Guiding approaches

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.