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Community based services

Market analysis of community based services

The following webpages provide a high-level summary of the community based care services in Norfolk. This includes:

Quality ratings are based on care quality commission (CQC) ratings of the overall market and our view of sustainability in comparison to other East of England and comparator local authorities.

Unpaid carers

Think carer, think family - make every contact count

Unpaid carers (sometimes called informal carers) play a vital role in the health and wellbeing of our county. They are key partners in maintaining the independence of people with care needs but providing care can have a major impact on carers' lives and we all have a duty to support them.

There are almost 100,000 people in Norfolk providing essential support to a family member or friend. They may not think of their role as a 'carer' or know that support is available to them.

Evidence shows that carers are more likely to experience poor quality of life, increased social isolation and ill-health than the average member of the public. It is our responsibility to 'think carer' and ensure that we support carers to maintain their caring role.

Carers matter Norfolk

Carers matter Norfolk delivers a highly personalised service that enables carers to improve their health and wellbeing and support them in their caring role.

On behalf of Norfolk County Council, carers matter Norfolk provide carers' assessments, information, support, and advice for unpaid carers in Norfolk. They offer a seven day a week, advice line service, together with one-on-one community support.

Find out more about carers matter and support for carers.

Carers charter

We have also developed a carers charter, produced by carers and councillors working together. This sets out our principles and pledges for:

  • Carers in work
  • Young carers in education
  • Carers in the community

We want everyone to think about how they can implement the principles in the carers charter and support carers through their work.

Read the Norfolk carers charter online.

How providers can support unpaid carers

'Think carer, think family'. Providers can make every contact count by getting paid staff to:

  • Check in with the carer, ask how they are and if there is anything that they need support with. Make sure staff know who to contact when they are concerned about the health and wellbeing of the carer.
  • Treat the carer as an equal partner in the delivery of care. Take their views and concerns about the person they are caring for seriously.
  • Make sure that staff know what support is available for carers and how support can be accessed
  • Support the carer to access the support that they need if they are struggling
  • Have a carer's policy for their own organisation detailing how they will support their own staff who have informal caring responsibilities 

Feedback

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"
  • "Care and support identifies me as a carer and is tailored around my needs as well"

Voluntary, community and social enterprise sector

Our vision

Our vision is to ensure that access to good quality information and advice is freely and easily accessible to all, helping people to:

  • Plan effectively for the future
  • Solve emerging problems
  • Make well informed life choices to maximise their health, wellbeing and happiness

Strategic priorities

Our strategic priorities are:

  • Getting people to the right place as quickly as possible
  • Development of a triage approach and single point of referral which will assess people's needs and get them the right support as quickly as possible
  • Designing with social justice in mind: Running social justice through the heart of delivery, focusing on the four pillars of social justice; equity, access, participation, and rights
  • Working alongside connecting communities to develop a formalised voluntary, community and social enterprise sector (VCSE) pathway
  • Building in the living well model: By developing and building the links to the living well approach and advice services to maximize opportunity for people to utilise their own assets and resilience and promote their independence
  • Improved access: Making the service easier to access using a range of technologies, including the ability to self-help
  • Connecting people to their community: The focus will be to connect people to their community whilst supporting them to build their assets and promote their independence

Care act responsibilities

The Care Act (2014) sets out an information and advice duty for local authorities to inform residents and people with care needs in the following way:

  • How the social care system works and how people can access it
  • What's available and a choice of how people receive services (to include health, housing and employment)
  • Financial advice to understand care charges, ways to pay, money management and where to get independent financial advice
  • How to raise concerns about safety and well-being

Promoting independence

Giving good information and advice that is easy to access enables people to make informed choices and promotes their independence. It can also support them to develop links within their community offering greater stability and improved health outcomes.

Prevent, reduce and delay

Through providing early help to support people and reduce the demand on formal care services. There is also the opportunity to support people to build their own assets and to make better links with their community.

Advice, advocacy and representation

We commission VCSE organisations to deliver advice, advocacy and representation under a partnership agreement.

This advice, advocacy and representation includes:

Social welfare, information advice and representation

Our social welfare advice includes guidance on:

  • Money and debt
  • Welfare benefits/ universal credit (UC) (UC is a welfare benefit and isn't usually singled out in advice context)
  • Pensions
  • Housing
  • Family and relationships, such as child protection or child contact
  • Employment (in the context of advice this is relating to employment law and rights, not support finding a job or CV writing for example)
  • Discrimination
  • Education
  • Immigration
  • Taxes
  • Legal
  • Health and wellbeing, such as mental health and social care support entitlements
  • Consumer rights
  • Carers rights
  • Domestic abuse, such as legal remedies including non-molestation orders or support with court applications

Community advocacy and specialist support

Our community advocacy and specialist support:

  • Facilitates access to a process or a service
  • Advocates on behalf of people, ensuring their voices are heard
  • Supports people to understand their decisions (and to seek advice on their issue)
  • Promotes self-advocacy and empowers people to do this
  • Supports people to be independent
  • Enables people to have choice and control

Social isolation and loneliness

We fund a package of services to help tackle loneliness and social isolation, including:

Clients are helped to:

  • Access social and community activities, volunteering opportunities and local support networks
  • Identify and overcome barriers that prevent them from becoming connected
  • Reconnect with family and friends and make new connections in their community

In addition, we provided grant funding to citizens advice bureaus as part of a community advice and support offer.

Norfolk citizens advice

Activity and impact of Norfolk citizens advice from 1 April 2022 to 21 March 2023:

  • Number of clients: 13,642
  • Number issues supported: 42,200
  • Number of cases: 13,074
  • Number of activities: 39,393
  • Income gain for clients supported: £1,401,830
  • Debt written off: £1,108,893

A client will usually come to the service with multiple issues. If they have not used the service previously, a new case will be opened. Activities refer to the number of individual actions undertaken for the clients being supported.

Our offer targeting support via hardship and debt services is funded through the household support fund.

Integrated VCSE delivery

In 2021, the Norfolk and Waveney VCSE assembly was formally established, with the following overarching functions:

  • To provide a VCSE engagement forum across Norfolk and Waveney, with a focus on health inequalities and prevention, with connection at neighbourhood, place, and system levels
  • To provide a mechanism to support the collaborative design of services and the capability to respond to emerging needs
  • To increase influence and participation of VCSE organisations and groups in the design and delivery of health and care services within the integrated care system (ICS)

The model for the VCSE assembly continues to develop in line with the developments being made in our ICS and recognises engagement mechanisms at a system-level, such as the links to our existing thematic VCSE forums, such as:

  • Children and young people
  • Older people
  • Mental health

It is also supporting the progress around place and neighbourhood connections.

Challenges

The challenges we face for integrated VCSE delivery include: 

  • Lack of a co-ordinated vision for the role of the VCSE in supporting health and care activities
  • Lack of formal processes to make referral to the VCSE simple and timely
  • The need to make best use of the VCSE resources available, formally linking VCSE provision into service/care pathways
  • The need to secure funding to progress the VCSE partnering agenda
  • The difficulties of engaging communities of interest/underserved communities and embedding the community voice into ICS in (full) decision making
  • The failure to address known health inequalities through missed opportunities to target health interventions to those most vulnerable/least engaged with services and support. Increasing the number of people accessing services with avoidable needs.

Supply and demand

There are approximately 12,000 formal and informal charitable organisations in Norfolk and Waveney. Registered charities report an annual income of £709m.

Key actions

Our key actions for working towards an integrated VCSE delivery are: 

  • To better understand what services are currently being delivered and the service pathways that these VCSE services can best support
  • To scope opportunities for the development of micro enterprises to support areas that are sparsely populated
  • To deliver the connecting communities programme, ensuring that people can access the right service, in the right place, at the right time
  • To embed the newly commissioned information, advice and advocacy model
  • To continue to fund the citizens advice bureau to deliver information and advice support

Feedback

We want people living in Norfolk to say:

  • "As well as family and friends, I have people who care about me"
  • "I can get information and advice that is accurate, up to date and provided in a way that I can understand"
  • "I can get information and advice that helps me think about and plan my life"
  • "I can live the life I want and do the things that are important to me as independently as possible"
  • "I am valued for the contribution that I make to my community"

Housing

A home should provide a safe foundation for a good life. Specialist housing enables many people who have a need for care and support to stay independent in their local community.

In Norfolk, we have two types of specialist housing:

By working with registered social landlords (RSL) and care providers, we can actively shape the specialist housing market for Norfolk, giving people choice when it comes to deciding where to live.

For further information,  download our specialist housing position statement for developers and landlords (PDF) [1MB].

Norfolk needs modern, specialist housing for adults of all ages with care and support needs. We launched two specialist housing capital programmes to facilitate new developments:

  • £29m on independent living, which began in January 2019
  • £18m on supported living, which began in April 2021

The two programmes are working with a range of RSLs to facilitate the development of further specialist housing in Norfolk over the next 5 years.

Our commitment

Our commitment as a Council is to:

  • Deliver 1,135 units of affordable rent independent living and 181 units of affordable rent supported living
  • Prioritise people's independence and wellbeing, focussing on the right home at the right time within the right community
  • Ensure people feel safe and comfortable in their own home, which is accessible and equipped with appropriate aids, adaptations, and technology

Challenges

  • Identifying RSLs who are keen to develop specialist housing in the areas of greatest need and for particular cohorts, such as supported living for mental health
  • Balancing the pace of new housing developments against urgent needs (particularly for supported living)
  • Ensuring there is a clear care commissioning framework for each specialism that sets out specifications that are attractive to the market
  • We currently have two models of care for older people's housing that we commission, in addition to other housing options for people in Norfolk, such as sheltered housing. Our focus on new schemes is to invest in the independent living model. In addition, we also have 17 existing housing with care (HwC) schemes, delivered through Norse care, GP Radis and Norfolk first support (NFS). We will be working with our care providers and landlords for HwC to review the current model and ensure it is fit for purpose as part of the housing options in Norfolk.
  • One of the challenges is the complex customer journey for people who may want to explore whether independent living or HwC is right for them. Working with landlords and care providers, we are investing in promotional material and new support officers to help people from their initial interest to moving into a scheme.

Key data

Details of the 2022-2023 spend and the number of individual people that have accessed independent living, supported living, and shared lives services during 2022-2023:

Housing market analysis

Services for older people (aged 65 years old and above)

Our spend on independent living services in 2022-2023:

  • £14.7m

Number of people accessing our commissioned independent living services in 2022-2023:

  • 452

Number of Norfolk County Council (NCC) accredited locations (buildings) (where the location is registered by March 2023):

Number of NCC accredited places (beds) (where the location is registered by March 2023):

  • Housing with care and independent living for older people: 856
  • Supported living for older people: 117
  • Shared lives (adult fostering) for older people: 0

Percentage of care quality commission (CQC) registered and inspected locations rated 'good' or 'outstanding' by CQC or provider assessment and market management solution (PAMMS) as at 1 March 2023:

  • Housing with care and independent living for older people: 88.9%
  • Supported living for older people: 66.7%
  • Shared lives (adult fostering) for older people: 100%

 

Services for adults with learning disabilities and/or autism

Spend on independent living services in 2022-2023:

  • £40.4m

Number of people accessing our commissioned independent living services in 2022-2023:

  • 807

Number of Norfolk County Council (NCC) accredited locations (buildings) (where the location is registered by March 2023):

Number of NCC accredited places (beds) (where the location is registered by March 2023):

  • Housing with care and independent living for adults with learning disabilities and/or autism: 150
  • Supported living for adults with learning disabilities and/or autism: 614
  • Shared lives (adult fostering) for adults with learning disabilities and/or autism: 0

Percentage of care quality commission (CQC) registered and inspected locations rated 'good' or 'outstanding' by CQC or provider assessment and market management solution (PAMMS) as at 1 March 2023:

  • Housing with care and independent living for adults with learning disabilities and/or autism: 100%
  • Supported living for adults with learning disabilities and/or autism: 68.2%
  • Shared lives (adult fostering) for adults with learning disabilities and/or autism: 100%

 

Services for adults with physical disabilities

Spend on independent living services in 2022-2023:

  • £1m

Number of people accessing our commissioned independent living services in 2022-2023:

  • 73

Number of Norfolk County Council (NCC) accredited locations (buildings) (where the location is registered by March 2023):

Number of NCC accredited places (beds) (where the location is registered by March 2023):

  • Housing with care and independent living for adults with physical disabilities: 506
  • Supported living for adults with physical disabilities: 82
  • Shared lives (adult fostering) for adults with physical disabilities: 0

Percentage of care quality commission (CQC)registered and inspected locations rated 'good' or 'outstanding' by CQC or provider assessment and market management solution (PAMMS) as at 1 March 2023:

  • Housing with care and independent living for adults with physical disabilities: 83.3%
  • Supported living for adults with physical disabilities: 70%
  • Shared lives (adult fostering) for adults with physical disabilities: 100%

 

Services for adults with mental health conditions

Spend on independent living services in 2022-2023:

  • £2.8m

Number of people accessing our commissioned independent living services in 2022-2023:

  • 201

Number of Norfolk County Council (NCC) accredited locations (buildings) (where the location is registered by March 2023):

Number of NCC accredited places (beds) (where the location is registered by March 2023):

  • Housing with care and independent living for adults with mental health conditions: 404
  • Supported living for adults with mental health conditions: 241
  • Shared lives (adult fostering) for adults with mental health conditions: 0

Percentage of care quality commission (CQC) registered and inspected locations rated 'good' or 'outstanding' by CQC or provider assessment and market management solution (PAMMS) as at 1 March 2023:

  • Housing with care and independent living for adults with mental health conditions: 77.8%
  • Supported living for adults with mental health conditions: 59.1%
  • Shared lives (adult fostering) for adults with mental health conditions: 100%

 

Independent living

Supply and demand

By 2041, the number of people living in Norfolk aged over 75 will have increased by 42%. Norfolk's supply of independent living is well below England's average and is far behind other comparable counties. In fact, Norfolk is 40th out of 45 in the provision of independent living in all local authorities.

The programme is committed to helping develop a further 1,135 units of independent living. Since the programme launched:

  • Two new schemes are now open (Fakenham and Acle), providing 124 new homes
  • A 91-apartment scheme in Harleston has been approved and will start on site in 2024
  • Four further schemes are in the planning process
  • A healthy pipeline of schemes is being progressed
  • We tendered for new care provision for the Old Maltings and Saxon House and have awarded the contracts
  • We worked with NHS partners, registered social landlords, Norse care, and other stakeholders to implement a community step-down model to support system pressures over the winter. This initiative involved the use of up to 25 housing with care flats as a short-term option to enable people to return to the community following a hospital episode while their long-term care and support was arranged.

Messages to the market

  • We will continue to work with landlords and care providers of our existing housing with care schemes to continue to develop and evolve the service offer
  • We have developed an independent living and housing with care provider framework to give care providers a consistent and clearly communicated offer, which provides opportunities to become providers of care at new independent living schemes (subject to development constraints)
  • We welcome discussions with registered social landlords around new independent living opportunities in all market towns in Norfolk, and we have a priority need in Thetford

Supported living

Supply and demand

Far too many people with physical disabilities, learning disabilities, people with autism, or poor mental health in Norfolk are being housed unnecessarily in residential care as the only safe housing option.

Since the programme launched, we have refined the demand for supported living in Norfolk to reflect exactly what specialist care commissioners and operational teams know is needed.

The analysis shows we need around 300 units of different types of supported living in Norfolk across learning disabilities, autism, and mental health. So far, we have seen:

  • 14 high specification transforming care partnerships (TCP)homes purchased and adapted
  • A further seven high specification properties in active search
  • A new learning disability enablement scheme opened
  • An 18-home community housing scheme in planning
  • A nine-home mental health scheme in pre-planning
  • A mental health provider has recently added seven step-down flats to its provision in Norwich
  • A healthy pipeline of opportunities being progressed

Messages to the market

  • There is a priority need for landlords and land opportunities for 12 units of housing for people with mental health needs in both Norwich and Kings Lynn
  • There is a need for a cluster of 6-8 units of specialist bungalows designed for people with autism in the Norwich area
  • There is a need for more general needs housing in clusters to house individuals who can move on from enablement services but still have a need for floating care and support. These would be in locations that support our enablement schemes in North Walsham, Norwich, Kings Lynn, Attleborough, and Great Yarmouth.
  • There are specific care frameworks under the supported living care framework for autism, learning disabilities, mental health, and transforming care partnership

Specialist retirement housing

The Three Dragons and Opinion Research Services report into specialist retirement housing highlighted the following need across Norfolk:

  • In 2020, it was estimated that there was an unmet need for 2,809 units of extra care housing and 3,203 units of sheltered housing. By 2041, it is estimated that these figures will have risen to 5,130 and 9,644, respectively.
  • By 2041, each of the rural districts will need more than 750 extra care units and more than 1,000 sheltered units. Norwich will require 285 extra care units and potentially up to 415 sheltered units if current tenure preference is taken into account.

Homelessness

For homelessness, we have and will continue to:

  • Actively engage with the Norfolk strategic housing partnership, advocating a partnership approach to prevention and homelessness solutions
  • Work strategically with partners to deliver appropriate housing and support for those experiencing or at risk of homelessness
  • Work with theNorfolk office of data and analytics to develop a data dashboard that will enable quarterly reporting, ensuring predictive analysis leading to service improvements
  • Review services that prevent homelessness and rough sleeping, including the social impact bond
  • Strengthen the partnership approach to commissioning services for those who are socially excluded, including those who are experiencing challenges with their mental health

Disabled facilities grants

For disabled facilities grants (DFGs), we will:

  • Review the operational and strategic approach to DFGs so they better meet demand and support people to stay in their own homes
  • Revise performance reporting for DFGs so that it is meaningfully represented within the better care fund
  • Performance managed contracts for these services, undertaking regular reviews to ensure positive outcomes, value for money, and support strategic planning
  • Work with districts to understand how they currently promote DFGs and look for improvements
  • Work together to better align DFGs and community equipment

Feedback

We want people receiving our services to say:

  • "I live in a home that is accessible and designed so that I can be as independent as possible"
  • "I have a place I can call home, not just a 'bed' or somewhere that provides me with care"

What people have told us about moving into independent living or supported living schemes:

  • A woman made new friends at the independent living on-site hair salon and is now considering moving in after chatting with other residents over a weekly coffee in the lounge
  • A man has moved into his new independent living home after losing independence and is so pleased he could bring his dog
  • A man moving into his own home through the TCP was supported by staff to walk into town for a coffee, something he had not done before
  • People with learning disabilities are excited to start their employment journey near to their new enablement home

Victims and survivors of domestic abuse

Providing support in safe accommodation for victim-survivors (children and adults) of domestic abuse is a key priority for us.

During 2022-2023, £1,312,445 was spent on support provided in safe accommodation, which includes seven refuges and dispersed accommodation across Norfolk.

Key achievements in 2022-2023 that met some of the challenges outlined in the previous market position statement include:

  • Increasing the number of units of safe accommodation and ensuring this could be used by any person
  • Increased the commissioning of support for children so that every refuge could meet the needs of children as victim-survivors of domestic abuse
  • Developed a quality assessment framework to help improve the quality of support and safe accommodation across Norfolk
  • Opened a domestic abuse framework and increased the number of accredited providers by 50%
  • Developed an engagement framework with Nesta that is in the process of being piloted
  • Provided a district-wide sanctuary scheme to ensure those who wish to remain in their own homes, can do so safely. There's support and sanctuary schemes available in Norwich, the Broadland and South Norfolk districts, North Norfolk district, Great Yarmouth district, Breckland district, and King's Lynn and West Norfolk district.
  • Implemented a new accommodation protocol that has been endorsed across Norfolk. The protocol ensures those who require accommodation and may be moving out of safe accommodation are considered a high priority for affordable housing.
  • To improve the whole housing approach to domestic abuse through New Burdens Funding, we have funded key stakeholders to acquire domestic abuse housing alliance accreditation
  • To improve data intelligence, improvements have been made in our data monitoring of commissioned services, and we have worked with key partners to improve our understanding of the needs of male victim-survivors and/or those who have protected characteristics

A refreshed accommodation needs assessment based on 2022-2023 data is currently taking place, and will inform the support in safe accommodation strategy (PDF) [457KB] refresh. This will help us to understand how well we are meeting our domestic abuse act (2021) part 4 duties. To learn more about our duties, you can download the 'Domestic Abuse: statutory guidance' (PDF) from the GOV.UK website.

Our progress

Our ambitions for 2023-2024 include:

Ability to meet support in safe accommodation

We are looking to provide a further 10 units of dispersed accommodation, as this better meets the needs of all victim-survivors of domestic abuse.

We have a vision to provide six units of safe accommodation for those facing multiple disadvantages. This is being planned and, if successful, will be developed in 2024-2025.

Quality of support in safe accommodation

The new quality assessment framework has been piloted and will be formally rolled out over the year.

The audits will give us the opportunity to see what the status is of the quality of support and safe accommodation and will provide us with the opportunity to show areas of improvement.

Ability to meet support needs by all demographics

Our vision to increase the amount of safe accommodation that is dispersed and also enables those that wish to remain safely in their own homes has increased our ability to meet the needs of a wider demographic, and this will strengthen as we go forward.

Data intelligence

The lack of data being provided by the districts continues to be an area we wish to improve. Our understanding is that more needs to be done in relation to their systems so that data can be extrapolated and there is a reduced risk of duplication.

However, our ability to monitor commissioned services has improved, and it is hoped this will help our needs assessment refresh and be used to update the support in safe accommodation strategy.

Victim-survivor engagement

Having designed the engagement framework, we are now drawing together an engagement toolkit.

We aim to be better able to understand the best ways of engaging with different demographics and be able to further develop this as a pilot with victim-survivors of domestic abuse.

Challenges

Our challenges for working towards better support for domestic abuse victim-survivors include:

  • Demand for support in safe accommodation outstrips supply and competition for accommodation for affordable housing for victims-survivors of domestic abuse, along with other key groups such as people who are homeless, is high
  • Some of the refuges are not self-contained, and some require updating
  • Historically support providers have supported women, but increasingly, they will need to ensure their websites clearly identify that they can support male victim-survivors and LGBTQ+ communities, for example
  • The new contract specifications for the delivery of four of the recent refuges are higher, and will also apply to the other three refuges due to be tendered. We will need to consider what happens post March 2025, as New Burdens Funding is not guaranteed post March 2025.
  • Robust data is not available on the needs of male victim-survivors and/or those who have protected characteristics

Messages to the market

What we said we would do and what we achieved in 2021-2022:

  • Improve our response to domestic abuse by funding stakeholders to achieve domestic abuse housing alliance accreditation. This was achieved.
  • The district councils have been funded to provide a sanctuary scheme that will enable people throughout Norfolk, who want to stay in their own homes to do so safely. This was achieved.
  • A quality monitoring officer has been funded to help design and develop a new quality assurance framework (pilot starting December 2023). This was achieved.
  • Funded Nesta to design an engagement framework. We will be including engagement and, where possible, co-production in the future development of services. The development of the engagement framework was achieved. This year, we will be progressing to an engagement toolkit assisted by victim-survivors of domestic abuse.
  • We will work with partners to increase the amount and flexibility of safe accommodation, and by doing so, we aim to support all those who need it. This was achieved. A further 10 units (30 bed spaces) of dispersed accommodation have been brought forward over the past year. We are currently working with Homes England, South Norfolk Council, and a registered provider to purchase an additional 4 units (2023-2024). We are also working with Norwich City Council to scope opportunities for six units of safe accommodation for those facing multiple disadvantages.
  • We will commission additional support for children in all refuges and in satellite accommodation. This has been achieved, and this element is now included in our much-improved specification.
  • We will improve data intelligence in partnership with the Norfolk office of data and analytics. This has been partly achieved. We have worked hard to understand why tier 2 authorities are unable to provide the data we need.

Feedback

We want people to tell us:

  • "I feel safe and know that I am safe"

What people have told us about the support they have received:

  • One victim-survivor said, "The activities and support they are providing have helped to increase my children's confidence, and they are now able to talk about their feelings to me"

Home care

Our vision

Our vision is built around four key pillars:

  1. Sustainability: Supporting a diverse homecare market to deliver manageable hours in the right-sized geographical areas
  2. Quality: Enabling the homecare market to meet 'good' and 'outstanding' care quality commission (CQC) ratings
  3. Resilience: Creating a strong, responsive home care market
  4. Capacity: Increasing capacity through re-defining home support provision

Current shape of the home care market

Home first is a key Council and integrated care system (ICS) priority, but currently there is insufficient capacity within the sector to deliver fully against this strategy. This impacts on communities, with challenges for both council and self-funders to access care in some parts of the county and in support of timely acute and community hospital discharges.

Norfolk has 106 domiciliary care providers registered with CQC, delivering support out of 135 Norfolk offices, of which 86 are part of the Council's home support framework. These providers support an estimated 5,575 people across Norfolk, funded by the Council and people who pay for their own care.

Challenges

Our challenges around home care include:

  • As of 1 March 2023, 70.3% of home care services for older people, people with mental health conditions, learning disability and physical disability needs were rated 'good' or 'outstanding'
  • The workforce remains the most significant factor affecting the sustainability of this sector. Staff shortages have increased during the last year and have been worse in the domiciliary care sector. Visit the workforce challenge webpage for further details about the challenges we face with staff.
  • Uncertainty over fuel and energy costs continues to be of concern to providers operating within this sector
  • In the more densely populated areas of Norfolk, there is a high density of framework providers, impacting the efficiency of rounds
  • The quality of home care provision in Norfolk is poor compared with other local authorities, and against the East of England and England averages. There are increasing numbers of providers who are receiving successive 'requires improvement' and 'inadequate' ratings, which suggests that they are not able to deliver sustainable improvements. Visit the quality challenge webpage for more information about the quality of home care provision.

Key data

The 2022-2023 spend and the number of people accessing home care services by client group:

Home care services for older people

  • Our spend on home support commissioned services in 2022-2023: £37.3m
  • The number of people accessing home support that we fund in 2022-2023: 3,048
  • The number of Norfolk County Council (NCC) accredited locations registered at March 2023: 84
  • Percentage of CQC registered and inspected home support services rated 'good' or 'outstanding' by CQC or provider assessment and market management solution (PAMMS) as at 1 March 2023: 69.1%

Home care services for people with learning disabilities and/or autism

  • Our spend on home support commissioned services in 2022-2023: £2.3m
  • The number of people accessing home support that we fund in 2022-2023: 161
  • The number of Norfolk County Council (NCC) accredited locations registered at March 2023: 48
  • Percentage of CQC registered and inspected home support services rated 'good' or 'outstanding' by CQC or PAMMS as at 1 March 2023: 72.9%

Home care services for people with mental health conditions

  • Our spend on home support commissioned services in 2022-2023: £1.4m
  • The number of people accessing home support that we fund in 2022-2023: 158
  • The number of Norfolk County Council (NCC) accredited locations registered at March 2023: 56
  • Percentage of CQC registered and inspected home support services rated 'good' or 'outstanding' by CQC or PAMMS as at 1 March 2023: 70.9%

Home care services for people aged 18 and above with physical disabilities

  • Our spend on home support commissioned services in 2022-2023: £6.5m
  • The number of people accessing home support that we fund in 2022-2023: 490
  • The number of Norfolk County Council (NCC) accredited locations registered at March 2023: 79
  • Percentage of CQC registered and inspected home support services rated 'good' or 'outstanding' by CQC or PAMMS as at 1 March 2023: 68.4

Supply and demand

Currently, home care services are supporting an estimated 5,575 people in Norfolk, of which 3,345 are via council-commissioned services. In addition, there are people identified on the interim care list waiting for care packages to be sourced for them. As at 23 May 2023 the number of people on this list is 65, requiring 590 hours of support.

There is insufficient supply to meet demand in North, South, and West Norfolk, with 91% of the hours of support on the interim care list requiring support in these areas.

The majority of home care in Norfolk is provided by the independent sector, with one Council part-owned company operating in this market.

In addition, the Council operates an in-house reablement service, Norfolk first support (NFS), which provides intermediate reablement services and is funded by the Council and the integrated care board (ICB) through the better care fund. Over the last year in particular, the service has delivered home support as a provider of last resort to help manage gaps in the market and the handing back of home care packages, which has reduced reablement capacity.

Financial incentives have been offered to independent home care providers to encourage investment in the additional capacity required to meet demand. This includes the £2,000 incentive to enable providers to provide care to people being discharged from hospital.

Commissioning intentions

The model for commissioning home care across Norfolk has been shaped through co-production and will be moving into the procurement and implementation phases once the final provider and service user engagement has been completed, with procurement commencing in July 2023. This includes the proposed introduction of a principal provider model that will provide up to 70% of the commissioned care required, supported by a framework for the remaining 30%.

This programme of activity will be delivered over the course of three years, between 2023 and 2026. This is a significant commissioning programme for transformation, in one of our largest care markets.

Key messages to providers

Our key messages to providers are that:

  • We want to have our key strategic relationships with providers who are CQC or PAMMS rated 'good' or above. This will be part of the principal provider model we intend to implement.
  • We want to enhance collaboration between providers and the health and social care system
  • We have a priority need for home care in the north, south, and west of the county
  • We want to ensure consistent coverage across all of the county
  • We will work with providers across the system to develop a home care service model that delivers the best value. The role of the voluntary, community and social enterprise sector (VCSE) in supporting non-regulated provision should be explored as part of this review along with the potential development of micro-enterprises in the more sparsely populated areas of Norfolk.

Feedback

We want people to say:

  • "I am supported in managing my health and care needs in ways that make sense to me"
  • "I am supported by people who listen carefully, so that they know what matters to me and how to support me to live the life I want"
  • "I have considerate support delivered by competent, well-trained people"
  • "I am confident that the people supporting me have the skills needed to meet my care and support needs in the best way"
  • "At all times, I am treated with dignity and respect"
  • "I am supported as I want to be"

Direct payments

Challenges

The challenges we face with the direct payments support service (DPSS) include:

  • People are sceptical of having a direct payment service rather than a commissioned service, mostly due to a lack of understanding of what a direct payment means and the support that is available to those that choose to meet their needs via a direct payment
  • People are worried about the complexities and responsibilities of being an individual employer
  • Difficulties in recruiting a personal assistant (PA):
    • Increased demand for PA services in rural locations
    • Competitive national recruitment market
    • Competitive rates of pay
  • Encouraging personal assistants to undertake free training to improve their knowledge and skills to support those that they work for
  • Supporting people who begin to struggle to be an individual employer due to conditions such as dementia, which impact their capacity to manage a direct payment, and who have no family or connections to manage their direct payment for them

Supply and demand

There are currently 1350 direct payments individual employers who are supported by the DPSS. These employers employ 2,119 PAs (some on a flexible, casual basis).

There is a high demand for PAs, often in rural localities, requiring multiple visits for complex needs.

The direct payment support service uses a proactive recruitment tool called a PA register through ukcil.com, which enables employers to be matched to appropriate PAs available and looking for work. 2432 PAs have signed up for the PA register since May 2021.

Self-employed personal assistants looking for work are able to advertise their services and availability for free on the Norfolk community directory.

Key data

The 2022-2023 spend and the number of individual people at the year-end that have accessed a direct payment:

Direct payments for older people

  • Our spend on direct payment services in 2022-2023: £7.3m
  • The number of people with direct payments funded by us in 2022-2023: 443

Direct payments for people with learning disabilities and/or autism

  • Our spend on direct payment services in 2022-2023: £6.7m
  • The number of people with direct payments funded by us in 2022-2023: 404

Direct payments for people with mental health conditions

  • Our spend on direct payment services in 2022-2023: £1m
  • The number of people with direct payments funded by us in 2022-2023: 99

Direct payments for people aged 18 and over with physical disabilities

  • Our spend on direct payment services in 2022-2023: £7.8m
  • The number of people with direct payments funded by us in 2022-2023: 664

Key messages to PAs and individual employers

Our key messages to PAs and individual employers:

  • The DPSS has the employment services team as a dedicated team providing end-to-end recruitment and employment support, and the payroll team to provide support when managing the complexities of being an individual employer
  • Free training is available to employers for their PAs to support PAs in maximising their skills to strengthen knowledge and increase the skilled workforce across Norfolk
  • The DPSS is working collaboratively with adult social services to ensure increased promotion and understanding of appropriate direct payments to ensure needs are met in a person-centred way
  • The DPSS is promoting market stimulation and the role of PAs to continue to increase and retain the workforce
  • The DPSS continues to investigate and develop new market models to support direct payment users, such as self-employed 'hive working' models and increasing community micro-providers
  • We are dedicated to ensuring PA carers are supported and have access to training to improve skills and service, help retain service and improve confidence in direct payments
  • PAs supporting direct payments individual employers have the stability of knowing who and where they are working and that their employer is supported in employing them
  • The DPSS is constantly evolving to provide a platinum service for those it supports, moving forward in thinking, technology, and customer service

Our ambition

Our ambition for direct payments is:

  • For the DPSS to provide a platinum service that direct payments users need and deserve
  • Ensuing a person-centred way of delivering a direct payment Service
  • Striving to have a passionate, skilled PA workforce supporting Norfolk people to remain independent
  • To continue to work to promote and increase the supply of PAs across Norfolk and rural areas to support Norfolk people with care needs to remain in their own homes and be independent

Feedback

What we want people to say:

  • "I employ my own PAs who support me to live an independent and meaningful life the way I can control and as I want it to be"
  • "I am supported by the DPSS to have the confidence and knowledge to be a good employer to my PAs and know who to turn to for additional support"

Day opportunities for older people and people with physical disabilities

The older people and physical disabilities market is made up of a mixture of voluntary sector and volunteer-led provision against more formalised services delivering more complex provision to people with:

  • Dementia
  • Frailty
  • Acquired brain injuries
  • Physical disabilities

Current shape of the day opportunities market

The older people and people with physical disabilities day opportunities market has been disproportionately impacted by the Covid-19 pandemic. This impacts communities, with challenges for both council and self-funders to access care in some parts of the county.

This market is still in a period of recovery from Covid-19 with a number of sustainability challenges. Work is ongoing to support recovery and will continue through the development of a strategic plan for day opportunity services.

Key data

The 2022-2023 spend and the snapshot at the end of March 2023 of the number of people accessing day services for older people and people with physical disabilities, excluding transport costs:

Day services for older people

  • Our spend on day services for older people in 2022-2023: £0.77m
  • The number of older people accessing day services funded by us in 2022-2023: 228
  • The number of Norfolk County Council (NCC) accredited locations registered by March 2023: 45

Day service for people with physical disabilities

  • Our spend on day services for older people with disabilities in 2022-2023: £0.9m
  • The number of older people with physical disabilities accessing day services funded by us in 2022-2023: 164
  • The number of NCC accredited locations registered by March 2023: 56

Challenges

The challenges we face around day services for older people and people with physical disabilities are:

  • The current referral processes pose a risk to the sustainability of the older people's day opportunities market, with a lack of referrals being seen in several areas of Norfolk
  • The current mix of provisions and the lack of consistency in the contract terms and conditions across the market present a challenge to the development of a sustainable day opportunity offer

Supply and demand

A snapshot at the end of April 2023 highlights that there were 228 older people and 164 people with physical disabilities accessing day services funded by us and delivered from 101 registered locations.

Covid-19 has had a significant impact on referrals into day services, leading to some centres reporting that they are not financially sustainable.

Commissioning intentions

Our intentions for commissioning day opportunities for older people and people with physical disabilities are:

  • A single framework for all-day services is in development, with a plan for the new service model(s) to be implemented in 2024
  • To develop a brokerage sourcing process to make it easier to refer people for day opportunities. We started a pilot in April where brokerages are now sourcing placements to support social workers in accessing day services.
  • Developing innovative outreach and preventative service models and supporting people to access community and voluntary sector services, as an alternative to formal day opportunity services, where this is appropriate
  • Development of improved performance data collection systems to monitor outcomes being achieved and using this information to improve service provision

Key messages to providers

Our key messages to providers are that:

  • We want providers to support the strategic re-design of older people's day opportunity services to develop a model that delivers the best value and supports people to access the right services at the right time and in the right place
  • We want to enhance collaborative working between providers and the health and social care system
  • We want to ensure the delivery of a consistent day-service model across the county

Feedback

We want people to say:

  • "I am supported in managing my health and care needs in ways that make sense to me"
  • "I am supported by people who listen carefully, so that they know what matters to me and how to support me to live the life I want"
  • "I have considerate support delivered by competent, well-trained people"
  • "I am confident that the people supporting me have the skills needed to meet my care and support needs in the best way"
  • "At all times, I am treated with dignity and respect"
  • "I am supported as I want to be"

Day opportunities for people with mental ill-health

Mental health day opportunities are a combination of private and voluntary not-for-profit provision, mainly offering an outreach service and supporting those in their homes and in the community.

There are a number of services delivered by residential care home providers where someone comes into the service and has a meal, a shower, and support with managing bills and budgeting, for example.

Current shape of the mental health day opportunities market

In the main, mental health day opportunity services remained accessible to those with mental ill-health during the pandemic. At the time of this report, there were 681 people accessing support from 44 different providers.

The 2022-2023 spend and the snapshot at the end of March 2023 of the number of people accessing day services for those with mental health, excluding transport costs:

  • Our spend on day services for adults with mental health conditions in 2022-2023: £3.8m
  • The number of people accessing day services for people with mental health conditions, funded by us in 2022-2023: 681
  • The number of Norfolk County Council (NCC) accredited locations registered by March 2023: 44

Challenges

Challenges with day opportunities for people with mental ill-health include:

  • Having sufficient commissioning resources to be able to review and understand in more detail the range of interventions and their effectiveness for people with mental health problems currently offered under the day opportunities heading

Supply and demand

The services provided are predominantly community outreach services. Day opportunities services provide a range of support options, such as:

  • Personalised one-to-one support
  • Connecting people to peer support (individual and group)
  • Centre-based provision

Services support individuals to improve and maintain their mental health and well-being. People are supported to identify goals that are important to them and that help them to continue to live as independently as possible.

In January 2023, the percentage of people accessing day opportunities support in each locality was:

  • Norwich: 51%
  • South Norfolk: 20%
  • North Norfolk: 14%
  • West Norfolk: 8%
  • East Norfolk: 7%

Commissioning intentions

Our intentions for commissioning day opportunities for people with mental ill-health:

  • Explore a separate procurement approach that may be a better fit for current mental health day opportunity services
  • A single framework for all day services is in development, along with a plan for the new service model(s) to be implemented
  • To better understand what is being delivered, what is working well and what needs to change
  • Developing innovative outreach and preventative service models, supporting people to access community, voluntary sectors, employment and hobbies
  • Introduce psychological and trauma informed practices
  • Explore alternative models of support and whether these are of benefit

Key messages to providers

We want to work alongside stakeholders to better understand:

  • Current delivery and what will be needed in the future
  • What is working well
  • What people want and how they want to be supported
  • What 'good' looks like and how we can evidence that this is being achieved
  • We want to work with providers to develop new approaches to determine how best we can work together
  • We want to continue working collaboratively to support providers and understand their challenges
  • We want to ensure the delivery of a consistent day opportunities model across the county, embedding recovery, rehabilitation and psychological and trauma informed approaches

Feedback

We want people to say:

  • "I am supported to manage and continue my mental and physical health recovery, addressing inequalities experienced by those with mental ill health"
  • "I am supported to have less avoidable harm, which includes better psychological and mental wellbeing and improved confidence, self-esteem, and self-perception"
  • "I am supported to have a positive experience of support through flexible, emotionally resilient, competent, reflective, and self-aware colleagues who demonstrate tolerance and hope, forming honest and respectful relationships"
  • "I am supported to regain and develop skills and encouraged to participate in the community, meaningful activities, hobbies, leisure, employment, managing my home, keeping safe, and daily living tasks"

Life opportunities for people with learning disabilities and/or autism

'My life, my ambition, my future', the co-produced Norfolk learning disabilities strategy, set out a vision for shaping and delivering opportunities for people with a learning disability and/or autism in Norfolk, which created the foundations for our new life opportunities model.

Read the full Norfolk learning disabilities strategy on the Norfolk learning disability partnership website.

Life opportunities and our day services for people with a learning disability and/or autism are an important part of people's lives, offering a range of different:

  • Social opportunities
  • Skill development
  • Work experience
  • Employment opportunities

For families and carers, our life opportunities services also offer respite from their caring role since most people attending live with their family or carer.

Our services are delivered across Norfolk through a wide range of delivery approaches and settings. For us, variety is key to ensuring successful outcomes for the individuals who access these services.

Current shape of the day opportunities market

In April 2023, we opened our new life opportunities framework. The framework replaced the previous contracting arrangements from 1995 and 2012 for providers delivering day services to individuals with learning disabilities and/or autism in Norfolk.

The new life opportunities framework will provide a much more robust set of contractual terms and conditions. Our key drivers for the introduction of the new framework were to ensure parity in the learning disability and autism market.

Following a tender process, providers who were successful are now aligned under a single set of terms and conditions (including payment terms) to support sustainability and encourage future innovation and transformation of services through the introduction of the life opportunities pathway model.

The pathways will be introduced following co-produced pilots, where providers will have the opportunity to tender for one or more of these focused delivery models. Each pathway will have its own specification, which will help providers understand expectations and outcomes for individuals.

Key data

The 2022-23 spend and the snapshot at the end of March 2023 of the number of people accessing day services for people with a learning disability and/or autism. This excludes travel costs but includes spending on independence matters and the personal assistant service:

  • Our spend on day services for adults with learning disabilities and/or autism in 2022-2023: £17.6m
  • The number of people accessing day services for adults with learning disabilities and/or autism funded by us in 2022-2023: 1,239
  • The number of Norfolk County Council (NCC) accredited locations registered by March 2023: 71

Challenges

Challenges with life opportunities for people with learning disabilities and/or autism include ensuring the sustainability of our providers in a post-pandemic world, including:

  • The long-lasting negative financial impact
  • A vulnerable and unsettled workforce
  • Workforce shortages
  • An increased demand for placements

Read more about market sustainability challenges.

Supply and demand

39 providers have now successfully joined our life opportunities framework to deliver a day service to people with a learning disability and/or autism.

The life opportunities framework will now remain open to further support a vibrant and varied life opportunities market.

We hope to increase the number of successful life opportunities placements.

Market development opportunities

The life opportunities strategy for adults with a learning disability and/or autism will detail the model for day opportunities that we want to commission.

Learn more about life opportunities on the GOV.UK website. 

Commissioning intentions

Our intentions for commissioning life opportunities for people with learning disabilities and/or autism are:

  • To introduce our three distinct pathways: Skills and employment, promoting independence and enriching lives
  • Commence a pilot for our enriching lives pathway in early summer 2023
  • Go to tender for our skills and employment pathway in late summer 2023
  • Commence a pilot for our promoting independence pathway in autumn 2023
  • Development of improved performance data collection systems to monitor outcomes being achieved for individuals
  • Consider a distinct model of delivery to support our most complex cohort, and consider how our outreach services will be commissioned in the future

Key messages to providers

Our key messages to providers are that:

  • We want to continue to work collaboratively with our life opportunity providers, people who use our life opportunities services, and their families, parents, and carers
  • We want to ensure the delivery of good, quality, person-centred services that maximise people's independence and support people to lead fulfilling and varied lives

Feedback

We want people to say:

  • "I am valued and treated with dignity"
  • "I am treated as an individual and receive support that is person-centred"
  • "I am supported to live as independently as I am able or wish to"
  • "I feel that I have choice and control over the way my support is delivered"
  • "I am supported to maximise my health and wellbeing"
  • "My personal outcomes are achieved"
  • "I am supported to take part in the local community and to develop and maintain friendships"
  • "I am supported to move into work and maximise my economic wellbeing"
  • "My safety and security are maintained"
  • "Staffing and management arrangements enable me to receive a high-quality service"