Market Position – Local Context

Local Context

In addition to the implementation of the Care Act 2014, the next 12 months will see the simultaneous implementation of a range of far reaching local work programmes which will shape Adult Social Care within the District. These include:

Integration of Social Care and Health – “Connecting Care”

The “Connecting Care” programme is tasked with the integration of health, social care and third sector community services within Wakefield District to support improved outcomes for the citizens of Wakefield District in the context of the local demographic challenges and the acute hospital reconfiguration within the Mid-Yorkshire footprint. This will require different and improved responses from community and primary care services to support people at or closer to home, outside of an acute hospital setting where appropriate.

The “Connecting Care” programme is focused on the development of integrated community services provided from three district ‘hubs’ and is underpinned by widening the

primary care offer and promoting self- care through access to secondary care, advice and clear referral pathways to trained practitioners. The initiative has a particular focus on the

frail and elderly, people with respiratory and coronary heart disease and those with mental health conditions.

The Council has begun implementation of a redesign of its assessment and care management arrangements in order to work alongside the developing Connecting Care Programme.

Social Care Workforce

The “Skills for Care” National Minimum Data Set for Social Care (NMDS-SC) 2015 estimates that across the whole sector in England there are 39,000 care providing

establishments, 1,520,000 social care jobs and a workforce of 1,450,000 people, as some people hold more than one job.

The NMDS-SC 2015 provides the following local analysis:

  • The Wakefield District contains 161 CQC registered services with an estimated 8,500 jobs employed in adult social care, split between the statutory sector (16%), the independent sector (72%) and direct payment recipients (12%). This includes managerial and professional roles in addition to direct care.
  • Wakefield District has an average whole time equivalent ratio of 0.7, meaning that on average 100 jobs equates to around 70 whole time jobs.
  • The average annual pay for direct care within Wakefield is comparable to the national average and higher than the Yorkshire and Humber average although management rates are significantly lower.
  • Wakefield District has a staff turnover rate of 16.9%, which is considerably lower than the Yorkshire & Humber average of 22.8%.
  • The average age of the local social care workforce is 43 and it is anticipated that 765 workers could be due to retire in the next 5 years.

Within the Council’s limited and reducing resources importance is given to creating an environment to support an effective, sustainable and trained social care workforce through specifying within contracts conditions to support the workforce. In addition, the Council provides access to:

  • a comprehensive range of distance learning and open learning resources signposting organisations/individuals to fully funded learning and development opportunities in 23 key areas of social care.
  • the CIS Assessment Tool, where staff complete online or paper based assessments to evidence knowledge, identify gaps and prioritise learning and development needs across a range of subject areas.
  • the Social Care Information & Learning Service (Scils), an online learning resource/community dedicated to the Health & Social Care Sector.

The Transfer of the Public Health Function to Local Authorities

The Health and Social Care Act 2012 transferred the statutory responsibility for Public Health from Primary Care Trusts

(now replaced by Clinical Commissioning Groups) to Local Authorities in April 2013. This reform changed the focus of Public Health from a “professional to patient” perspective to one of community focus providing an opportunity to work

with all Council Directorates to influence decisions to improve public health across the district.

The Better Care Fund

The Better Care Fund is a performance based pooled budget arrangement between the Council and NHS Wakefield Clinical Commissioning Group. It encourages health and social care commissioners to bring services and resources together to improve outcomes for local people by reducing emergency admissions to hospital, supporting early hospital discharge arrangements and helping more people to be cared for closer to home. The Wakefield Health and Wellbeing Board have supported a proposal for a pooled budget of £42 million targeted at a planned 3.2% reduction in emergency hospital admissions by 2016/17.

The Local Third Sector

The Third Sector Strategy for Wakefield District 2013-2016 “Meeting the Challenge Together” identifies that Wakefield District is home to a well-established third sector ranging from the smallest self-help and campaigning groups to large service delivery organisations and national charities with approximately 2,800 people working for the sector in the District changing the lives of individuals and communities.

Nova Wakefield District is the support agency for Voluntary and Community Groups in the Wakefield District.

The District’s third sector includes 567 registered organisations with a collective annual income of approximately £78m. In addition, it is estimated that there over 700 unregistered groups. It is also estimated that 45% of third sector organisations in Wakefield receive a grant from a local statutory agency and 19% hold public contracts.

The range of activities and services carried out by the sector within the district as expected is diverse, with approximately 20% of third sector provision within the health and wellbeing sector.

Rising demand for care and support, changing public expectations together with extreme budget pressures, mean that the development and expansion of the Third Sector is vital for the future sustainability of the social care sector by leveraging the capacity and resources of the local third sector

organisations that are already making positive impacts in the District.

The Wakefield Together Partnership has identified four strategic objectives for the Third Sector Strategy:

  1. To grow active citizens and voluntary action through effective third sector engagement within local communities.
  2. To increase third sector opportunities to design and deliver public services
  3. To promote the third sector so that it has opportunity to influence policy and decision making.
  4. To develop effective infrastructure support for the third sector throughout the District.

As a crucial component of the developing Connecting Care programme, the diversity of provision within the local third sector will support social prescribing, preventative services and low level interventions specifically reflecting the individual needs within each of the GP network areas harnessing the capacities, skills and energies of the local communities

to build civic activism whilst benefiting from the sector’s workforce, resources, diversity of provision, agility and flexibility.

The transformation of in-house Adult Social Care Services

The Council has been transforming its delivery of in-house Personal Care (Domiciliary Care) Services for a number

of years, reducing the size of in-house service provision whilst focussing on reablement. The next stage of this transformation is nearing its conclusion with the aim of re- designing the service to deliver better outcomes for people with a more efficient service delivery model that supports the integrated “connecting care” programme by preventing unnecessary admissions to hospital and reducing delays

in hospital discharges. Reablement will be the focus of this service. The independent sector domiciliary sector will

continue to be developed to provide the required capacity to aid throughput of the re-focussed in-house service.

Transition to Adulthood

The council’s transition planning for young persons with on-going care and support needs are being strengthened with the integration of a number of specialist adult support Social Workers within Children’s Teams. The aim is to implement a variety of care and support options which maximise young adult’s independence as far as practical and supports their carers by widening and supplementing

service options to include for example, training, employment support and network building together with a range of living options developed in partnership with housing providers as alternatives to registered care home provision

Strategic Housing

There is a known, direct link between good housing and good health and well-being. Evidence for the housing need required locally is provided through the Strategic Housing Market Assessment, the latest of which is due for refresh sometime in 2015.

Strategic Housing and Social Care will work together to commission support to enable people to live as independently as possible.

The Council’s Strategic Housing Department specify in their Housing Strategy targets (2013-18) that more affordable and specialist homes for older people, people with learning disabilities and those with mental health conditions are needed. In addition the use of Bed and Breakfast will be kept to a minimum for temporary accommodation. A new Homelessness Strategy was adopted in 2014 to maintain and develop the focus on effective homelessness prevention services.

The Council’s Financial Position

The Government’s comprehensive spending review in October 2010 produced unprecedented cuts in public spending.

The continued Government driven austerity measures are requiring significantly deeper cuts than those originally announced.

It is estimated that Wakefield Council’s funding will have reduced by approximately £185 million between 2011 and 2020.

Within this unprecedented financial position the Council continues to evaluate and implement all opportunities to reduce costs requiring very tough and unpalatable decisions. Needs will have to be met in less costly ways and the cessation of services will inevitably occur.

The impact on providers of the austerity measures going forward will include:

  • Decommissioning and / or re-commissioning services as appropriate to achieve best value.
  • Changes to Social Care individual support packages focused on keeping people safe and managing risks.
  • A need for providers to create efficiencies through service delivery and share those savings with the Council.
  • Open book accounting methodologies