to the Wakefield District

Wakefield District is made up of the city of Wakefield and some independent rural and urban towns and villages spread across the district.

Who lives in the district?

Of the 353,802 people in Wakefield, 60.2% (213,070) are adults aged 18 to 64, and 19.0% (67,050) are aged 65 and over. 2.2% (7,705) are 85 and over.

The district is home to 353,802 people, an increase of 7% since 2012 and is anticipated to grow to 385,400 by 2030.

The 2021 Census figures show that 11.8% of our population define their ethnicity as other than White British compared to 7.2% in the 2011 Census.

Further information on population health needs can be found within the Wakefield Joint Needs Assessment.

Care Quality Commission (CQC) Ratings of Contracted Services in Wakefield

Key social care facts - what does the market look like

Long term support

Between 1 April 2021 and 31 March 2022:

• we provided 906 short term services to maximise people’s independence
• 5,616 adults received long term care and support, either in the community or in residential or nursing settings
• 64% of adults receiving long term care were supported in the community, 36% were in residential or nursing care setting
• 490 aged 65 and over were permanently moved into residential care with our help (including self-funders)

At the end of June 2023, there were:

• 1,527 people aged 18-64 in receipt of long term support - 83% supported at home
• 2,781 people aged 65+ of which 60% supported to live at home

Short Term Support

Between 1 April 2021 and 31 March 2022:

• there were 906 episodes of short term support to maximise independence provided. 775 (85.5%) were new referrals and 131 (14.5%) from people already in receipt of a longer term service
• the number of episodes of short term support for new clients has decreased 11% compared to 2020 / 2021 (95 less) and 21% for existing clients (34 less)
• 192 people went on to receive long term support in comparison to 260 people in 2020 – 2021

What do we know?

The demand for new requests for support with social care services in Wakefield district is growing. In 2022-23, Wakefield Council’s adult social care received 12,383 new requests for support: an average of 34 per day. This demand is growing in line with population increase. Other types of demand on our services, such as applications to authorise Deprivation of Liberty (DoLS), adult safeguarding and provision of equipment have shown an increase year on year.

Personalisation and Prevention

Voluntary Community and Third Sector

We have a framework called the Third Sector Funding Framework. We want to use this framework to develop a strong third sector that which offers alternatives to public services. This will help our local communities in the Wakefield District by building on community assets and bringing many benefits. We will use the framework to support how we fund the Voluntary Community and Social Enterprise Sector (VCSE) across the district.

Our key commissioning messages

We aim to continue to offer a mixture of grant funding agreements and contracts going forward for the third sector. Available funding will be balanced with terms of agreement. This is to secure financial stability for businesses.

We will review existing funding agreements and find gaps in services. We will use the Third Sector Funding Framework to commission low level preventative support. This will be at a community level where appropriate.

We will move towards an asset-based commissioning approach. This will enable people, communities, and organisations to work together as equal partners. This will mean they can best use of all assets to improve whole life and community outcomes. 

Develop the market in relation to community-based support. This will encourage and support innovation from service providers. This will hopefully include providers expanding their role in communities to provide a broader offer.

Extra Care Schemes

Extra Care Schemes across the district offer a total of 218 beds, 194 of which Wakefield Council has nomination rights.

1. Sherwood Court, Kettlethorpe
2. Frickley Mews, South Elmsall
3. De Lacey Gardens, Pontefract
4. Whinn Dale, Normanton

Key commissioning messages

We are not currently exploring opportunities for further schemes as there are vacancies.

The care and support within Extra Care is commissioned from the independent sector for two of the schemes. We will explore this model for the remaining two schemes where we currently deliver care in-house.

Personal Budgets

We want more people to use direct payments in all areas of service. We are also improving how we handle individual service funds. Our goal is to help more adults use personal budgets. This is by finding new ways to support them and promoting personalised care.

Our key commissioning messages

We want to review our current offer for direct payments. This will empower more people and give them the opportunity to be creative with options to purchase self-directed support. 

We want to re-commission the direct payment support service for a period of two years. This may be expanded to offer a choice of providers, increasing choice and control.

We want to increase take up of direct payments individual service funds across all service areas.

We want to increase the number of personal assistants employed across the district.

Working Age Adults

Learning Disability and 18 to 64 services

We are seeing a small but growing need for residential placements mainly for more specialist local provision. Outside of learning disabilities we are also seeing a growing gap for younger individuals with early onset dementia and other long term health conditions.

Our key commissioning messages

We want to reduce the use of out of district placements and the number of learning disability residential placements. We will develop other accommodation options with providers and registered housing providers. For example, appropriately adapted supported living.

We want to introduce more formal contracting arrangements for spot specialist residential placements jointly with the Wakefield Integrated Care System.

We want to understand the needs for young adults. Particularly those with early onset dementia who do not fall into learning disability / autism categories.

Supported Living

We expect a small growth in demand for other accommodation choices. This includes appropriately adapted general needs housing and is due to the following factors:

There are more young people coming through transitions from children to adults’ services who are wanting to be more independent and move from the family home.

There are more people living with elderly parents or carers who need long term accommodation plans.

There are still several people living in residential placements which we believe could be better supported to live in their local community through tenancy-based housing.

The Transforming Care Agenda to avoid long term hospital stays. The need for specialised supported living accommodation for people with complex needs also affects it. This can relate to the design and environment of the properties. It can also relate to the expertise and training of the support staff. Often it relates to both.

Our key commissioning messages

There are currently two contracts for supported living. We will combine them into one contract separated into three equal parts.

Some of our supported living properties have been empty for a long time or aren't fit for purpose. We will review the commissioning of these.

We will work with providers to make supported living services more efficient. For example, through greater use of telecare and shared support.

We will develop a framework for housing providers to support when new accommodation developments are needed.

We will continue to transform the current stock of properties.

Support and Enablement

Currently supply is meeting demand, but there is a small waiting list. This is for smaller packages where a few hours a week is required, or for more rural areas where it is harder to recruit carers. There is a small demand to support more complex individuals or those who wish to change provider.

Our key commissioning messages

We want to explore the use of individual personal budgets. This includes individual service funds, cash budgets and direct payments. This is to stimulate choice within the market.

We want to explore having one contracted framework. Re-procuring a new framework that covers support and enablement (MyLife framework) and supported living could enable this.

Daytime Activities

People with learning disabilities, including those with more complex needs, should be able to access meaningful daytime activities. There is currently a lack of provision for people with these kinds of needs.

There are several groups that potentially offer alternative day activity opportunities. This would expand local provision and choices for individuals. We need to understand this market more. We also need to understand how individuals can access these opportunities through use of their personal budgets.

Our key commissioning messages

We will develop a framework of day activity and short breaks options. This will include options for people with behaviour that challenges or with profound and multiple learning disabilities.

We are looking to improve employment opportunities for people with learning disability / autism.

We will continue our move away from building based daytime activities. This move will be towards more vocational and community-based activities. This will happen through a more creative use of individual personal budgets to stimulate choice within the market. It will be recognised that there is still a small need for building-based day activities.

Short Breaks

There is a growing waiting list and lack of local provision, including for emergency respite. There also continues to be a reliance on commissioned bed-based provision for more adults’ short breaks. There are many ways of providing a short break beyond overnight residential provision. However, for many individuals and their families overnight stay remains important. These need to be explored further if we are to meet the increasing demand.

Our key commissioning messages

The commissioned overnight short break services are going back out to tender in 2023.

We will work with families, providers, and individuals to explore alternative options in the market for short breaks and overnight stays. We can support people to develop their independence and life skills.

We will commission a framework of short breaks providers.

We will look at alternative ways people can use their personal budget for breaks.

Housing and Accommodation Pathways – Homelessness Prevention

Homelessness Pathways

Like most councils, we are seeing an increase in the number of homeless people. This is particularly the case in the current economic climate. This is against a competitive letting market for general housing. Individuals are also presenting with more complex needs, particularly mental health needs. This means they need more support over a longer period of time against limited housing options, so waiting lists are growing. Providers are also finding it harder to recruit staff without housing support experience.

The homelessness pathways have been in place for several years and are due to be re-tendered in 2025. In preparation for this we need to review these. We want to re-commission these differently in future to meet the changing market.

Older People

Domiciliary Care

We follow the Home First approach. As of the 23rd of July there are around 1,500 people staying longer in their own homes. This is with the support of Domiciliary Care. This has had a positive impact for users of these services. However, this means carers need more training to meet the care needs.

We also recognise that as a system the current time and task model has been in place for a while.  We know that we now need to work with providers and our provider forums and provider groups to co-produce a new model with them.

Our key commissioning messages

We plan to retender the Domiciliary Care contract and move to a new model and joint framework with the Integrated Care Board (ICB). As part of this we are pursuing the option of a flexible purchasing system. This will restrict the number of contracted providers but will allow new providers to be appointed as and when needed. This will be an integrated commissioning approach.

Over the longer term we are exploring a more locality / geographical based model to help improve sustainability in this sector. This would make it easier for providers to employ non drivers. There would also be less travel time and lower fuel costs which would have a positive impact on the environment.

The urgent response service has been successful. Due to this there is the intention to procure this service again to ease winter pressures between November 2023 and March 2024.

Commissioning a 24-hour domiciliary care support service model is being considered. This would fulfil the Home First approach and avoid admission to care homes. The focus of this would be to allow for assessment over a 24-hour period. This would allow health and social work assessments to take place and increase the opportunity for reablement at home.

Care Homes

In Wakefield we have an oversupply of residential beds. There is also an insufficient capacity for nursing, including nursing dementia. There are changes to occupancy rates from taking a Home First approach. Our data is telling us that there is an increase in the number of people receiving domiciliary care in their own homes. This is also happening for longer. This supports our Home First approach. However, it impacts on our traditional 65+ care home placements that the market relied upon.

Wakefield Council and ICB is currently working with care providers in this sector to better understand these changes in needs. They are also trying to understand how we need to develop the care home market going forward. Providers in this sector have also advised us of the impact of various pressures. These include the cost of living crisis, higher than inflation increases in utility costs, and a lack of nursing staff.

The main initiative to support hospital discharges and winter pressures has been the commissioning of Discharge to Assess (D2A) block beds in care homes. This was to support timely discharges and was successfully trialled between November 2022 and March 2023. With funding from the Hospital Discharge Fund this initiative has been funded for a further year with 5 care homes supporting 25 block beds.

Our key commissioning messages

To develop a new care home strategy and integrated framework with the ICB over the next 3 years. Phase one of this approach is to align contracts and we are due to start an interim framework towards this in 2023.

To have a joint contract in place with the ICB from April 2025.

To have a better understanding the implications of the Home First approach on this sector and the resulting increased complexity of residents.

To review the use of one to one’s and how best to develop the care home market going forward including D2A to meet Winter pressures.

Carers

The Council commissions a single, integrated service to provide support to adult and young adult carers residing within the Wakefield District. Carers Wakefield and District provide an integrated and flexible support service. This includes carer support workers who have specialist skills and knowledge to meet the needs of specific carer groups.

Using the Think Local Act Personal (TLAP) Making it Real Statements we want unpaid carers to be able to say:

• "I have the right information and advice to be able to make informed decisions"
• "I have access to appropriate support that suits my needs, including respite care and carers’ breaks"
• "I am identified, recognised and valued for the care that I provide"
• "I am respected for the skills, experience and knowledge that I have and am treated as an equal partner in care"
• "that care and support identifies me as a carer and is tailored around my needs as well"

Our key commissioning messages

To continue to work closely with our Public Health colleagues to review our carers offer. This needs to be across all service areas to identify gaps in support.

To increase the uptake of carer assessments and personal budgets offered.

To increase advocacy support.

To work with district wide partners to provide carers access to tailored information and support. This is to promote overall wellbeing and help them to achieve the outcomes which matters most to them.

Workforce Recruitment and Retention

What do we know about the Adult Social Care Workforce in Wakefield?

For Wakefield, Skills for Care provides local analysis.

The 9,500 in 2021 / 2022 was comprised of 8,600 filled posts and 950 vacancies.

In 2022 / 2023 increase of 250 posts (3%) and the number of vacancies has increased by 275 (14%).

Working aged over 55 represented 27%. Given this age profile, approximately 2,200 posts will be reaching retirement age in the next ten years.

Staff turnover rate in Wakefield was 26.1% which was similar to the region average of 28.1% and lower than England at 30.0%.

For more information and support with recruitment and retention, please visit the Skills for Care website.

What do we need to develop?

The Adult Social Care Reform white paper sets out a 10-year vision for adult social care. It includes plans from the government to work with the adult social care sector. This will be to develop and invest in knowledge, skills, health and wellbeing, and recruitment policies to improve social care as a long-term career choice.

Workforce recruitment remains a significant challenge locally. So we have invested in a Wakefield Cares Careers Hub (WCCH). The hub will support a sustainable workforce market for care and support services across the district. This supports the attraction and recruitment of people into the sector.

Wakefield has also developed the ‘Make a difference programme’. This is intended to support both internal and external provider recruitment of vacancies. It is also a training programme to help people that may not have relevant work experience. Or people who may not have had the opportunity to train for a career in adult social care.

Wakefield is keen to work with the care sector to ensure that we continue to develop our workforce strategy and skill mix across the sector. We are listening to provider feedback and scrutinising the current demand for social care support. This is to ensure we target our service delivery and shape commissioning activities around a sustainable workforce.

Using the TLAP Making it Real Statements we want people receiving support to tell us:

• “I am supported by people who listen carefully, so that they know what matters to be and how to support me to live the life I want”
• “I have considerate support delivered by competent, well-trained people”

We want people working in the sector to say:

• “I am proud to care in Wakefield”
• “I am a care professional”
• “I have the skills and confidence to deliver high quality care”

How much do we spend on adult social care in Wakefield Council?

Financial Year 2021 / 2022 and 2022 / 2023

The total spent on adults aged 18 to 64 in 2021/22 was £46,693,000. In comparison the amount spent on the same in 2022/23 was £53,745,000.

The total spent on all adults aged 65 and over in 2021/22 was £46,693,000. In comparison the amount spent on the same in 2022/23 was £57,855,000.

What do we know?

The adult social care budget for 2023 / 24 has been increased to consider the increased cost pressures to providers, particularly in relation to National Living Wage increases and inflationary pressures. The budget increase has been partly funded by the adult social care discharge fund and market sustainability and the Fair Cost of Care grant fund, the Social Care grant and the 2% adult social care precept.

Nationally and locally, there is a significant challenge around the financial vulnerability of certain elements of the independent care sector and that will have a future impact on our local care market. We recognise the risk this brings and the need to fund our commissioned care and support providers in a sustainable way that enables them to pay competitive wages that reflect the quality of care that is expected from staff, and we are working towards the Department of Health and Social Care (DHSC) Cost of Care exercise outcomes.

What do we need to understand?

However, despite additional funding provided by the Government, closing the gap could more than double the current budget the Council has available. Given our budget constraints and pressures, it is unlikely that we will be able to fully meet the funding gap. However, we aim to work with our care sector to test and better understand where the financial pressures are and how we can best support the sector within the funding resources that we have available.

We split commissioning into three main areas:

1. Personalisation and prevention
2. Working age adults
3. Older people

YorTender advertises all tender opportunities. You can find more information on our procurement and tendering pages. This page describes the current commissioning arrangements and the current market.

Personalisation and Prevention

Our current funding agreements and contracts support personalisation and prevention across the Wakefield District. Some of these are jointly funded and / or commissioned with our Integrated Care Board (ICB) and Public Health. We work with a range of providers, including many Voluntary, Community and Social Enterprise (VCSE) organisations. This is to focus on promoting wellbeing and offering early targeted help. We have 15 active funding agreements which support a range of early help and VCSE initiatives across the district.

Carers

Carers are supported by:

• adult social care supporting 2,455 carers to balance their caring role during 2021 / 22
• carer’s assessments being offered to look at how caring affects their own life
• our belief that all carers deserve a quality of life and to live the lives they want to live

• our future plans to benchmark and improve overall service for carers

We will use the Yorkshire and Humber Carer Quality Markers to do this. This is because we know the importance of identifying and recognising unpaid carers

Working Age Adults

Current Commissioning Arrangements

Within Wakefield, the Council has lead commissioning responsibilities for several things. This includes adults with a learning disability and for autistic adults. It also covers mental health support and homelessness community and housing related support. The Council has lead responsibility for mental health social care. This is with our local mental health trust, Southwest Yorkshire partnership NHS foundation trust.

The main commissioning responsibility for mental health inpatient services sits with the Wakefield Integrated Care Board (WICB). WICB are part of the West Yorkshire Integrated Care System. Their work includes leading on the Transforming Care Programme. Wakefield is part of the Calderdale, Kirklees, and Wakefield Transforming Care Partnership (CKW TCP).

The council contracts are also used for people who receive continuing health care funding. This doesn't include those who are fully health funded.

Funding Agreements

The council also has three funding agreements for working age adults. This includes three for daytime activities and peer support. There is also one for supporting victims of domestic abuse, and one for cold weather shelter for rough sleepers. We review these on a two-year cycle.

For all services we will be considering how we can use direct payments, individual service funds, personal health budgets and cash budgets more creatively. These are for people to use for their care and support.

Specialist Residential Care

We provide specialist residential care to working age adults by:

246 adults with learning disabilities living in more specialist residential placements. This is at a total cost of over £20 million per year including 90 out of area placements.

In 2022 / 2023, there were 30 permanent admissions into residential. 70% (21) of these were from community, 27% (8) from hospital, and 3% (1) young person transitioning from children’s provision.

Making most placements on a ‘spot’ purchase basis. These may be fully funded by social care or partially funded with health. The numbers remain static year on year.

Supported Living

We provide supported living to working age adults by:

• 330 individuals living within Supported Living for people with learning disabilities and autism. It costs £18 million per year
• the council directly contracting 240 Supported Living units 

This is a mixture of shared properties and single occupancy flats. 24-hour support is provided in the majority of these. Some have sleep-in support at night and others a waking night support worker.

A Housing Needs Assessment was completed in 2020. This indicated that the emerging specialist housing need for people with learning disabilities was low. It estimated that 16 properties were required over the next 15 years. The report also highlighted the need for more general needs housing choices. This is because not all individuals required specialist housing.

Support and Enablement

We provide support and enablement to working age adults by:

• the Council’s pseudo dynamic purchasing framework of providers called ‘MyLife’. This is to support individuals in their own home or living with family, friends, or other carers
• having 22 providers on the framework who deliver 7,000 hours per week

The service covers these groups of adults and young people:

• adults with learning disabilities
• adults with autism
• young people moving through transitions
• adults with acquired brain injuries
• some adults who may have more complex learning disabilities that may challenge services

They are eligible for social care services and / or NHS joint / fully funded packages of care.

The framework is an open framework and new providers can apply to join. Providers must be CQC registered to support adults with learning disabilities and autism. They must also have experience of doing this.

Daytime Activities

The current pathway for young people and adults with learning disabilities, in terms of daytime activities, is focused on day services. Historically there has been minimal involvement from commissioners in this market.

Providers do not have to be registered with CQC.

Services are commissioned on a ‘spot purchase’ basis without any overarching framework. This means that services are not ‘contract monitored’.

The largest provider of day services is the Council itself.

Short Breaks

We provide short breaks to working age adults by:

• commissioning overnight residential short breaks for around 54 people with learning disabilities
  This totals around 2,912 nights per year.
• arranging the majority of stays in advance and spreading them the year
  This is so that the individual and their family can have regular breaks.
• providing breaks at short notice in cases of emergency
  For example, if a carer is unexpectedly hospitalised.

This facility is currently fully subscribed.

Homelessness Pathways

Homelessness Pathways can support working age adults.

The Council commissions six contracts and two funding agreements. These are on behalf of the Council Housing Needs Service.

These providers are commissioned to support 522 people at any one time, providing 2,146 hours of support per week.

In addition, the Domestic Abuse Refuge provides support in 12 units.

This is to support homeless individuals with keeping their homes or finding new ones.

The Council also contracts provision of short-term accommodation for families fleeing domestic violence. This is also for temporary accommodation for individuals who are homeless.

Providing housing support and support with accessing other professional services. These include Mental Health support, addiction clinics and other preventative services.

Older People

Current Commissioning Arrangements

Adult social care has a strategic priority for people and communities. It states that: “we will support people to live safely in the place they call home with the people and things that they love, in communities where people look out for one another, doing things that matter to them.

To meet this priority, we have adopted a Home First approach. This includes our Hospital Discharge Pathways throughout the System Discharge Programme of work. 

This programme of work is a partnership across health, social care, voluntary and providers. It has created our Integrated Transfer of Care Hub (ITOCH), with post discharge tracking and support and Care Home liaison function.

The programme has also introduced several new services to improve discharge outcomes, including:

• voluntary care sector discharge model (Connecting Communities)
• dementia support pathway
• reablement and integrated care team expansion
• domiciliary care urgent response service
• night response service
• virtual ward
• rehabilitation into the community beds (D2A)
• a challenging behaviour unit
• step up / down community beds in the district to support safe and timely and complex discharges

Discharges have been increased by 11% in the second half of 2022 / 2023 and our domiciliary care waiting list has considerably reduced.

Current Council Contracts

The Council commissions Domiciliary Care and Care Home provision for fully and joint funded Social Care packages. The Wakefield Integrated Care Board (ICB) have NHS contracts in place for their fully funded CHC placements provision. As we are moving towards integrated commissioning. Our future intention is to commission these jointly with the ICB.

Domiciliary care

There were a high number of domiciliary care packages awaiting allocation to a commissioned domiciliary care provider before October 2022. Several non-commissioned providers were used on a 'spot contract' basis to meet demands. There has been a recent re-tendering exercise. As a result there is no waiting list for domiciliary care within Wakefield. The use of spot providers has also considerably reduced.

Care homes

Within the Wakefield District, there are:

• 96 residential and nursing homes with 2,797 beds registered with the Care Quality Commission (CQC)
  These cater for older people’s needs (65 and over) and younger people’s needs (under 65 years).
• 67 residential and nursing homes with 2,569 beds registered with the Care Quality Commission (CQC) in Wakefield District
  These cater for older people’s needs (65 and over).

These homes accommodate service users with a range of care needs, including dementia, mental health, learning disabilities and physical disabilities.

The Council has a Framework Agreement for the Provision of Care in a Registered Care Home. Within this:

• 48 care homes (2,173 beds, 85%) registered with CQC
  These cater for adults 65 and over are contracted under the Framework Agreement.
• 40% of all placements in residential homes and nursing homes are funded by Wakefield Council. 25% are self-funding their placement
• there are three internal Wakefield Council care homes and 18 non-contracted care homes
  The council also contracts 62 external care homes.
• 37 homes providing residential care, and 11 homes providing nursing care

Over the past five years, 39% of contracted nursing homes in Wakefield have stopped providing nursing care. This reduces capacity to meet the needs of individuals who need nursing or nursing dementia placements. This is creating pressure in the market.

Table one illustrates the occupancy levels per type of care. (Care homes are registered for more than one care category, so the figures in the table do not total the figures stated above). Some homes have flexible vacancies, for example, a vacant bed may be used for residential or dementia depending on needs. The reasons for unavailable vacancies vary. It includes outbreaks, insufficient staffing levels, refurbishment, management decisions and voluntary embargos.

For residential and residential with dementia around 90% of provision is occupied. This includes vacancies unavailable. This could suggest a future need.

Quality Assurance

Both the Council and Integrated Care Board (ICB) want to collaborate with providers to drive up quality across the district. They believe that working closely with providers will support a higher quality and vibrant market. To do so the Council and ICB have taken an integrated approach to how we manage quality and provider oversight. This oversees arising risks and concerns in relation to provider performance. Our aim is to work in partnership with providers and the CQC to address these. We have developed an Integrated Quality Assurance Framework with the ICB as part of our joint quality assurance approach. Within this strategy Wakefield is making a commitment about quality and effectiveness. We promise people will receive personalised, high-quality reliable services.

Through quality assurance we seek to:

• evaluate what we do
• identify and consolidate strengths
• address weaknesses
• learn in order to improve what is offered and delivered to people with care and support needs

Single Shared View of Quality

Using the TLAP Making it Real Statements for quality we want people to tell us:

• I am confident that the people supporting me have the skills needed to meet my care and support needs in the best way
• I feel safe
• at all times I am treated with dignity and respect

We want providers to tell us:

• I feel supported to deliver high quality of care
• I will encourage and support my staff to progress their career in the social care sector
• I will employ suitable qualified managers who have a collective vision of what “good” care looks like