Guiding approaches

Our approaches for the market position statement and the future improvement of the social care market in Norfolk are guided by key legislations, policies, strategies and frameworks. These include:

• The care act
• People at the heart of care policy
• Health and social care integration policy
• Local government finance act (1992) and local audit and accountability act (2014)
• Market sustainability and fair cost of care fund
• Norfolk and Waveney adult social care workforce strategy
• Engagement and co-production

The care act (2014) requires local authorities to promote the efficient and effective operation of the care and support market. This means that people needing to access care and support will have:

• A variety of providers to choose from offering a good range of services
• Good quality services to choose from
• Information to make informed decisions about the right services to meet their needs

To achieve these requirements, local authorities must:

• Understand the importance of ensuring the sustainability of the market. A sustainable market means that providers are paid a 'fair' fee rate so that they can deliver the services and support that people need at the right level of quality. Read more about market sustainability and fair cost of care.
• Support the continuous improvement in the quality of services and encourage innovative practice to improve the efficiency and effectiveness of services supplied
• Understand the importance of having staff within social care who have the skills and ability needed to deliver high quality services

Local authorities must have appropriate systems in place to fulfil their duties in relation to market shaping and commissioning. More information about our market shaping strategies.

The money that councils are given comes from the taxes that people pay to the Government. To spend the money in the best way means that we must let providers know what services are needed and what we believe is a fair price to pay for them.

Providers who are not delivering what is needed can either change what they do or decide to stop supplying the services that are no longer needed. This process is defined as 'shaping the market'. 

The 'people at the heart of care: adult social care reform' policy paper is a 10 year vision that sets out long term aspirations for how people will experience care and support. The strategy has a focus on three key aims:

1. Supporting people to have choice, control, and independence
2. Provision of outstanding quality of care
3. Provision of care in a way that is fair and accessible to everyone who needs it

The strategy sets out the responsibility of local authorities to ensure that their local care market is healthy and diverse. Support for sustainable care markets, including moving towards paying providers a fair rate for care, are key aspects in the delivery of the vision for social care reform.

As part of the levelling up agenda, the Government is committed to addressing the current geographical inequalities so that everyone, everywhere receives outstanding quality and tailored care.

The 'health and social care integration: joining up care for people, places, and populations' policy paper sets out the Government's plans to make integrated health and social care a reality for everyone across England and to level up access, experience and outcomes across the country.

Key objectives

Joined up care

As people who use health and social care services require ever more joined up care to meet their needs, achieving this will make all the difference both to the quality of care and to the sense of satisfaction for staff. For example, closer working between mental health and social care services can reduce admissions and improve the quality of life for those living with a mental illness.

National priorities

The Government has worked with stakeholders in the development of a framework with a focussed set of national priorities and an approach for prioritising shared outcomes at a local level, focussed on individual and population health and wellbeing.

Ensuring strong leadership and accountability

Criteria for place-level governance and accountability for the delivery of shared outcomes. The key characteristics needed in any model will be for it to develop a clear, shared plan and, crucially, to be able to demonstrate a track record of delivery against agreed shared outcomes over time, underpinned by pooled and aligned resources.

Finance and integration

Local leaders should have the flexibility to deploy resources to meet the health and care needs of their population, as necessary. NHS and local government organisations will be supported and encouraged to do more to align and pool budgets, both to ensure a better use of resources to address immediate needs, but also to support long-term investment in population health and wellbeing.

Digital and data - maximising transparency and personal choice

A core level of digital capability everywhere will be critical to delivering integrated health and care and enabling transformed models of care. When several organisations are involved in meeting the needs of one person, the data and information required to support them should be available in one place, enabling safe and proactive decision making and a seamless experience for people.

Delivering integration through our workforce

The health and social care workforce are our biggest asset, and they are at the heart of wrapping care and support around individuals. We want to ensure that staff feel confident, motivated, and valued in their roles and that they can work together in a person's interests regardless of who they are employed by. Staff should be able to progress their careers across the health and social care family, supporting the skills agenda in their local economy.

How to achieve the key objectives 

To achieve this, integrated care systems will support joint health and social care workforce planning at place level, working with both national and local organisations.

There is a commitment to:

• Improve initial training and on-going learning and development opportunities for staff
• Create opportunities for joint, continuous development and joint roles across health and social care
• Increase the number of clinical practice placements in adult social care for health undergraduates

The local government finance act (1992) requires a council to set a balanced budget annually.

The local audit and accountability act (2014) requires that a council's auditors be satisfied that the council has made proper arrangements for securing economy, efficiency, and effectiveness in its use of the money it has available.

We therefore must manage the delivery of our care market duties within the wider context of financial constraints.

The market sustainability and fair cost of care fund guidance is aimed at calculating the actual costs of delivering care and developing a plan to narrow the gap between local authority and self-funder fee rates to secure a sustainable care sector. This paper was one of the key elements of charging reform underpinning the national social care reform programme.

A delay of two years in the implementation of the social care reform was announced in the Chancellor of the Exchequer autumn statement in October 2022. Local authorities were required to publish their fair cost of care reports and a market sustainability plan.

Read our fair cost of care reports and market sustainability plan for Norfolk

The fair cost of care reports detail the process undertaken to calculate the median cost of care for care homes primarily supporting people aged 65 and above and domiciliary care services for people aged 18 and above.

The market sustainability plan is aligned with the market position statement. It focuses on three elements:

1. An assessment of the current stability of the care market
2. An assessment of the impact of future market changes between now and October 2025, when social care reform is now due to be implemented
3. A recognition of the gap between the current market median rates (from the cost of care exercise) and the current average fee rates that we pay. This section also includes our plans to help address the sustainability issues identified.

In Norfolk we have recognised the pressures of the working age adult sector, who work with adults under the age of 65. This sector is facing acute financial sustainability concerns and it is acknowledged that a major piece of work is needed to better understand the costs of delivering care within this sector.

The adult social care workforce strategy provides an overview of the social care workforce in Norfolk and Waveney and the challenges faced. It provides a statement of our strategic workforce priorities in the immediate, medium, and longer term and the action we will take to deliver those priorities.

Our two key ambitions are to grow and transform the social care workforce and ensure that the workforce is valued. We seek to enable staff, volunteers, and carers to continue responding to the increasingly complex demands of 21st century care and provide support to ensure we have the right people with the right skills and values in the right places at the right time and enable a good and steady pipeline of new entrants.

We aim to attract the right people into the social care sector and develop and retain those already working here. It also means being clear about what is expected from a future adult social care workforce. For registered managers and owners, it means having the business skills and processes in place to expand and develop their services and to invest in their workforce.

During 2022-2023 there have been a number of projects and events that have helped gather the views of people accessing services and those providing them. These have included:

Ethical framework

The work that we have been doing to develop an ethical framework has provided rich information from people accessing care and support, their carers and families, providers delivering services and their staff. People have told us that:

• Care and support services need to be person centred. For example, being in line with the "No decision about me without me" policy.
• We need to listen and be guided by people with lived experience, and for them to be equal partners in how services and support should be commissioned and delivered
• They want more choice and diversity of services, particularly in services for working age adults
• We need to ensure that individuals are supported to access the setting that is best suited for them
• We need to question accepted practice and conventional wisdom and keep checking that we are achieving best value for people accessing services and for the Council who commissions them
• We need to fully understand the needs of the community and the role that the community can play in supporting people
• We need to help people to branch out and do things that matter to them individually
• There needs to be better pay, progression and opportunities for the adult social care workforce
• People want to be supported to make informed choices
• There should be reduced reliance on paid services. The best support delivering the best outcomes might not be formal care.
• People don't know what they don't know. For example, it is difficult to make decisions if you are not clear about the options available.
• Mistakes will be made so how do we learn from them to prevent similar issues arising again. A learning culture not a blame culture.

Fair cost of care and market sustainability plan

The work that we undertook last year with providers on the fair cost of care and market sustainability plan provided a wealth of information about the current state of the market for domiciliary care and older adult care home services. Providers told us that:

• The financial difficulties and current instability in the market that they are facing means that they might not be able to continue to deliver services in Norfolk
• Recruitment and retention issues continued to be the most significant challenge facing providers
• The acuity of need is increasing, people in their services are far more complex and that this requires staff with higher skill levels and expertise to support them. These skills are not matched by the pay rates that providers are able to afford to pay their staff. We have committed to continue to engage in national discussions for parity of pay with equivalent roles within the NHS and will continue to increase pay rates included within the usual price breakdown by the national living wage (NLW) percentage increase to ensure that providers are funded to pay above the NLW rate. Norfolk care association (NorCA) and Norfolk and Suffolk care support (NSCS) commissioned an external review of job roles to develop the care worker job evaluation framework which has just been published and is being widely promoted.
• Our current care definitions do not adequately reflect the current needs being supported in the older adult home care sector. In partnership with providers, we will be reviewing care definitions during 2023 and will ensure that new criteria are accurate reflections of needs to be met in a care home environment, as opposed to independent living or home care, for example. Providers who are interested in working with us on this can contact us at integratedcommissioners@norfolk.gov.uk.
• Occupancy levels are low for some providers, and they report that they are not getting the level of placements needed to keep their businesses sustainable. They want to better understand what we need as a Council and where we need it. In response to this feedback, with the Norfolk and Waveney integrated commissioning board (ICB) we are working together with providers as part of the collaborative care management review project, to co-produce care home service models that will support a more sustainable sector.
• Nursing referrals are particularly low, and many providers are not covering the cost of their nurse staff establishment with the funded nursing care (FNC) income that they are receiving. They want to work with us and the ICB to better understand this position and to work together to find solutions. The collaborative care management review project will support this understanding and identify next steps.
• The uncertainty of current and future inflationary pressures was making business planning difficult. Many providers reported that they had had to increase staff pay rates several times during the year to retain staff.

Regional market development priorities

Stakeholder engagement supporting the regional market development priorities for the East of England local authorities reported that we should:

• Listen more. Hearing about people's experiences will help identify where services are, or are not, delivering the intended outcomes.
• Be more human. For example, "putting the person into personalisation."
• Build trust and relationships. Creating safe spaces where people can be open and voice ideas and concerns.
• Start with a blank page. Often the priorities identified by local authorities are the right ones, but people want to contribute to how they can be best achieved. To consider how people with lived experiences and their families can co-produce commissioning mechanisms that would impact on service quality such as inclusions in provider contracts and in the monitoring of performance.