Our key aims

The main goal of the market position statement (MPS) is to encourage commissioners, people who use services, carers, and provider organisations to work together to explain what care services and support are needed in Norfolk and why.

The key aims detailed within the MPS are:

• Access to the right high-quality support, in the right place at the right time. Supporting people to live independently for longer.
• A sustainable, high-quality workforce that is well trained and supported, with opportunities for a great career in social care
• At least 85% of commissioned services will be 'good' or 'outstanding'. We are seeking sustained improvement towards this by 2024 and delivery by 2026.
• Working together to shape a sustainable market that provides a choice of high-quality provision
• Working together to design a better, more efficient sector
• Working together to design a lower carbon sector

These webpages set out:

• What we are doing to achieve our aims
• Our progress towards meeting our aims in the last year
• How we will measure that we have achieved our aims
• The impact meeting our aims will have on staff and the people receiving support

How we will achieve this aim

We will achieve this aim through market shaping as well as:

• Via our connecting communities transformation programme, we will develop front line services with the voluntary, community and social enterprise sector (VCSE) that deliver advice and support
• We will work with providers through our home care strategy to increase the service capacity to enable more people to be supported to remain at home
• For home care providers who want to develop a specialism in working with clients with a learning disability and/or autism, we will work to develop a training programme to assist providers with meeting the regulatory requirements for this specialism
• We will ensure that our commissioning approach enables the development of services, such as the community equipment service to ensure that they are supporting people to remain at home now and can meet future needs
• We will continue to support the development of independent living and supported living schemes backed by capital funds that we provide
• We will support residential providers to meet higher acuity of needs through staff training and development, and with the support of the NHS as key partners in ensuring care delivery
• We will, in partnership with providers, review the current care definitions for residential and nursing care for older people
• We will continue working with the Norfolk and Waveney integrated care board (ICB) to improve the way that we work together to commission and contract continuing health care and funded nursing care for older people
• For working age adults, we will review the current approach to commissioning and the way that we pay for care. We will do this alongside providers and operational colleagues.
• We want a residential market that can support working age adults with learning disabilities, autism, and mental health conditions to live their most independent life within their local community
• In partnership with the ICB, we are engaging in the national programme 'small supports' to develop more locally grown organisations that can provide care and support to people with a learning disability and/or autism who are of working age and may have spent a long period of time in hospital
• We have started the transformation of learning disability day opportunities provision and expect to see more people being supported through these services to become work ready and to be more independent in their activities of daily living. For clients with the most complex needs we want day opportunity providers to deliver personalised care and support.

What we achieved in 2022

Connecting communities

Through the connecting communities transformation programme, new ways of working have been designed which has enabled the social care community engagement (SCCE) team to manage demand better. This has meant that our care and assessment phoneline has remained open for all needs since September, where previously this was sometimes open for emergencies only. 

The new information, advice and advocacy (IAA) service was implemented during 2022, supporting more people to get the information and advice that they need.

In the community referrals trial of the connecting communities transformation programme, we tripled SCCE referrals to the development worker team as part of our goal to increase community connections for people contacting the front door. We're now focused on achieving these results team-wide week-on-week in addition to making the most of other preventative routes like:

• Carers matter
• Norfolk first support (NFS)
• Assistive technology

Because of the work of initial engagement, people contacting SCCE for support are now less likely to be referred for a care package and more likely to be supported to stay independent with preventative tools and community connections.

Home care commissioning

The home care commissioning team has worked with Norfolk care association (NorCA) and providers to co-produce new home care service models.

The lack of available capacity within home care services resulted in around 800 people in July 2022 unable to secure the care and support they needed. A home care improvement plan was developed which focused on the delivery of actions that could improve this position. This included the commissioning of additional block contracts, use of technology and exploring the use of alternative provision such as personal assistants or via community and voluntary sector support. This work has significantly reduced the number of people on the interim care list which now stands at 65 as at 23 May 2023.

Integrated equipment services

During 2022, along with the ICB, we retendered the integrated community equipment service. This has a focus on improved efficiency and in supporting our, and ICB's, aims for carbon reduction.

How we will measure that we have achieved this aim

• More people being supported to access community and voluntary sector advice and support at an earlier stage, delaying the need for formal care
• Reduction in the number of individuals waiting for home care provision
• We will see an increase in home support agencies who feel skilled in delivering the specialism of learning disability and/or autism as part of a domiciliary care service for people
• More individuals in receipt of a re-abling style of care, enabling them to live more independently for longer
• More people accessing independent living schemes
• We will deliver another 10 supported living schemes across Norfolk by April 2025
• New care definitions for older adult residential and nursing provision developed
• For working age adults, we will work to re-develop the residential care market, driving quality, maintaining sufficiency for the needs presenting and working with the sector to make any model aspirational for people of working age who need residential care
• We will see our first small support organisation start the registration process with care quality commission (CQC)
• Through improved contract and performance management, commissioned services will have key performance indicators requiring providers and commissioners to work together on customer engagement, delivering both effective contract management and the continuous improvement of services

Impact

People will tell us:

• "I can get information and advice that helps me to 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 supported to manage my health and care needs in ways that make sense to me"
• "I live in a home, which 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" somewhere that provides me with care"

How we will achieve this aim

We will achieve this aim by:

• We will continue to commission Norfolk and Suffolk care support (NSCS) to provide access to training for the social care workforce
• Development and delivery of plans in alignment with the Norfolk and Waveney adult social care workforce strategy
• Ensuring training offers are aligned to the skills for care code of conduct which sets the standard expected of all adult social care workers and healthcare support workers in England. Outlining the behaviours and attitudes that people who need care and support should rightly expect.
• Sharing and developing best practice guidance from the quality strategy programme
• Enabling further join up opportunities between health and social care
• Supporting access to training and mentoring opportunities, including training specifically for providers who want to deliver services to people with a learning disability and/or autism
• Supporting access to specific leadership training programmes
• Commissioning local recruitment campaigns and initiatives to attract new staff to the sector
• Focusing on best practice and retention of staff
• Working with Norfolk care association (NorCA) and NSCS to implement a care worker job evaluation framework for the sector
• Co-producing an ethical framework for Norfolk
• Working with eastern region councils to develop a centre of excellence for international recruitment and the support offer

What we achieved in 2022

• Developed and delivered a multi-channel local recruitment campaign, including maintaining support via the Norfolk care careers brand
• Supported providers with best practice recruitment workshops, including one to one consultancy and the purchase of care friends licences
• Encouragement and financing of the blue light card rewards programme for staff working in the social care sector
• Commissioned a talent pipeline called earn as you learn, linking local students to flexible work opportunities
• Established a community of practice for international recruitment in recognition of the growing interest of providers in this talent pipeline
• Building on the legacy of developing skills in health and social care (DSHSC) to ensure there is a range of high quality and relevant training, skills development and mentoring opportunities for the workforce.
• Created opportunities for link up with health via the Norfolk and Waveney integrated care board (ICB). Such as events and links to international recruitment support.
• Secured government funding to deliver an eastern region centre of excellence during 2023 to support safe and effective international recruitment

How we will measure that we have achieved this aim

• We need to maintain sufficiency of provision, providing regular activity for people with a learning disability and/or autism, across residential, supported living and domiciliary care
• There will be an improvement in the care quality commission (CQC) ratings of services through staff being supported to achieve the skills and competencies required to deliver good quality care and support
• Monitoring engagement with training and mentoring and by asking participants what the impact has been on their skills development and the quality of care they deliver
• Training and qualification expectations will be more explicit within service specifications
• Engagement with the workforce directly
• Monitor take-up of the evaluation framework amongst providers
• Recruitment campaign indicators
• Skills for care reported vacancy rates
• Reporting of interim care levels, which indicates the extent that people are waiting for the right longer-term care needs to be met

Impact

People receiving support will tell us:

• "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"

People working in the sector will say:

• "I am proud to care in Norfolk"
• "I am a care professional"
• "I have the skills and confidence to deliver high quality care"
• "I feel able to add value to the service that I work in"

How we will achieve this aim

We will achieve this aim by:

• Involving people who use services in improving service quality
• Working with care quality commission (CQC) to fast-track providers for an inspection who are identified through the provider assessment and market management solution (PAMMS) process as making significant quality improvements
• Implement a robust commissioning and procurement process, aligned to the integrated quality service improvement and escalation policy, that will seek to take action that could include the termination of contracts with providers who continue to be non-compliant
• Through our integrated care system quality improvement programme which will ensure a focus on quality across all health and social care workstreams and activities
• Through paying a fair price for care that will support delivery of the quality standards required
• Ensure that any block contracts being tendered have a minimum threshold requirement for any provider to be at least 'good' or 'outstanding', otherwise they will not be able to bid

What we achieved in 2022

• Development of a quality plan supported by a robust quality assurance process
• Developed and published an integrated quality escalation policy
• We have established a provider led workstream within the quality improvement programme developing peer to peer support and webinars on outstanding practice
• Continued access to free, accredited training for staff
• A cohort of managers graduated from the my home life leadership programme
• Continued NHS in-reach support and training to adult social care services to support providers to safely manage the higher acuity of presenting needs

Challenges in achieving this aim

The challenges we face around quality ratings include:

• Insufficient CQC capacity to undertake timely reviews of providers who are demonstrating significant quality improvements
• CQC focus is on providers who are poorly performing so we will need to use PAMMS inspections as the measure of improvement

How we will measure that we have achieved this aim

• Improved PAMMS ratings
• Improved CQC ratings
• Fewer safeguarding concerns
• Reduction in complaints received and local government office enquiries
• Increased uptake in staff training and development

Impact

People will tell us:

• "I am confident that the people supporting me have the skills needed to meet my care and support needs in the best way"
• "I feel safe"
• "At all times I am treated with dignity and respect"
• "I have control over the support that I receive so that it is delivered in ways that best meet my needs"

Providers will tell us:

• "I feel supported to deliver a high quality of care"
• "I will encourage and support my staff to progress their career in the social care sector"
• "I will employ suitably qualified managers who have a collective vision of what 'good' care looks like"
• "My staff feel part of the solution and are inspired to make continuous improvements in the services that we deliver"
• "I am confident to develop person-centred, creative, and flexible care and support" 

How we will achieve this aim

We will achieve this aim by:

• Paying providers a fair rate that will deliver the quality of service specified within the contract and service specification
• Clarity of commissioning intent shared with providers to enable them to plan
• Information about current and future demand modelling made available to providers
• Robust information about current and future needs and the services required to meet them
• Developing more ways of delivering personalised support options such as direct payments and individual service funds, giving people more choice and control over how their care is delivered. As part of this we will engage with a national programme called small supports to find more innovative ways to deliver services to those people with a learning disability and/or autism. This will involve identifying local based champions who could be supported and enabled to deliver services within their local communities.

What we achieved in 2022

• During 2022-2023 we implemented the previous year's cost of care review that was undertaken for providers of older adult care homes which significantly increased the fee rates we paid
• In partnership with older adult care homes and over 18 year old domiciliary care providers, we undertook thenational fair cost of care exercise during 2022-2023, to gain a better understanding of the actual costs of delivering care in Norfolk for these sectors
• We updated the pre-Covid-19 demand modelling for older adult care home provision and have looked at this at a locality level to inform our commissioning intentions and support provider business planning. Learn more about older adult care on the older people accommodation based support webpage. 
• We undertook some open book accounting reviews for providers who had highlighted concerns around their financial viability

Challenges in achieving this aim

Insufficient care quality commission (CQC)capacity to undertake timely reviews of providers who are demonstrating significant quality improvements. QCQ focus is on providers who are poorly performing so we will need to use Provider assessment and market management solution (PAMMS) inspections as the measure of improvement.

How we will measure that we have achieved this aim

• New co-produced service models that deliver better, person centred outcomes for local people
• Evidence of integrated commissioning underpinned by joint commissioning strategies and joint service specifications
• We expect to see an increase in people choosing to access different ways to organise their care and support needs
• We will have better data sets indicating our population needs to inform commissioning intentions around housing, types of care and more personalised support options
• More people are supported to live in independent settings
• Ensuring that our revised usual rates are regularly reviewed and that they reflect the actual costs of delivery in different areas of Norfolk
• Providers report that the fee rates paid are fair and reasonable, whilst representing best value for health and social care commissioners
• Providers report that they have sufficient information to enable them to plan

Impact

People will tell us:

• "I have a choice of good quality support options available to me that will meet my needs"

Providers will tell us:

• "I am paid a fair rate to deliver good quality care and my business is financially secure"
• "I am clear about what the Council wants to commission, meaning that I can plan"

How we will we achieve this aim

To achieve this aim:

• We have been piloting an innovative new virtual care agency approach with seven domiciliary care agencies in Norfolk and the technology company Alcove. We are evaluating this pilot to see if this has delivered the outcomes expected. If deemed successful, we will then be looking to expand the blended care package offer across the whole county.
• We will encourage and champion innovation and technology enabled services where they benefit people and where the innovation results in more efficient and effective services
• We will encourage services to play an active part in research to improve care for all, foster innovation and enhance people's experience of care
• We will be open for discussions about the use of assistive technology in supporting less labour-intensive approaches
• Development of a more collaborative geographical home care service model that delivers greater service efficiencies

What we achieved in 2022

We worked with the digital health and social care team at the NHS Norfolk and Waveney integrated care board to secure grant funding to support the implementation of digital social care records systems with care quality commission (CQC) registered providers in Norfolk.

Through this process we have secured around £1.5m of grant funding which enables CQC registered care providers to be able to apply for 50% of the first-year cost of implementing a new digital social care records system, up to a total of £10,000.

The fund was launched in October 2022, and we have already had applications to bring the total number of care providers in Norfolk with a digital social care records system to over 60%.

We implemented a pilot for an innovative new virtual care agency approach with seven domiciliary care agencies in Norfolk and the technology company Alcove. This pilot offers blended digital and physical domiciliary care packages whereby low-level check-in calls are done via a video care phone, freeing up 'in-person' resources to support more people who need physical support as part of their care visit.

We worked with Norfolk and Suffolk care support, who are contracted by the better security, better care programme (BSBC) to support providers to register with, and complete, the data security and protection toolkit (DSPT). Due to the success of this programme in Norfolk, the county has a much higher compliance rate than the national average. Norfolk and Suffolk care support has been contracted to provide this support for a further two years.

How we will measure that we have achieved this aim

• 80% of CQC registered care providers, in Norfolk, will have a digital social care records system in place by the end of March 2024
• An increase in the number of care packages that take a blended approach to service delivery where technological solutions and physical support work together to drive better outcomes

Impact

People will tell us:

• "I have more face-to-face time with staff supporting me, which improves my experience of care"
• "My home has the right equipment and technology to enable me to live as independently as possible, for as long as possible"

Providers will tell us:

• "I am encouraged to be innovative"
• "My ideas for a more efficient sector are welcomed and given full consideration"

How we will we achieve this aim

We will achieve this aim by:

• During 2023-2024 we will undertake a carbon footprint assessment of the social care services delivered by us. We are funding two energy assessors this year to support providers to improve the energy performance of their buildings.
• Particular attention will be put towards actions that can both reduce carbon utility and fuel costs to relieve some of the inflationary financial pressures facing the sector
• For contracts and services which support the provision of care, such as community equipment, we will require a commitment to carbon reduction aligned to the our carbon reduction plan
• Development of a more collaborative geographical home care service model that enables improved service efficiencies regarding the delivery of care rounds

What we achieved in 2022

The retendered integrated community equipment service included carbon reduction as part of the evaluation criteria, for the first time. Medequip who were awarded the contract, which started in April 2023, have put in place a range of initiatives such as:

• The use of electric vans
• Supporting the development of the electric vehicle charging points
• The reuse and recycling of equipment

How we will measure that we have achieved this

We will work with providers to design key performance indictors that help us to understand how providers are looking to reduce their carbon footprint

Impact

People will tell us:

• "I live in a home that stays warm and comfortable all year round"

Providers will tell us:

• "I feel supported in our efforts to reduce our carbon footprint whilst not compromising on service quality"
• "I am proud to do my bit to help protect the environment and know what is expected of me"