Community based services

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"