Commissioning Intentions
Advocacy – The Council currently spends £0.252m on advocacy support. This level of investment is likely to continue until 2023 when the Council will retender the contract for advocacy services. The contract for advocacy will be retendered and awarded in July 2023 via the Council e-tendering system “The Chest”.
It is expected the demand for advocacy support will increase proportionally with population growth. There is also anticipated to be an increase in demand for Independent Mental Health Advocacy (IMHA) as a result of increased availability of provision in the borough for people with Mental Health supported in hospital settings.
It is likely we will see an increased demand for IMHA due to changes seen within the Draft Mental Health Bill, as the offer of an IMHA will be extended to those patients that are staying in hospital voluntarily or informally as opposed to just those detained on formal orders.
It is anticipated that the move to Liberty Protection Safeguards (LPS) will increase the demand for Independent Mental Capacity Advocates, particularly due to the increase in eligible settings and expansion of age range. Mental Capacity Act Deprivation of Liberty Safeguards (MCA DoLS) will be transferring to Liberty Protection Safeguards (LPS); this is estimated to take place in 2023-2024. LPS now apply to not only care homes and hospitals but also Supported Accommodation, Shared Lives accommodation and people’s own homes. 16- and 17-year-olds will also come under the LPS framework too.
Community Navigation – The Community Navigator contract has demonstrated value for money both in terms of cost avoided within the statutory sector and improved quality of life for those accessing the service, and this underlies the Council’s decision to continue to support this through a new contract.
Knowsley Council has commissioned a service called Knowsley Networkers. This contract is jointly funded with NHS Cheshire and Merseyside (Knowsley Place). There were 140 new referrals in the year to November 2022, and we would expect similar number in 2023/24. There has and continues to be a steady rate of referrals into the Knowsley Networkers Service, and this trend looks set to continue. Most referrals will now be made via the Healthy Knowsley Service (HKS) Single Point of Access (SPA).
Community Support and Employment – Community support and employment services largely support people with a Learning Disability or Mental Health condition to access meaningful activities, work, volunteering or learning opportunities.
There have been an increasing number of these services and support options start up in Knowsley over the last few years and we see this as a continuing growth area particularly as the Council begins to transition away from traditional day service models, in which the Council will continue to invest in. The Council will increase its commissioning activity in this area, but residents will also be supported to take a Direct Payment to choose the support which best meets their individual aspirations.
Technology Enabled Care (TEC) – (previously been referred to as (AT) Assistive Technology) – The Council will continue to support the provision of TEC services through revenue resources. We will continue to look for opportunities to work with our partners in health, including looking for external funding. The Council will work in cost effective ways such as looking to help people make use of the technology that they already have access to. We are also keen to work with sheltered and supported living providers to ensure they are ‘future proofing’ homes with this solution in mind, and ensuring they are adopting new models for properties.
We are aware that technology is changing all the time and there are new equipment items on the market. We therefore require our commissioned services to offer a choice of flexible options that offer value for money.
This current contractual arrangement for the provision of the TEC service will continue until December 2024 during which time a strategic review of the TEC offer will be carried out which will consider the implications of, and the opportunities presented by the switch to digital telecommunication in 2025, especially around health monitoring and intervention. Growth areas include TEC as first approach services to respond to the growing demand for truly preventative technology that uses data analytics to prevent incidents from occurring, not simply providing a response when an incident occurs.
Carers Support – There is a range of support available for carers in Knowsley through universal services (those available to the general public), targeted services and through the community and voluntary sector. However, we know that there are gaps in provision. The All Age Carers’ Strategy 2020-2025 brings together the knowledge of Council services with that of a range of partners and carers in the borough. The Council and local stakeholders have been refreshing this Strategy and it will start to be implemented in 2023 onwards.
The strategy has long term priorities which include: Health and Wellbeing – support to recognise how caring is impacting on your physical or mental health; Leisure and Culture – ensuring that carers have opportunities to leisure and culture activities to enable regular breaks from their caring role; Carers Assessments – supporting carers with their needs and aspirations; Maximising Income – supporting carers to maximise and make the most of their income; Need for a Break (Respite) – Ensuring carers can access regular breaks for themselves and the person they care for; Loneliness and Social Isolation – Supporting carers to explore opportunities to build and maintain relationships.
The Council is particularly interested in working with providers who can provide respite and regular short breaks in a variety of settings to support carers. Market opportunities for Carers services and support will be advertised to the market in the summer of 2023 via the Council e-tendering system “The Chest”.
The current budget for carer’s prevention and wellbeing universal services is £0.475m per year.
Domiciliary Care – Domiciliary Care provision is currently being reviewed throughout 2023, with a view to developing the model further, including outcomes-based commissioning and the delegation of tasks currently undertaken by health professionals to domiciliary care providers.
In 2019, Knowsley Council introduced the role of Trusted Assessor within domiciliary care. This allowed agencies to make referrals to social care where a judgement had been made that a change to the level of care was necessary and following the review, we anticipate further development of Technology Enabled Care and Community Equipment to aid this.
The Council and NHS Cheshire and Merseyside spends in excess of £13 million on domiciliary care annually and expect to commission approximately 14,500 hours per week.
We anticipate further opportunities for lead providers to bid would commence around October 2023. The Council is considering different delivery models, and any opportunities in the future will be advertised via the Council’s e-tendering system “The Chest”. Providers can also apply to be a spot provider on The Chest. Applications can be made twice annually and will be evaluated periodically throughout the year. Spot providers can pick up business across all zones in Knowsley that lead providers are unable to deliver.
Personal Assistants (PAs) – Currently the Council and its partners in Health spend £10.2m on supporting Knowsley residents to employ Personal Assistants. Investment in this area is expected to increase as the more people are supported to recruit PAs to meet their needs in more personalised ways.
Organisations can join the Open List of providers who can support people to manage the employment of PAs by agreeing to work with the Council and maintaining a minimum set of standards. If you would like to join the Open List, please contact Knowsley’s Whole Life Commissioning Team via wlct@knowsley.gov.uk.
There is a significant market opportunity for Personal Assistant’s to support people in Knowsley.
Shared Lives Carers – The Shared Lives scheme is currently under review with phase one completed and phase two to be completed by the end of 2023. Once completed this will inform the future commissioning arrangements for the service, which is anticipated to lead to increased investment in the recruitment to and retention in Shared Lives carers.
As the Shared Lives Carers Scheme is managed by Knowsley Council’s in-house provider services, those who wish to enquire about the possibility of becoming a Shared Lives Carer should contact the Council on 0151 443 2060.
Supported Living – The Liverpool City Region Local Authorities have collaborated on the development of a Complex Care Flexible Purchasing System. Providers seeking opportunities are required to apply to join this framework. The Council will be seeking to work with and develop a range of providers to support people with Learning Disabilities and Mental Health conditions – we want to encourage a mixed market of providers who can deliver truly personalised support.
Currently the Council and its partners in Health spend £19.6m on Supported Living. While there is expected to be an increase in demand for Supported Accommodation, as the model becomes more about enabling people to develop independent living skills, especially as it is predicted to be the preferred option for young people transitioning from children’s services to adult services. It is anticipated that there will be no significant increase in the budget for Supported Living. However, this remains a significant market opportunity for providers of these services.
Extra Care – The Council will continue to invest in Extra Care housing over the next five years as the preferred option for meeting Knowsley residents housing and care needs aiming to continue the trend of decreasing the amount of people entering residential care and instead meeting their needs by Extra Care housing.
We want to work with developers and care providers with ideas about core and cluster models for Extra Care with mixed developments, which have independent living options with additional units for respite and step up / step down support or end of life care. There is a need for all models of Extra Care in Knowsley ranging from affordable rent to full ownership and we are asking providers to consider “mixed communities” as part of future models. The Council’s Allocations Policy describes how supported housing and Extra Care places are prioritised within the Borough. This policy is being refreshed and is expected to be published in Spring 2023. The Council will refresh the Extra Care Sufficiency Strategy, and this will guide development opportunities.
As new schemes are developed, there will be opportunities for providers to deliver the on-site support in these schemes and the care and support being delivered in existing extra-care units will be subject to a competitive tendering process when current contracts expire. Possible tenders will be advertised via The Chest, the North West’s Local Authority Procurement Portal.
Residential and Nursing Care – Currently the Council and its partners in Health spend £11.6m on nursing care in the borough. The spend on nursing care is expected to increase in line with the projected increase in demand in this area.
There will be continuing reductions in residential care placements as we carry on developing alternative service models which will mean a further reduction in residential care beds commissioned. The Council is fully committed to reduce its use of residential care as this model of provision is not suitable to meet the needs or aspirations of people in Knowsley.
In 2020 the Council has developed a new specification and terms and conditions for residential and nursing care providers which were launched through the retendering of residential and nursing provision in the borough; it is a Pseudo Dynamic Purchasing System (PDPS) framework which is open to new providers who are looking to operate in the Borough of Knowsley. This opportunity is available via the Council’s e-tendering system, “The Chest”.
In addition, a standard specification is being developed across the Liverpool City Region in 2022/23. It is anticipated that there will need to be one new nursing home and one new dementia nursing home opened in the Borough to meet the demand for nursing care from the Older Peoples populations group.
The Council is interested in hearing from providers who wish to either open a new home in the borough or who wish to transition from residential care to nursing provision and dementia nursing provision. The Council and its partners will actively engage with residential care providers to encourage and support alternative models of delivery such as nursing and dementia nursing provision. Consideration will need to be given to registration, staffing and access to training.
Home First – The Council intends to continue the development of services that enable people to remain in their own homes as long as possible, avoid unnecessary hospital admissions and return home from hospital and other care settings as soon as they can.
The council is undergoing a review of community response services currently with the aim to ensure the future model will address the changing needs of Knowsley residents. The Council will also place greater emphasis on measures that will get help to get people home directly from hospital, for example through the increased use of the Technology Enabled Care wherever possible.
It is anticipated that at times of higher pressure, the Council may continue to put in place short term measures, to relieve pressure on hospitals. The Council will also consider options for future delivery models with regard to Intermediate Care provision towards the end of the year 2023 and will look for opportunities to embed rehabilitation within nursing services going forward. All our commissioned care and support services will be required to implement enabling approaches.
The Council remains committed to its Home First approach and to delivering Step Up / Step Down services that maximise independence and help relieve pressure on acute hospital services. Typically, the Council also receives additional funding each year to assist with winter pressures, and it uses those funds to implement short term increases in services, which help to prevent hospital admissions and expedite hospital discharge. Following the completion of the falls response service pilot project, the Council will evaluate the impact of the services and if necessary, seek additional funding to continue the service into the future
The Council anticipates that there are likely to be opportunities within the market for services that support Home First and Step Up / Step Down approaches. These include, but are not limited to, short term projects to address winter pressures and potential long term falls response contracts. Any opportunities within these areas will be advertised to providers via The Chest.
To deliver our plans to meet the care and support needs of adults in Liverpool, we require a market as diverse as our population, consisting of a variety of providers of different shapes and sizes, who want to collaborate with us to innovate, and provide exceptional care and support for adults in the city that improves their prospects, outcomes and experiences. We are keen to talk to and support new and existing providers who have ideas that align with our transformation themes, want to share best practice and develop outcome-based care and support provision for adults in Liverpool. We want to develop our partnership with the VCSE sector, making commissioned opportunities more accessible to local organisations who are passionate about the places and people they work in and with,
and invest in exceptional organisations to increase their capacity.
We see the post COVID-19 environment as a chance to express some choices about how we recover, to ‘re-set’ some service offers, to connect differently with providers and partners in ways that build on the best of our efforts together during the pandemic and ways that embrace the innovation we showed.
Residential and Nursing Care
Nationally, older people make up an estimated 95% of care and nursing home residents, and if we look at the availability of beds for the increasing numbers of older people, these have declined from around 11.3 beds in care homes per 100 people aged 75+ to 10.1. Beds in nursing homes have shown a smaller decline. In line with those national trends, the number of residential and nursing placements commissioned by Liverpool City Council has decreased over the past five years. The reduction in beds correlates with an increased spend on preventative services, and services that support people to live independently for longer.
Reablement and Prevention
As we focus on promoting the independence and wellbeing of residents, we will increase the number of beds we commission from providers that offer support to people to be able to live in a community setting again – whether their own homes, sheltered or Extra Care facilities. Some existing care home settings may evolve to specialise in this kind of care.
We have invested in a variety of community projects that seek to prevent or delay the need for residential care. These include rehabilitation support to individuals in their own homes and on a residential basis, new and alternative ways of meeting the support needs of people living in their own homes, reducing isolation and improving and increasing the interaction people have with others and within their own communities. In line with our transformation themes, over the next five years we will actively increase the level of spend on preventing and delaying the need for residential care.
Home care
Home care plays a fundamental role in Adult Social Care and is vital to enable people to remain living in their own homes for as long as possible. Home care is the largest of all social care service areas, with 26 providers offering 30,000 hours of care and support per week to just under 2,500 clients at any one time, through around 3,000 carers. The number of people who purchase their own home care through agencies is not known.
The need for home care increases every year, though the data would suggest that this is as much due to increases in demand for adults with more and more complex needs as it is from the growing volume of older people in our population who are living with frailty and dementia. As demand for residential and nursing care contracts decreases, in the short term at least, due to the impact of COVID-19, we expect demand for home care to exceed pre-pandemic levels.
Assistive technologies and telecare
Use of technology to enhance social care provision in Liverpool has, however, got so much more potential to support more people in Liverpool and during the COVID-19 pandemic, remote working proved to have a reach way beyond initial assessments. Over the next 3 years we intend to increase the use of assistive technologies by at least 4,000 to support people to live independently for longer, enabling people to do things for themselves where they can, and in some cases as an alternative to increasing care services.
We are making plans to move to new methods of connectivity, including the 5G test bed, and planning that the new telecare service from 2021 will provide a wider range of equipment. Our new approach to service delivery underpinned by technology will need us to focus on problem solving, not the equipment itself. The technology is an enabler to system transformation, not a bolt-on optional extra.
Community Support and Supported Living
Day Services: Most day services in Liverpool are designed for and accessed by adults with learning disabilities. Traditionally, people have accessed the same day services in Liverpool for long periods of time throughout their lives. Our vision for day provision in Liverpool will align with the all-age approach to quality of life that we are adopting across the local authority, providing opportunities for people that connect to their age and stage of life, personal hobbies and interests, and offer positive outcomes, enabling them to progress their independence, where possible.
Supported Living: We currently support 1,028 adults in supported living arrangements 850 individuals are living in shared housing arrangements, and 178 are living independently with 24-hour support. All adults with learning disabilities or mental health conditions should have the opportunity to live as independently as they are able to, within their own tenancies or accommodation where possible with packages of care that they have full control over and that meet their individual needs, supporting them at different ages and stages of life to live full lives. By 2021, we will have reassessed the needs of every adult in shared housing supported living arrangements in the city, taking an asset-based approach to the care they receive, promoting and building on their strengths. We will actively move away from traditional shared housing models and as a priority, look to accommodate people within clusters of independent accommodation with care and support available as and when required, and utilising assistive technologies to promote independence.
Shared Lives: We currently support 95 adults in Shared Lives services, supported by 66 Shared Lives carers. Over the next five years, we will increase our use of Shared Lives to enable adults of all ages to remain living within the community within family environments. Specifically, we will seek to increase the number of Shared Lives placements available to people with learning disabilities to at least 150 over the next three to five years. Additionally, we will work with Shared Lives providers to develop alternative models of care and support using Shared Lives principles to create a range of service offers that improve outcomes and quality of life for adults with care and support needs in Liverpool.
Extra Care Housing: In Liverpool, we are in short supply of Extra Care Housing, and require an additional 500 homes to meet the needs of older people in our city. We will work with registered housing providers and developers to build a minimum of 500 Extra Care Homes over the next five years, with mixed tenures available. Additionally, we will work to transition suitable sheltered schemes in the city to extra care sites. We will promote dementia friendly design within new Extra Care provision and prioritise working with providers who can demonstrate innovation, meeting the needs of older people who may experience isolation.
Homelessness
We have a shortage of affordable housing across the city, specifically single bed-roomed, self-contained accommodation and houses that can accommodate larger families who require 4+ bedrooms. We are keen to explore new ways of working with social and private landlords in Liverpool who can enable us to develop an adequate supply of affordable housing. We require long term support services for people with Multiple and Complex Needs, that have a reablement focus, supporting vulnerable adults to live as independently as they’re able to. We depend heavily on temporary accommodation which can limit opportunities for people to move on or progress in their lives. We are keen to explore new models of accommodation that encompass outcome focused support for people.
We want to speak to community-based organisations who can support our plans for earlier identification of vulnerable households to design new services that
can support families through difficult periods and help them to avoid crisis that could lead to homelessness. We’d like to work with services that are funded from other sources to LCC to incorporate them into wider pathways for people who are homeless, rough sleeping and/or have additional complex needs.
The Market position statement outlines the models of care that Sefton Council wishes to encourage. It helps commissioners to develop effective approaches to address local needs and identifies the services and interventions that the
Council would be interested in commissioning. Good, well-functioning, Strategic Commissioning should include the following elements:
Focused on outcomes and population health
Based on an assessment of population need
About driving improved experiences for local people
Assessing and forecasting future needs
Planning the nature and range of future services
Strengthening local accountability Working in partnership – integrating processes and governance
Linking financial investment to population need
Built from system leadership and principles that bind members
We are committed in the future to further develop jointly commissioned services with our strategic health partners, the CCGs. The Integrated Commissioning Group is the key vehicle for this, it is a formal sub group of the Health and Wellbeing Board and includes key commissioning, Directors and Finance representation from the Local Council and the CCGs in Sefton. Joint commissioning will achieve economies of scale, savings and reduce duplication of services and most importantly drive improvements for people that live in Sefton. The resources saved can be applied to any gaps in service delivery.
This will include:
■ Enabling, through established governance mechanisms, pooled resources to develop a broader joint commissioning framework across partner agencies to direct the commissioning intentions for early help holistic approaches and maximise best value.
■ Develop an intelligence led approach to commissioning that draws together key public funding streams to develop a broader joint commissioning framework across partner agencies to direct the commissioning intentions for prevention and early help
■ Ensure all stakeholders, including adults and Unpaid Carers, have a voice at every stage of the commissioning cycle and provide feedback to measure and review impact and enable redesigned services that better meet the needs of the people who live in Sefton.