Supporting information

People at the Heart of Care

‘People at the Heart of Care’ is the government’s 10-year vision for the reform of adult social care.

One Devon Vision, Ambitions and Strategy

‘One Devon’ outlines the priorities of our integrated care partnership and the structures and governance we have agreed across the health and care system in pursuing them. This is now being developed into a joint forward plan.

Devon County Council Strategic Plan
‘A Better Place’ outlines the priorities of the county council its various services have agreed to work together to achieve. This is currently under review, recognising the changing context post-pandemic and due to cost of-living challenges.

Joint Strategic Needs Assessment
This statutory document gathers the main evidence that helps us understand the population of Devon and their needs.

Joint Health and Wellbeing Strategy
‘Healthy and Happy Communities’ considers the evidence in the JSNA and sets our priorities for improving the health and wellbeing the people of Devon.

Our Vision for Adult Social Care 
‘Promoting Independence in Devon’ (this document) responds to the above, summarising our vision for the distinctive role social care plays in the wider health and wellbeing system.

Our Strategies for delivering our vision
‘Living Well in Devon’, ‘Ageing Well in Devon’, and ‘Caring Well in Devon’ outline our strategies for achieving our vision for people at different stages of their lives.

Adult Social Care Annual Report
Our annual report assesses how well we are doing in delivering that plan and whether we are making a positive difference to people’s lives.

Market Position Statement
This statutory document considers the demand for and supply of social care services and is aimed at the market of service providers we commission from.

Market Sustainability Plan
This new statutory document lays out how the council will work with its local providers to develop a sufficient, affordable, diverse, and high-quality adult social care market.

Service Policies, Strategies and Plans
We also publish policies, strategies, and plans, jointly where appropriate, regarding specific services and how we intend to meet the needs of specific groups.

Safeguarding Plan
Our strategic business plan defines the objectives and priorities of our safeguarding partnership.

Safeguarding Annual Report
Our annual safeguarding report lays out how our safeguarding partnership has achieved its objectives and priorities over the previous year.

What our needs assessment tells us

The following are highlighted in our the Joint Strategic Needs Assessment as the main current and future health and wellbeing challenges across Devon:

• An ageing and growing population.
• Access to services, including socio-economic and cultural barriers.
• Complex patterns of urban and rural deprivation.
• Housing issues (quality and affordability).
• Earlier onset of health problems in more deprived areas (typically 10-15 years earlier than the least deprived areas).
• Poor mental health and wellbeing, social isolation, and loneliness.
• Poor health outcomes caused by modifiable health-related behaviours.
• Pressures on services (especially unplanned care) caused by increasing long-term conditions, multi-morbidity, and frailty.
• Shifting to a prevention focus across the health and care system.
• Unpaid care and associated health outcomes for carers.

In adult social care, our particular challenges are:

• An ageing population which is also growing faster than the national average with growing levels of frailty and dementia.
• The extending life expectancy and increasing complexity of need of people with learning and physical disabilities.
• The growing number of people with long-term conditions with the health service lacking sufficient capacity to address them.
• A changing profile of mental health needs and growth in demand from autistic people.
• High levels of social isolation resulting in loneliness in all age groups exacerbated by the pandemic.
• A sparse and predominantly rural population with patterns of deprivation marked by isolated pockets and hidden need.
• Significant inequalities in healthy life expectancy between the most and least deprived parts of the county.
• The growing number of people with often multiple unpaid caring responsibilities.
• Improvements in health-related behaviours in younger age groups not mirrored by the middle-aged and elderly.
• A disparity between the quality of indoor and outdoor environments in Devon with incomes lower than the national average, house prices higher, and housing quality variable.
• Changes in the benefits system having unforeseen consequences.
• A working age population that is not growing at the same rate as the non-working population with recruitment and retention challenges in our workforce escalating.
• A complex organisational geography with multiple NHS partners.

What benchmarking and other data tells us

As part of the government’s sector-led approach to improving social care, we make statutory returns which enable comparative performance to be analysed through the Adult Social Care Outcomes Framework and associated publications in our Annual Report.

From recent annual reports, we can discern insights from long-term trends that have informed our vision and strategies:

• Almost half of the council’s budget is now spent on adult social care, a proportion that has increased significantly over the last decade.
• The significant majority of this budget is spent on independent and voluntary sector provision with the council mainly focussed on strategic and person-level commissioning. 
• Despite the aged and ageing population in Devon, more than half of this spend is now on people aged 18-64, in particular people with learning disabilities and autistic people.
• We support a greater proportion of our 18-64 population than is typical, especially in community settings and to a greater extent with pressures at transition and when elderly parents can no longer fulfil their caring roles.
• With the growth in the population of older people, and despite the council protecting spend on the most vulnerable, an older person is less likely than before the austerity period to receive council support, in part because of means testing.
• We serve fewer older people relative to our population in all settings than is typical although about a half of people living in care homes and a third of people being supported in their own homes in Devon fund their own care.
• We pay higher than typical fees to our providers, in particular in the hourly rate for regulated personal care services, although our weekly rate for residential and nursing care is now above comparator averages.
• Despite this, we still face challenges in securing sufficient services, especially in the community, lacking capacity to deliver up to 5,000 hours of personal care services each week. 
• This impacts on the wider health and care system, and with greater sufficiency and more prompt availability of services we could do more to avoid admissions into and secure prompt discharge from hospital.
• We have improved the reach of our short-term services and could do even better if capacity wasn’t being used to respond to insufficiency elsewhere
• The biggest challenge to market sufficiency in Devon is workforce recruitment and retention, with high levels of vacancy and turnover a particular concern, and pay inadequate to attract sufficient new entrants in a competitive local jobs market.
• Our aim is to keep people at home wherever possible; the proportion we support in residential care is similar to that typical elsewhere and on a long-term downward trend although still more than we would like. 
• In recent years, the overall satisfaction of service users with adult social care in Devon has been above all comparators but this is not the case with carers who highlight their social isolation and lack of employment opportunities as reasons why.
• We also perform well on indexes that seek to measure people’s quality of life, especially for service users where we rank among the highest in the country.
• More people with learning disabilities in Devon live in the community rather than in institutional care and are in paid employment than is typical, both good indicators of independence.
• People in Devon continue to be more likely to use direct payments than is typical elsewhere but whereas research shows this usually leads to better outcomes, that may not be so where the motive is to secure service provision
• Our levels of safeguarding concerns and enquiries are now broadly in line with comparators, and during the pandemic we responded to changes in settings and themes, with more related to abuse and neglect in the home.
• Work across the health and care system resulted in the number of deaths in care homes from Covid-19 during the peak pandemic period relative to our population were among the lowest in the country and high uptake of vaccines among the residents and care homes continues to offer good levels of protection.
• The proportion of adult social care providers in Devon rated Good or Outstanding has consistently been above the national and regional averages for some years, illustrating our good partnership working on quality assurance and improvement

We consider what people have told us and the insights we take from comparative data relevant to the people they relate to in our ‘Living Well in Devon’, ‘Ageing Well in Devon’, and ‘Caring Well in Devon’. Evidence specific to them is contained in those strategies. 

The legislation that guides us

Local authorities are required by legislation to deliver adult social care services that meet defined statutory responsibilities.

The Care Act (2014) defines our main duties including:

• Shaping the adult social care market to ensure quality, choice, diversity, affordability, and sufficiency with contingencies to address provider failure.
• Providing social care for people with eligible needs through assessment, support planning, financial assessment, arranging support, and review.
• Commissioning or delivering a range preventative and short-term services (including information and advice) that reduce, prevent, or delay the need for ongoing care and support.
• Considering individual wellbeing and equality of access and outcome in decision making.
• Promoting integration between health and social care services including through integrated commissioning.
• Safeguarding adults at risk and overseeing governance of the local safeguarding system.

The Health and Care Act (2022) introduced:

• Guidance on the structure and governance of integrated care systems, including the role of local authorities within them, with key strategies and reports put on a statutory footing.
• Assurance by the Care Quality Commission of both integrated care systems and local authority adult social care functions.
• Requirements for adult social care providers to return information used in the monitoring and improvement of provision.
• More flexibility in the discharge from hospital of people with care and support needs.
• Duties to reduce inequalities in the access to and outcomes of health services.
• Commitments to spending a set proportion of the NHS budget on mental health.
• Changes to how health services are commissioned nationally, regionally, and locally.
• Consideration of people’s health and wellbeing – and the quality, efficiency, and sustainability of health services – in decision making.

Changes to charging for adult social care, amending capital limits, and introducing a care cap and the right for people to request the local authority arranges their services have currently been postponed.

We are also guided by:

• The Mental Health Act (1983)
• The Mental Capacity Act (2005)
• The Health and Social Care Act (2008)
• The Health and Social Care Act (2012)

The government’s vision for reform

The government has laid out its agenda for the reform of adult social care in ‘People at the Heart of Care’ published in March 2022. This set out principles and plans to reform how people are charged for their care to make individual contributions more predictable and within a defined limit, but also to lay out a long-term vision the care system will take steps towards.

The government defines its vision as being one that:

• Offers people choice and control over the care they receive
• Promotes independence and enables people to live well as part of a community
• Values our exemplary and committed social care workforce, enabling them to deliver the outstanding quality care that they want to provide
• Recognises unpaid carers for their contribution and treats them fairly

This 10-year vision to transform care and support in England has three objectives:

The publication builds on the Care Act (2014) and its focus on wellbeing, incorporates the specific reforms regarding charging, integration and assurance incorporated into the Health and Care Act (2022) and begins to lay out the additional funding adult social care will receive over time and how it will be used.

In doing so, it highlighted the strategic risks and issues faced by adult social care:

• Rising to the challenge of increasing demand and rising costs.
• Shaping healthy and diverse social care markets.
• Addressing variation in the quality and safety of care.
• Supporting the adult social care workforce.
• Enabling people to navigate the system to find the right care and support.
• Accelerating the adoption of technology.
• Expanding the choice of housing options.
• Driving integration of health and care services.

The ADASS, LGA and NHS Confederation joint vision for the sector

The Association of Directors of Adult Social Services (ADASS), NHS Confederation and the Local Government Association (LGA) have published a joint vision on the long-term solutions required to make our health and care system resilient, preventative, and promoting independence.

This states that high quality, responsive, preventative, and personalised health and care services contribute so much to our lives and society by:

• Enabling people to live their best lives and be active in their local communities.

• Supporting unpaid carers to continue caring whilst working and living their own lives.
• Offering rewarding, skilled employment and long-term careers to over three million people.
• Bringing together the best of the NHS, local authorities, adult social care providers, public health and the community and voluntary sector to support people to live good lives, meet growing needs and expectations of those who draw on care and health services.
• Boosting local, regional, and national economies by contributing to economic outputs (Gross Domestic Product) as major employers and contracting with local businesses. Recent analysis shows that every pound invested in the NHS results in around £4 back to the economy through increased gross valued added (GVA), including through gains in productivity and workforce participation; and that the estimated adult social care sector GVA was £23.6 billion in 2016.

The vision is relevant to those who need care, support, or treatment now or in the future, provide unpaid care for family members, work in social care or health, or run businesses that contribute to health and wellbeing outcomes. It focuses on:

• Maximising health and wellbeing and preventing or delaying people from developing health and social care needs.
• Redirecting resources so that when people need treatment, and short-term support they are assisted to make as full a recovery as possible, restoring their health, wellbeing and independence.
• Maximising independence and wellbeing for people with ongoing heath and/or social care needs by working with them to put in place the care and support that works for them. 

They call on the Government to work with the sector and to put in place concrete measures to ensure that local leaders can achieve this culture shift, now and in the future asking that the Government:

• Invest in prevention and early intervention.
• Create the ability to plan for the long term.
• Deliver a long-term, fully funded workforce
• Let local leaders lead.
• Recognise the health and care sector as an economic asset.

Core components of the proposed recovery model for people to regain their health and independence following a crisis such as an episode in hospital are:

• Prevention, including crisis support – first and foremost, to identify people at risk of admission and to put in place care and support, including crisis support, to prevent them need hospital treatment
• Discharge planning – NHS and social care to plan appropriate discharge support on day one of admission, with involvement of the community and voluntary sector and housing providers
• Multi-disciplinary teams – including adult social care, NHS community health professionals, the community and voluntary sector, housing, and mental health services
• Timely, shared and trusted data – all commissioners and providers across health, care and the voluntary and community sector to contribute and have access to a shared data set to enable them to have a ‘single version of the truth’
• Rapid review – adult social care and NHS staff jointly review all people being discharged from hospital to make sure that they have the information to make informed choices about the risks and benefits of different options and ensure that any ongoing treatment, care and support is appropriate, with the aim of regaining independence, confidence and connectedness
• Support for informed choices – whether in hospital, in a temporary residential setting or at home, everyone should be the information, time and support in order to make informed choices about their care and housing support in the future
• Going home with support – including primary care, community mental health services, domiciliary and community and voluntary sector support with an agreed date for rapid review to assess any ongoing health and care needs
• Bed-based intermediate support in residential care homes – for a limited period with an agreed recovery, rehabilitation and reablement plan to ensure that care and support is focused on helping people to return to their own homes or make decisions about longer term care options
• More investment in diverse models of care – including Shared Lives, carers support, ‘floating support, and supported employment as effective models of care and support to maximise independence at home
• More investment in a range of housing options, including supported accommodation – for people who are unable to return to their own homes, to enable them to live in different housing within their communities with the appropriate level of support.

The One Devon partnership integrated care strategy

The partnership of health, local government and care organisations working together in One Devon (our integrated care system) has co-designed its operating model outlining how it will work together to achieve our vision of people in Devon having equal chances to lead long, happy and healthy lives. 

To achieve these new ways of working, we must make best use of new collaborative structures in One Devon at System, Place and Neighbourhood level:

• Provider Collaboratives of health and care providers working to improve care pathways and deliver better outcomes for patients and service users, making the best use of system resources in areas such as workforce, technology, and estates.
• Place-based partnerships –our 5 Local Care Partnerships (LCPs), which bring together a wide range of organisations, including the NHS, Local Authorities, District Councils and Voluntary, Community and Social Enterprise, to deliver integrated health and care services.
• Neighbourhoods, within which partners such as primary care services, NHS community services, social care and other providers work to deliver improved outcomes for their population.

Our ambitions for the next five years are:

• Effective and efficient care, collaborating to improve quality and productivity.
• An integrated care model that better joins up health and care services.
• The Devon deal, working with communities to address local challenges.
• Children and young people having the best start in life.
• Digital Devon, meaning people can interact with us and be supported online.
• Being equally well in Devon, tackling inequalities of access and outcome.

Building on the analysis in our Joint Strategic Needs Assessment, the One Devon Integrated Partnership Board has declared the twelve challenges our local health and care partnership aspires to address.

To do this we have recently agreed and published our ‘One Devon Partnership Integrated Care Strategy’ we have agreed the following strategic objectives:

• Improving outcomes in population health and healthcare:
  • We will save lives by adopting a zero-suicide approach in Devon, transforming system wide suicide prevention and care.
  • We will have a safe and sustainable health and care system.
  • People (including unpaid carers) in Devon will have the support, skills, knowledge, and information they need to be confidently involved as equal partners in all aspects of their health and care.
  • Population heath and prevention will be everybody’s responsibility and inform everything we do. 
  • Children in Devon will have improved school readiness, enabling them to make good future progress through school and life.
  • People in Devon will be supported to stay well at home, through preventative, pro-active and personalised care.

• Tackling inequalities in outcomes, experience, and access:
  • People in Devon will have access to the information and services they need, in a way that works for them, so everyone has an equal opportunity to be healthy and well.
  • Everyone in Devon will be offered protection from preventable infections.
  • Everyone in Devon who needs end of life care will receive it and be able to die in their preferred place.
  • The most vulnerable people in Devon will have accessible, suitable, warm, and dry housing.
  • In partnership with Devon’s diverse people and communities, Equality, Diversity, and Inclusion will be everyone’s responsibility so that diverse populations have equity in outcomes, access, and experience.  

• Enhancing productivity and value for money:
  • People in Devon will know how to access the right service first time and navigate the services they need across health and care, improving personal experience and service productivity and efficiency.
  • People in Devon will only have to tell their story once and clinicians will have access to the information they need when they need it, through a shared digital system across health and care.
  • We will make the best use of our funds by maximising economies of scale and increasing cost effectiveness.
  • We will have enough people with the right skills to deliver excellent health and care in Devon, deployed in an affordable way.

• Helping the NHS support broader social and economic development:
  • People in Devon will be provided with greater support to access and stay in employment and develop their careers.
  • Local and county-wide businesses, education providers and the Voluntary, Community and Social Enterprise (VCSE) will be supported to develop economically and sustainably.
  • We will create a greener and more environmentally sustainable health and care system in Devon, that tackles climate change, supports healthier living (including promoting physical activity and active travel).

Local communities and community groups in Devon will be empowered and supported to be more resilient, recognising them as equal partners in supporting the health and wellbeing of local people.

The Devon joint health and wellbeing strategy

Devon’s Health and Wellbeing Board has a duty to produce a Joint Health and Wellbeing Strategy (a local strategy for the local population addressing the needs identified in the Joint Strategic Needs Assessment) and ‘Healthy and Happy Communities’ sets priorities for improving health and wellbeing outcomes through to 2025.

The strategy establishes the following principles:

• Prioritise prevention and early intervention.
• Recognise the growing contribution of voluntary, community and social enterprise organisations.
• Support the role of the public in the continuing development of services.
• Respond to inequalities in access and outcome which are avoidable.
• Seek to ensure that people have access to the information and support they need to stay well, tailoring services to their needs.
• Adapt for the future by developing relationships and supporting partnerships across the community to support those with more complex needs.
• Develop the wider health and wellbeing workforce and embrace digital solutions.

And sets the following priorities:

• Create opportunities for all: inclusive economic growth, education, and social mobility
  • Narrow gaps in educational attainment and adult skills
  • Reduce levels of child poverty
  • Support economic growth in more disadvantaged areas
  • Increase social mobility
• Healthy, safe, strong, and sustainable communities: creating conditions for good health and wellbeing where we live, work, and learn
  • Improve housing conditions, reduce homelessness, and increase supply of appropriate, high-quality housing
  • Create conditions for good health, physical activity, and social interaction
  • Support healthy workplaces and schools
  • Help keep communities and individuals safe
• Focus on mental health: building good emotional health and wellbeing, happiness, and resilience
  • Reduce loneliness in all age groups
  • Identify people at risk and intervene to improve poor mental health as soon as possible
  • Proactively address the mental health consequences of trauma and adverse childhood experiences
  • Promote a positive approach to mental health and wellbeing
• Maintain good health for all: supporting people to stay as healthy as possible for as long as possible
  • Prevent ill health by enabling people to live healthier lives
  • Detect disease in the early stages to reduce impact on health
  • Support those living with long-term conditions to maintain a good quality of life maintain
  • Support carers to improve and maintain their own health and wellbeing
  • Promote public health interventions to prevent the spread of infectious disease
    

The Devon County Council strategic plan

Our Devon County Council Strategic Plan 2021-25 focuses on how the council will help the people of Devon to recover from the COVID-19 pandemic, build on the resilience of local people and communities to create a fairer, healthier, and more caring place, and grasp the opportunity to create a greener, more prosperous, and inclusive future for all where people thrive in growing up, and have every chance to live well and prosper as adults.

It defines the big strategic challenges facing Devon as:

• Responding to the threat of climate change
• Meeting the needs of our changing population
• Improving fairness and equality in access and outcome
• Inspiring trust and confidence in the people we serve
• Maintaining financial resilience, sustainability, and prosperity

And given that context, sets the following priorities:

• Responding to the climate emergency
• Being ambitious for children and young people
• Supporting sustainable economic recovery
• Tackling poverty and inequality
• Improving health and wellbeing
• Helping communities to be safe, connected, and resilient

It commits the council to being:

• Trusted – leading and collaborating well; making food decisions; using resources effectively and being financially resilient
• Inclusive – being intolerant to prejudice and discrimination; developing and nurturing our workforce; hearing the voices of all our communities
• Innovative – listening and learning; using data well; transforming the way we work to improve our services

In our annual plan 2022-23, the council has made several commitments regarding adult social care, including:

• Implementing the government’s reform agenda
• Delivering the Love Care programme to raise the profile of working in care and improve conditions for care workers
• Continuing the Proud to Care recruitment campaign in support of independent sector care providers
• Giving additional support to carers.
• Encouraging walking and cycling and other ways to increase physical activity
• Improving access to mental health services.
• Continuing to work with and support voluntary, community, and social enterprise organisations to address the impacts of increasing costs of living.
• Working with partners to tackle social isolation and loneliness particularly among older people, young people, those with disabilities or living with long-term chronic conditions​.