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Supporting health and social care providers in Devon

MPS: Supported living

MPS: Supported living

What do we want from this area in the future?

  1. Support that is person-centred and that promotes individual independence and personal progression: supporting people to access employment, services and facilities, use technology, develop personal relationships and socialise in a way that meets individual needs and aspirations, allowing a choice of provider to help people achieve their goals and reducing support as people become more independent. As people develop their independence, we expect providers to alter the number of support hours needed to reflect and support  progression to independence.
  2. Support that is high quality and delivers the outcomes in a person’s ‘my care and support plan’: Commissioners will work with Providers to develop Provider Development Plans that focus on models of delivery which promote quality and achievement of outcomes. The development of a supported living framework will set out quality thresholds
  3. Sharing of support where a group of people living together (in a building or a network) all have a need for roughly the same level of shared hours of care and support: We would look to try and keep the ‘shared’ elements of support as small as possible, focusing on the individual care and support hours needed to help people get better access to the local community and to form their own networks of friends.
  4. The right type of accommodation: People need different types of accommodation at different stages of their lives to meet their changing needs and situations. People don’t always want to share the same living space with others, and we will be looking to commission options for people to share support without having to share accommodation.
  5. Affordable accommodation let as a tenancy: We want to encourage landlords who offer reasonable rents so that people can access paid employment and become more independent. Tenancy agreements need to be clear and transparent.
  6. The right location for the accommodation: good access to public transport, employment, education, support networks, community facilities and local services. DCC does not wish to commission new supportive living placements in the following locations; Ilfracombe. This is due to a range of factors related to the Supportive Living market and the local environment in these areas.
  7. Access to technology: internet access for Technology Enabled Care and Support is an important feature of good quality Supported Living.
  8. Right size of service that is cost – effective to run: Supported living services that involve on – site staff 24 hours a day are not likely to be affordable to Commissioners or financially viable for providers in the future, unless they involve a minimum of 4 people sharing at least some elements of support, be this in shared accommodation or self-contained units.

 

What is the assessment of need?

Supported living is a potential commissioning offer for any ‘care group’. However, the model of service is mainly used to offer community-based care and support to people with disabilities, or mental health needs. We believe that this is likely to continue to be the case in the long-term, however we will also be considering whether supported living can be used to meet the needs of older people as part of the development of a framework for housing with care.

Pie chart showing the number of people in supported living by care group, in Devon: 580 people who have a learning disability; 215 people with a mental health condition; 40 older people.
Pie chart showing the number of people in supported living by care group, in Devon: 580 people who have a learning disability; 215 people with a mental health condition; 40 older people.

Potential future need

Devon County Council is continuing to review the levels of need for supported living and is in the process of engaging people that use, or that might in the future use, supported living.  We are developing a plan with each service provider and will publish updates about the demand for supported living as new information becomes available.  Our current understanding is:

  • Out of the approximate 360 people aged 18-35 currently in residential care, there are many who in the future, may have their needs better met in supported living. This is increasingly likely for people under the age of 40. This understanding is reflected in the ambition described in the care homes section of the MPS – to significantly reduce the need for this age group to live in a care home environment. We are working across Devon and particularly in areas where we consider there to be an over-reliance on residential care. We are particularly interested in hearing from providers in Crediton, Bideford, Newton Abbot and Tavistock who wish to develop models of support that enable people to live as independently as possible.
  • Our analysis of people with mental health needs indicates move-on from residential care is likely to be suitable in 18 cases with a further 15 cases having the potential for movement. Reviews are under way to identify and work with people who could move to a supported living setting over the next two years.
  • For young people in ‘transition’, the estimated housing demand (2018/19-2020/21) is:
Type of housing/accommodation 
No. of young people who will ‘transition’ to Adults Services250-300
No. young people requiring housing75-90
  • We are undertaking work to better understand the numbers of people who will require Supported Living accommodation as adults, but we estimate this to be around 25% of the current cohort described above. We will share more detailed information as soon as it is available.
  • We are currently supporting nine people with mental health needs to move from residential care to supported living.  We expect this number to increase over the year although we are not yet able to confirm the number of people or the area in which they wish to live.
  • A small number of mental health care homes are choosing to de-register from residential care to supported living.  It is important that such care home providers discuss their registration with CQC and have an early conversation with Devon County Council, who will be able to advise on the need and model of the supported living service in their area and assist in ensuring a smooth transition for the people who are currently living with them should they decide to change their registration status.

 

What is the assessment of supply?

There are a significant number of vacancies in Social Care commissioned supported living properties at any one time. Over a quarter of vacancies are in Exeter and around a fifth in Okehampton/Hatherleigh and Bideford. Over-supply in some locations and the type of accommodation on offer, principally in shared houses, are considered to be factors.

Following completion of our needs analysis and, alongside work with providers and in local communities, we will review our assessment of supply during 2020 so that we can offer a more granular view of how markets need to change at a local level.

Social Care commissioners are working with Housing and Health commissioners to build a better directory of vacancies that will enable providers to reconfigure their provision and models of delivery to meet current and emerging needs.

We try and fill existing vacancies before commissioning new services unless a service is in a location or of a standard that is not the best way of meeting needs. However, where providers wish to offer new models of provision or diversity in their offer we would be pleased to talk with them as part of their business planning.

There has been in a shift in the market in the past year with larger care providers from outside the area, supported by investment companies and registered housing providers, entering the market – place and buying existing businesses. Some providers are considering de-registering current care homes to become supported living, whilst others are looking at new – build opportunities and buying up property to convert to supported living accommodation. This presents opportunities to increase the type and diversity of provision to better meet needs, improve quality of housing and achieve a clear separation between the housing and care provision. There are risks if the new provider does not engage with the Council at an early stage, leading to inappropriate and unviable provision in the wrong locations with a high level of voids and services that are poor and do not meet needs or promote independence.

 

What changes are we looking for from this service in the future, including any market opportunities, and what can Devon County Council help to move towards these changes?

We are looking for:

  • A variety of accommodation types that meet the differing needs of people at different stages at their lives, including a greater proportion of self-contained homes, that are accessible to local communities and services and let under a tenancy agreement. The Council is working with providers around reconfiguration of existing properties, new build proposals and de-registration of care homes to achieve the best possible mix of properties to meet needs
  • Rent and housing charges that are affordable, including for those people in employment. We wish to see a breakdown of proposed rents, service charges and housing support so that we can have discussions around affordability at an early stage
  • People living together, or in close proximity, having the same level of need for shared care and support. Through our interim contract process we are working with providers to consider how properties are configured and will continue to do so
  • Providers that promote independence including helping people to gain paid employment, move on into their own home, develop personal relationships and to make their own choices. Commissioners will continue to work through a Development Plan with each provider over the next two years
  • Provision that meets a minimum quality threshold, which will form part of any future contract. Any future tender will contain a qualitative element which providers will need to demonstrate to join the framework (see below). In the interim this will form part of the Provider Development Plan that will enable providers to develop models that meet current and future needs
  • Care provision that is affordable to the commissioner and viable for the provider. Commissioners will work with providers to set rates for future contracts. Transparency will be needed to understand costs of delivery and available budgets and this work will be undertaken as part of the development of a framework for Housing with Care
  • Care provision that is adaptable, with a workforce that is competent and able to respond to and support individuals with complex needs including physical health needs (e.g. Acquired Brain Injury) and behaviours that challenge. Commissioners will work with providers through the Provider Development Plan to identify skills and training needs and consider how these could be delivered, including through provider collaboration.

 

Development of carer households

Devon County Council is looking for providers who are interested in developing their business models to include carer households, where people are supported from age 16 to be introduced to higher levels of independence, whilst remaining in a safe and protective family environment. This is paid provision and is not the same as the care provided by an unpaid carer to members of their family, friends or neighbours

Many people would rather be in a family home than a care environment and a carer household approach enables people to be part of family life within the community. Being supported in a family environment can help people to develop independent living skills. It can also provide temporary respite for their carer so that they can continue to support them at home (please see section on replacement care)

Our direction of travel includes an increase in the number of carer households so that people with a range of needs can live in or receive short-term respite within family environments. Volumes and location are not yet clear but we are keen to talk with providers about this.

We are looking to develop a range of options that will support people to be as independent as possible and to support their aspirations to have a home of their own.

Developing this type of provision would increase a provider’s ability to meet a broader range of needs and enhance the overall scale of their business and role in Devon. Our analysis shows that a carer households offer is appropriate for many more adults.

To support people with a range of needs, we are looking for carer households who want to support people with a low level of need alongside a more bespoke, smaller cohort of carer households who are comfortable with supporting people with more complex needs – and we will work with you to enable you to do this.

Market opportunity - supporting living

The intention is to commission supported living and carer households through a framework agreement. A review of future commissioning is beginning and the market will be engaged during 2020 on developing future arrangements.

Commissioners will continue administering ‘interim supported living’ shared-hour agreements until any replacement contract arrangement is in place.

 

(Return to the Market Position Statement)

Last updated: 29/01/2020


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