Commissioning Intentions

Our commissioning intentions have been focused on changing behaviours to promote independence, developing evidence-based early interventions to prevent peoples’ care needs increasing, and devising new delivery models through joint work with our partners.

We gather data and feedback from a wide range of sources and analyse this in conjunction with predicted demand models to determine the requirements for future service provision.

We have a particular focus on using available resources more effectively and seek to work with a more diverse range of partners including voluntary and community sector organisations, small and medium sized enterprises (SMEs), and entrepreneurs to deliver high quality support for our residents.

The current Coronavirus pandemic has had and will continue to have for some time, a significant effect upon both the provider market and the demand for support. As such we are continuing to monitor the situation closely to understand what this means for our current commissioning plans and to engage with our providers and stakeholders to ensure that we maintain a stable market in these unprecedented times.

Where necessary we will revise our commissioning plans and re model services to ensure that we continue to meet needs of Darlington residents in the “new normal”

Coming Soon

The purpose of a collaborative commissioning process is to design how we best respond to the needs of people and communities by putting them at the heart of everything we do; the aim of improving outcomes, ensuring the right care, in the right place at the right time, harnessing the
power of people and communities by taking an inclusive asset-based approach, and making informed investment to ensure we maximise the value of the Gateshead pound.

Effective commissioning will be driven by a data led, evidence-based approach which also promotes collaboration, integration and innovation across the Gateshead System to meet identified current and future needs, as well as any gaps in provision. Our ambition is to provide a high quality, high
performing market through support and collaborative service design with people, providers and communities.

The aims of effectively commissioning in Gateshead will support:
• Early identification, assessment and diagnosis – effective working across health and social care to streamline processes, reduce waiting times for assessment and diagnosis, and avoid people having to tell their story multiple times.
• Continuity of care – there are arrangements in place to ensure continuity as young people move into adulthood.
• Information, advice and support – ease of access to a good range of services and user-friendly information.
• Early intervention – support the move towards ‘Prevention’ as well as improving access to and the availability of universal services.
• The availability and range of services – services are personalised, flexible and outcome focussed with a range of solutions on offer to meet people’s needs, often moving away from traditional models of support.
• Opportunities for connecting – enabling providers and the health and social care workforce to come together to identify opportunities for improved processes and service delivery. Also connecting communities and incorporating peer support into all health and social care pathways.
• Family and carergiver support – there is a range of mechanisms and support in place for caregivers to support them with and/or give caregivers a break from their caring role.
• A competent workforce – appropriately skilled and trained workforce.
• Value for money – that any services commissioned are done so on the basis of providing the most efficient and effective way of meeting people’s needs.

Our Commissioning Priorities are set out in detail here Introduction – Gateshead Council

 

Supported housing

Specialist and Supported Housing Supplementary Planning Document – Gateshead Council

 

Support for people with Learning Disabilities and Autistic people

People with Autism

We acknowledge we have a gap in services specifically for autistic adults without a learning disability.  However, many of our services for other specialist pathways (e.g. mental health and learning disabilities) also support individuals who are autistic, where autism is a primary support need and those who have autism and a learning disability.

We have recently commissioned the development of an all age Autism Strategy. This will be a system-wide piece involving NHS and a wide range of community partners and will have a notable emphasis on engagement and supporting an all-age approach for people with complex needs and those who are more independent.

We have commissioned an Autism Hubs service to support parents and carers of autistic children and young people. This service is being developed jointly with the Family Hubs offer and the Integrated Care Board.

We have developed the Autism Hubs offer following concerns around the growing waiting lists for assessment for autism and co-occurring conditions such as ADHD. This is increasing pressure across health and social care services and a gap was identified to help support parents and carers. The Autism Hubs aim to strengthen workforce capacity to support autistic people through a training offer for professionals.

Following engagement with autistic adults and families that identified gaps in mental health provision, we worked collaboratively with the ICB and mental health partner MIND to challenge gaps in their service and improve their offer for autistic adults. Initial work included an engagement activity with staff led by the Council and an educational workshop led by autistic adults. As a result of this collaboration, MIND successfully sought funding to develop an Autistic and ADHD Adult (18+) service, led and facilitated by neurodiverse experts-by-experience. The service is open to anyone living in Gateshead, Newcastle, North Tyneside, South Tyneside, and Northumberland who is either diagnosed or self-identifying as neurodiverse and wanting to improve their mental health and wellbeing.

In partnership with NENC ICB, we engaged with parents and carers of autistic children and young people which highlighted concerns around long waiting times for access to mental health provision. As a result, there are now primary-care based mental health staff deliver early intervention with children and young people exhibiting low mood and anxiety. Sessions are delivered out of our Family Hubs and coordinated with the Autism Hubs offer, to enable parent carers accessing the Autism Hubs the ability to attend a mental health drop-in with their child. The aim is to facilitate easier access to MH support for autistic CYP alongside an offer for parent carers that can improve parenting confidence and provide information, advice & guidance on the wider offer (e.g., training sessions, peer support group).

 

People with Learning Disabilities

Current provision

Supported Living Services: In-borough, the Council supports 43 services from external providers and a further 4 from our in-house provision. We also support a further 3 services out of borough.  7 of the in-borough services are identified as either individual flats with or without concierge.

The bulk of provision is through our dynamic purchasing system which has 37 registered providers able to support complex and non-complex packages. Additionally, the council purchases care & support from a further 7 ‘spot’ purchase providers.

Learning Disability and Direct Payments: From a working age adults perspective, a further 205 adults enabled to meet their care & support needs through a direct payment. 134 of that number are people with a primary support reason of Learning Disability.

Shared Lives – Gateshead’s Shared Lives offer predominantly supports those with learning disabilities and those with autism. There are currently four Shared Lives Support Workers and one Service Manager. A cost-benefit review was undertaken in 2021 which highlighted –

 

  • Cost savings delivered by the scheme over other alternative respite and residential care models.
  • A sustainable service, with live-in arrangements averaging over 4 years and short breaks arrangements around 6 years.

Ambitions

  • Developing our market sustainability plan for working age adults specialist provision re: needs & demand (including an analysis of voids across accommodation based contracted services), cost of care and provider failure / strategic contingency planning.
  • Reviewing our DPS framework arrangements to ensure future fit-for-purpose and to maximise the number of registered providers who actively pick up packages of care.
  • Supporting more people in age-appropriate settings e.g. reducing the number of working age adults where the only viable accommodation is that aimed at supporting older adults in a care home environment
  • Building on the 2021 review findings, our ambitions for Shared Lives include –
    • Understand the scope for expansion of the Shared Lives team as a possible role as a catalyst for recruiting more carers (a reliable, person-centred alternative to purchasing care and support for individuals with moderate needs)
    • Explore options for applying the Shared Lives approach to –
      • people with mental health problems living in the community and their carers
      • Young adults in transitionary supported living – to support their community inclusion and preparedness for moving on to more independent living (i.e. a bridge/in-reach offer alongside Keyring services).
    • Embed new partnership structures with health and social care colleagues across the NENC ICB footprint to implement projects for improved outcomes for learning disabilities, autism and enduring mental health problems; as well as supporting a robust and flexible social care workforce.
    • Updating our self-directed support offer, maximising the uptake of direct payments and individual service funds.
    • Within our wider work on coproduction, we are identifying specific opportunities within our work programme to engage with learning disability clients most meaningfully across the commissioning spectrum: from ‘business as usual’ contract monitoring and review, to decision making on service and strategy development.

 

Homes not hospitals (previously known as Transforming Care)

Housing for people with Complex Needs

The Council has established a complex housing programme intended to deliver an improved landscape for appropriately accommodating people with complex needs and behaviour which challenges.

Regionally, we are proactively working with partners on a Housing, Health & Care Programme, which is a new programme jointly run by the ICB, local authorities, and the housing sector looking at how we can improve the supply of housing with support for people who have “complex” health needs. The intention is to develop a unified approach and targeted action plan to facilitate a more effective hospital discharge solutions and improved independence outcomes and quality of life.

The initial stage of this work – currently underway and supported by the Housing Learning & Improvement Network (Housing LIN) – is to establish a regional baseline. The council is contributing to gathering data from across the system, in respect of-

  • Children and young people with complex support needs currently in registered residential, nursing, or residential education settings
  • Adults with complex support needs currently in residential or nursing settings, both the overall population and the subset for whom a package of support in a non-residential/nursing setting is or will be appropriate
  • Broken down by age, Primary Support Reason and/or Health Condition, and setting type

Though at early stages, our commissioners and care management teams are working with Housing colleagues to identify the overall social-care related requirements for accommodation, which would dovetail with the regional Housing, Health and Care programme. This activity is expected to consider-

  • Where certain needs or services are most effectively delivered through independent provision or through Council or NHS property portfolios.
  • Respite and step-up/step-down accommodation to offer a preventative contingency, reducing risk of avoidable admission to hospital / care homes, supporting hospital discharge and development of independent living skills and support for carers.

Transforming Care

At January 2024, Gateshead’s Dynamic Support Register identifies a total Transforming Care cohort of 11 people. The cohort breaks down as follows –

 

Age group Community Inpatient
Children & Young People 2 2
Adults (All age, 18+) 3 4

 

Care treatment and review meetings are held monthly on a partnership basis. Adult social care teams are part of these partnership meeting as is the lead commissioner for children & young people’s commissioning.

On a fortnightly basis, the NHS Trust’s community learning disability team holds a ‘flagging’ meeting to; identify new issues, changes and additions; discuss any urgent allocation or referrals between partners.  These meetings are attended by adult social care senior practitioners or service managers as well as the council’s commissioning lead for accommodation, ensuring a consistent and joined up approach across health and social care.

Monitoring arrangements are through multidisciplinary team (MDT) review, care treatment reviews and a dynamic risk register (also referred to as Dynamic Support Register, or DSR). DSR arrangements are chaired by NENC ICB. He council’s commissioners for adults’ services review the DSR for any updated clients or commentary on support required. There is a documented process in place for care & treatment reviews. Discharge planning MDT meetings for individuals can be monthly, or weekly closer to the person’s intended discharge date to ensure momentum and alignment across professionals for a positive outcome.

Supporting young people into adulthood

A project is currently underway to develop an enhanced offer to improve independent living capability and enhanced quality of life for young adults emerging from children and young peoples provision. The project is focused on the development of specialist accommodation and an enablement driven staff model to support e.g. up to 2 years transitionary care and support model. In-house solutions and market options are being considered in the options appraisal overview.

The hypothesis is that people accessing this service will over time, by virtue of increased independence and less reliance on care to live their daily lives, require less purchased care to meet their needs. This does however interact with market sustainability and other commercial factors outside of client needs, driving providers fee setting behaviour.

We recognise the need to prioritise engagement with the ICB for potential additional benefits and efficiency / shared benefits through the Better Care Fund and broader capital development options.

We have also identified the need to develop an approach of ‘generationally appropriate’ services which meet reasonable expectations of future working age adults with support needs as they transition to services typically supporting older adults.

We further recognise the need to develop internal capacity for matrix teams to deliver long term complex transformation projects, necessary to shape innovative care and support services.

Day opportunities provision

Day services provision for older people is predominantly delivered by the council (Blaydon Centre covering the west of the borough), and Age UK Gateshead (House on the Hill covering the centre and east of the borough). A small number of older people also receive a direct payment to fund day services outside of Gateshead. There is also a range of lower-level services to support older people in Gateshead operated by a range of organisations that don’t require any direct funding from the Council.  These are critical to support our Thrive Agenda and support people within their own communities.

For adults of working age, three of the four in-borough services are delivered by the council, and nine services outside of the borough are also used.

The council’s in-house provision is at capacity and cannot meet local demand. Current out of area placements are mostly spot arrangements. Therefore, unless people are utilising self directed support via Direct Payments or Individual Service Funds, the current alternative offer is day support via home or community support.

 We have identified a need to review day services and day opportunities provision. This will involve:

    • Review of the current market (Contracted, Direct Payments and Individual Service Funds, Community level)
    • Identifying and specifying the difference between day services and day opportunities
    • Identifying gaps and challenges
    • Shaping the market to meet future needs
    • Identifying the links to Caregivers support

The timing for reviewing day opportunities arrangements comes alongside the emergence of a new caregivers strategy and a review of current processes and future options for self-directed support.

 

Self-directed support and Direct Payments

The number of people receiving a direct payment has fallen over the years. The Council set a target for 24% of people using social care in receipt of a direct payment, however there are currently only 18.2% receiving a direct payment.

We have committed to set up a direct payment support service to increase the use of direct payments.  We are also keen to explore alternatives to direct payments, such as individualised service funds, and to promote the use of direct payments as a means of sourcing creative solutions to meet eligible care needs.

Also in process of mobilisation is:

  • an options appraisal and recommendations to redesign the council’s direct payment support offer and wider offer of other forms of self-directed support.
  • Develop structures and information to maximise the take-up of direct payments and other forms of self directed support, as well as reviewing arrangements to ensure personal budgets are used appropriately to meet outcomes.
  • Grow awareness of new offer to staff and users / carers / providers – and embed in strength-based practice approaches.
  • Develop an approved list of providers and services to help users and carers make informed choices.

Further, we need to ensure the PA rate is set appropriately.

 

Arrangements to support hospital discharge

Through BCF and Hospital Discharge Funds the Gateshead system has jointly commissioned a range of services to both support discharges and to prevent hospital admissions.  With funding available until the end of March 2025, we will look at capacity and demand and identify requirements from April 2025 onwards.

Gateshead now has a range of both Health and Social Care Services to support the various needs of people.  These include:

Pathway 0  –     We have commissioned Hospital to Home service, delivered by Age UK Gateshead. The service supports thousands of people a year with both home visits, phone calls and signposting to support as and when required.

Pathway 1 –      There are range of services to support people with short-term needs at home in Gateshead;

  • PRIME – Our reablement service that is delivered by Gateshead Council
  • Community Discharge Service – Home Care Service delivered by Hales Care Ltd who support people home from hospital and bridge any gaps whilst people are awaiting a long-term home care package
  • Hospice at Home – An End-of-Life service provided by the NHS Trust to support people at home
  • Community Rehab Team – A team that supported people with on-going health requirements at home, delivered again by the NHS Trust
  • Rapid Response Team – A multi-agency team made up of health and social care services that support people in crises to prevent hospital admissions and support people for up to 72 hours until either the conditions are managed, or alternative support commences

 

Pathway 2 –    Our short-term bed-based services are mainly delivered by our Promoting Independence Centres (PIC), run by Gateshead Council with support from health colleagues. A new PIC opened in early 2024 and will be our main centre replacing two old sites.  The new centre, Sister Winifred Laver Centre has a joint social care and health team working to support people to return home within a six week period.

Pathway 3 –    To support people out of hospital to bed-based services, we have developed a Trusted Assessment Model with a framework of providers who work to support people into temporary placements.   The independent sector providers have worked with us to ensure people a moved smoothly out of hospital on a spot contract basis. Where we have younger adults with more complex needs, arrangements are in place to contact various providers both within Gateshead and outside of the borough where     specialist services may be needed.

 

As we now have expanded Pathway 1 capacity, we are supporting more people home, where possible, and have both reduced delayed discharges and admissions into bed-based services to relieve hospital pressures.

Our investment in our new PIC will see an increased capacity of 10 beds to the system, as well as an enhanced team to be able to support people back home in a shorter timescale, to allow more people overall to be supported each year.  This will also have a major positive impact on our ‘Home First’ approach and our aim to reduce the overall number of people in long-term residential care provision.

In summary, twelve months ago, around 20 people experienced a delayed hospital discharge at any one time. Since October 2023, this has reduced to an average of 6 people.

Overall we have sufficient good quality capacity to meet current and forecasted demand for the next 15 months and will continue to monitor and flex services as and when required.

 

Extra Care Housing

We opened our 7th extra care housing provision, Watergate Court in April 2022.   This complements our Home First approach. A particular focus on supporting people living with dementia, in fit for purpose environments, is anticipated to reduce the demand for future dementia residential care provision.

We have ambitions to expand our extra care housing (ECH) settings by opening a further 3 sites with the aim for 180 additional units by 2027/28.   Further ECH schemes are required by 2040 to meet our growing needs and a delivery plan is being developed to support this.

Our first new site is to be developed in Central Gateshead, second site in the East, in Felling and the third site planned in the West of the borough with locations being considered.

We are planning to introduce a new Care & Support framework in 2024/25 to support any call off agreements as well as a framework for supported housing development to support future developments that require capital investment support from the Council.

Overall quality of provision of care is good and we will continue to monitor and support providers to introduce new initiatives in the years ahead.

Before the opening of Watergate Court in April 2022, the Council supported 223 people in extra care housing settings. At the end of December 2023, this had increased to 291.

 

Home care

Generalist home care – We have invested additional Market Sustainability and Improvement funds from December 2023 to enable providers to increase pay for workers ahead of the April 2024 National Living Wage (NLW) increases.  It is hoped that this will help sustain recruitment and retention within this market.

We have seen a growth in the available capacity within this market in the last 6 months with waiting lists  now at pre-pandemic levels.   Overall quality remains good with only one provider currently rated as Requires Improvement.

In order to secure capacity for the future years and continue with our Home First Approach, market capacity will need to grow rapidly in the coming years.  With that in mind, we are adopting the principles of the Ethical Care Charter Stages 1 & 2 and are working on a new delivery model that will focus on an outcomes based approach instead of the traditional time and task.

Our new approach will look at a wellbeing model and support people at home longer with the use of digital, technology and equipment/adaptations.

In January 2023, 629 service users a week were receiving generalist home care, using a total of 7938 hours of care and 137 people were waiting for a package of care to meet their needs.

By the end of December 2023, there 788 service users using a total of 9883 hours of care per week, with only 10 people waiting for a package of care to meet their needs.

Specialist home care – Lot 4 of our DPS framework includes 38 specialist homecare providers. Of these, 26  have a ‘Good’ CQC rating and 2 are rated as ‘Requires Improvement’. Of the remaining providers, 3 has not yet had their first CQC inspection and 7 are not registered with CQC.

There are 16 services on our contract framework for specialist home care with 14 rated good (87.5%) and 2 rated as requires improvement (12.5%) by CQC.

At the start of December 2022 there were 218 people receiving specialist home care using 11,828 hours of care and by the end of December 2023 this has increase to 241 using 12,803 hours of care.

 

Care homes

As at January 2024 there were 49 care homes in Gateshead, of which 22 are registered to include nursing provision.  This equates to a total of 1,960 beds, of which around 150 are vacant.  Due to the reduction in demand for residential care, and the consequential reduction in staffing, only around 60 of these beds are available for use.

We have signalled to the market our intentions to reduce reliance on bed based services, in line with our preventative, home first, strengths based approach.  We are anticipating a downwards shift in the numbers of people in care homes in Gateshead, and that those in need of bed based care will become increasingly more complex in the years to come.

A new procurement framework will be in place in early 2024-25.   This will look at the market sustainability investment and the setting of new fee models for all adult care homes in Gateshead.   The new contracts will look to improve the overall quality of care and gain a sustainable future market for the future changing needs.

In January 2023 115 people were in short term residential care and by December 2023 this had reduced to 52.

In January 2023 Gateshead Council supported 592 residents in long term residential care and 214 residents in long term nursing care. By the end of December 2023 this had reduced to 529 in long term residential care and 180 in long term residential nursing care. This is a total reduction of 97 people in long term care.

 

Carergivers

We have recently refreshed our Caregivers Strategy, Our Adults Caregivers Strategy – Gateshead Council which has been co-produced with caregivers, carers support organisations, the ICB and the wider Carers Partnership Board.

We are in the process of recommissioning our carers services alongside the ICB, as current arrangements come to an end in 2024. A review of existing contracts has been undertaken and we are engaging with caregivers to ensure their perspectives are considered for future models. We are also actively working with current providers and other organisations who support caregivers (e.g., Alzheimer’s Society and the Social Prescribing Teams).

We host the Carers Partnership Board which has membership including the local authority, the ICB, Healthwatch, Carers Trust, Gateshead Carers Association, Hospital Trusts.

There is an action plan attached the board and several workstreams to seek better outcomes for carers across themes such as communication and engagement, aligned to the Caregivers Strategy.

We would like to see the collaboration around our Carers Partnership Board grow. We would like to progress conversations started around the local hospital trusts and involvement with caregivers to improve the hospital discharge process.

We recognise the need for a dedicated strategy for young caregivers, and this forms part of the work programme for the next 12 months.

We are soon to undertake the following activity with local NHS partners –

  • Through the Carers Partnership Board, create a Carers Data Dashboard to improve collective system oversight and planning.
  • Update the carers JSNA content for carers.

 

Gateshead Caregivers Demographics

The 2021 UK census indicated 18,800 people who identify as caregivers in Gateshead. 59% of these are women and 41% men. We intend to increase our ability to offer advice and support to people who do not identify as unpaid carers.

Gateshead wards with the highest proportion of caregivers providing up to 50 hours care per week are: High Fell, Windy Nook and Whitehills, and Chopwell & Rowlands Gill.

Our data shows 22 carergivers attached to direct payments (either relating to themselves as carers or the person they care for). These direct payments mostly relate to cleaning or ‘agency’ services.

On average, each month the council through its contracted service providers undertakes –

  • 11 young carers assessments and 18 re-assessments per month
  • 20 adult carers assessments per month
  • 2 parent carer needs assessments per month

 

Intersecting Needs: Gateshead Carers Association (GCA, 2023) survey shows that –

  • Almost half of unpaid caregivers in Gateshead report having a disability or long-term illness
  • 95% (17, 840) White British & Irish Carers
  • 5% (951) Black, Asian, Mixed, Roma, Gypsy, ‘Other’
  • 43% of Caregivers nationally reported their caring role had caused financial difficulties (ASC Survey, 2022)

 

Young Carergivers

The majority of young caregivers provide up to 19 hours of care per week, with over 200 young caregivers providing up to 50 hours of care per week.

Overview of Young Caregivers in Gateshead (Source: UK Government Census, 2021)
Age range Number of caregivers
5-15 329
16-24 1,025
Total Young Carers 1,350

 

Gateshead Young Carers Service: At November 2023 there were 483 young people registered with the Young Carers Service. Over the preceding 12 months 183 young carers were referred from a wide range of sources: Schools & Colleges; Self/friends; NHS (Primary Care; Community Nursing, Hospitals); Children’s social care services; CYPS; Early Help.

Young Carers Survey 2023: In September 2023, we invited the young caregivers we support, to complete a survey evaluating the services that we deliver, the findings of which will be incorporated into the revised Young Carers Strategy.

Among our ambitions for young caregivers we are keen to pay particular attention to –

  • The impact of caregiving on education and future opportunities: Nationally, 27% of young carers aged 11-15 miss school (Children’s Society, 2023).
  • Reducing any inequality due to ethnicity: 106 young carers in Gateshead are from Black, Asian, Mixed and ‘Other’ ethnic backgrounds in Gateshead (Census, 2021). 13% of young people supported through our contract are from Black, Asian, Mixed and ‘Other’ ethnic backgrounds. Nationally, Young carers are 1.5 times as likely to be from black and minoritized ethnic backgrounds (Wong, 2017).
  • Improving our outreach: Carers Trust survey (2023) suggests that 73% of carers nationally do not identify themselves as a Caregiver.

 

In the past two years Gateshead has increased the number of Carers Assessments it has completed by just over 50%. The majority of outcomes from Carers Assessments are advice & information, Universal services or Signposting. 2023 has seen an increase in the number of Carers Assessments resulting in a direct payment, the figure has doubled in 2023 from 2021 (21,10).

 

Investment in care technology

In common with most areas of the country, we are facing increasing demand for Adult Social Care services. Care Technology has a key role to play in promoting independence and allowing people to live fulfilled lives at home for as long as possible. It gives people control over their care, supports their wellbeing, and prevents, reduces or delays the need for traditional and costly commissioned care services.

We recognise the need to increase our use of digital solutions and care technology, to complement and/or replace more traditional forms of care and support. We plan to commission independent support to develop our technology strategy to support this ambition.

We have completed the ADASS-NE ‘What Good Looks Like for digital working in adult social care’ Self-Assessment Tool, the outcome of which reflected our need to improve in this area.

We intend to embed within future contracts and tenders an expectation that commissioned providers demonstrate how they intend to utilise care technology as part of their service offer.

Over 7000 residents have a basic piece of assistive technology installed in their homes. 205 more residents have had assistive technology installed throughout the year. Of those residents with the basic assistive technology, 25% have additional assistive technology installed.

 

Community Equipment

The Gateshead Equipment Service (GES)

An equipment service contract is jointly commissioned by the local authority and the ICB with the ICB being the lead commissioner.

The primary objective of the service is the provision of equipment to both children and adults assessed as in need of loan equipment to enable them to live independently in the community with support.  This is either in their own home, assisted living facilities or care home settings. South Tyneside Foundation Trust are the current provider of the service.

The service has evolved over the last couple of years with an added focus to provide timely equipment to support people being discharged from hospital back home and for those requiring a short-term stay within a care home provision.

In 2023/24 we anticipate having supported over 13,000 people and delivered over 40,000 pieces of equipment.

 

Provider engagement and market workforce development:

On the whole, relationships with providers are good, recognising the need to work in partnership for a sustainable market and to ensure good quality provision.

Regular provider forums take place although these tend to be more operational in nature. It is our aim to ensure that as well as jointly tackling operational challenges, the provider forums evolve to also have a strategic focus, as well as provide opportunities for co-producing alternative solutions to meet future demand.

We are committed to developing a workforce strategy, in partnership with the sector, that not only focusses on the Council employed workforce, but the wider social care workforce in Gateshead. The success we have seen in respect of alternative routes into social work, is one of the areas we are keen to develop further for the wider social care workforce.

The care sector in Gateshead is a major contributor to the local economy and employs almost 6,000 people in over 6,000 posts, the vast majority of whom work in the independent sector. According to Skills for Care workforce data for 2022/23, of the 7,200 total posts in the sector, around 550 posts are vacant.

Of the independent sector workforce, on average 22% were reported to be on zero hours contracts across all types of CQC regulated provision. Whilst we are keen through our recommissioning work to uphold the principles of the ethical care charter, it is recognised that for some, the flexibility offered through zero hours contracts is attractive to them, and they are making a positive choice to work in this way. It will be important that we reflect this in our contracts.

There are some subtle but significant differences in profile of the workforce across different types of care, and we need to be mindful of these, both in terms of workforce initiatives, market sustainability and commissioning plans.

 

Overseas recruitment opportunities and challenges

According to Skills for Care data, non-EU nationals make up 10% of the independent sector workforce on average. This is most prevalent in the non-residential sector, at 17%. Whilst overseas recruitment has supported the growth of the Social Care workforce in Gateshead, we need to gain both better control and understanding of the workforce for individual organisations in Gateshead.  A recent survey to providers has found an increasing number of providers in Gateshead operating Sponsorship licenses for people working directly in Gateshead services.  The survey showed 432 sponsored overseas workers operating in Gateshead mainly within Care Home and Supported Living settings.   Most of these are operating small numbers of their overall workforce so risks are limited should issues arise.  There are a small number of providers who have larger (if not all) of their workforce being sponsored.

This creates further risks and future challenges should their both be provider failure or removal of sponsorship licences from the Home Office.

As we are entering new contract arrangements soon with the Care Home Market and Generalist Home Care, we intend to include specific areas around overseas recruitment and how we can both control the numbers of overseas workers a provider uses per service and expand our quality standards within the staffing elements.

Gateshead sees the overseas workforce as positive for the Social Care system and are keen to work with providers, but need to mitigate risks for providers, services users and the Council.

This is an area where the Regional Commissioning Group are keen to work together where possible so we can both learn and have some consistency across the region, as we work with similar providers.

Last updated 3rd June 2024

We acknowledge that developing long term commissioning intentions in this time following the Covid pandemic is challenging. However, our focus over the next 3 years will be to further implement Community Led Support.  This will continue to offer and develop opportunities to commission in a different way to meet the needs of the local population, both in terms of prevention and ongoing support. Our aims are that:

  • Co-production brings people and organisations together around a shared vision;
  • There is a focus on communities and each will be different;
  • People can get support and advice when they need it so that crises are prevented;
  • The culture becomes based on trust and empowerment;
  • People are treated as equals, their strengths and gifts built on;
  • Bureaucracy is the absolute minimum it has to be; and
  • The system is responsive, proportionate and delivers good outcomes.

Home Care aged 18+

The Council currently has a number of Business Partners and Spot Providers that are supported by an Approved List of Spot Providers. Should demand needs change, then any opportunities will be advertised via the North East procurement Organisation (NEPO). The current contract ends in November 2025.

Residential & Nursing Care

Middlesbrough Council are keen to engage with providers who are looking to develop or expand their Residential and Nursing Care Homes for Mental Health and Learning Disability provision.

We would like to hear from providers who are looking to develop general residential services for those aged 18-64.

Extra Care Housing for persons aged 55+ with eligible care and housing needs

There are currently voids in both of the extra care schemes within Middlesbrough and this remains reasonably stable. Middlesbrough Council are not looking to increase our Extra Care capacity at this time.

Enablement and Support for persons with Learning Disabilities, Mental Health, Physical Disabilities and/ or Autism

The Focussed Care & Support Framework provides care, enablement and support in the community and also in Independent Supported Living (ISL). Should demand needs change, then any opportunities will be advertised via the North East procurement Organisation (NEPO). This contract runs until the end of May 2026 with the option to extend for a further 2 years.

ISLs / Supported Housing

At the current time the Council is not looking at increasing ‘shared’ supported accommodation.

Tees Valley Complex Care and Support Framework

The current contract is Teeswide and is in partnership between Middlesbrough, Redcar & Cleveland, Stockton, Darlington and Hartlepool Council.  The contract ends in March 2029, should demand needs change, then any opportunities will be advertised via the North East Procurement Organisation (NEPO).

Tees Advocacy Service

The current contract is in partnership between Middlesbrough, Redcar & Cleveland and Stockton Council to provide access to IMHA, IMCA, paid RPR, Care Act and general advocacy advice. The current contract ends April 2026, with the option to extend until 2030. 

Day Services / Day Opportunities

Organisations that are looking to develop innovative services / opportunities in Middlesbrough can contact the Council via contractandcommissioningunit@middlesbrough.gov.uk  Of particular interest would be any services / opportunities that would be available in the evenings or weekends. We will be mapping current services to identify any gaps in provision throughout 2024.

Supported Housing

Middlesbrough Council’s Commissioning Team are always keen to hear from housing providers to discuss new and innovative models of service provision which can meet our current demands.  Housing providers should be registered with the Regulator of Social Housing and should be able to evidence their inclusion on the list, found on GOV.UK 

Support for Carers 

Middlesbrough Council jointly commissions the South Tees All Ages Carer Support Service with Redcar & Cleveland Council.  The contract ends in March 2025 and there is the option to extend for a further 2 years.

Support for People with Dementia and their Carers

The Dementia and Wellbeing Community Hub is a community base for people living with dementia, and their carers. Middlesbrough Council contract for a Dementia Advisor Service at the Hub. The contract ends in September 2024 and there is the option to extend for a further 2 years; further information can be found on middlesbrough.gov.uk

South Tyneside has ambitious commissioning intentions over the coming year. A number of factors, including the Covid-19 pandemic have meant unavoidable delays to the delivery of some long term strategic aims. Moving forward, the commissioning team will be focused on developing a thriving market which delivers outstanding quality and performance.

There is a commitment to continuing to develop models in co-production with residents, ensuring an outcomes-focused, person-centred, assets-based approach to all commissioning activity. With a focus on data and evidence, South Tyneside will continue to work in an integrated way to meet current and future needs as well as address any gaps in the market.

Self-directed Support

Market Summary: The council provides an in-house direct payments support service. The service currently supports 458 individuals with a direct payment, of this number:

  • 29% are aged 65 or over,
  • 43% have a learning disability as their primary support reason
  • 9% have mental health as their primary support reason

Individuals are supported to purchase a range of care and community services. The service facilitates the payment of a personal budget to an external provider should a third party managed account be preferable.

Future Vision: The council aims to further increase the uptake of Direct Payments and Personal Budgets as a means of giving people greater independence, choice and control over the care and support they receive. To meet the anticipated demand in the market, there will be a requirement for support in relation to the recruitment and support of personal assistants. The council intends to build on the review of the PA market to ensure that the market can meet increasing demand.

Intentions: Our intentions in relation to direct payments are to:

  • Further develop personalised commissioning approaches such as Individual Service Funds
  • Develop a Personal Assistant database
  • Increase the number of support options available for people to purchase

Residential and Nursing Homes

Market Summary: The council currently commissions 23 care homes for older people. This includes homes which are residential, EMI residential and nursing. These homes provide a total of 1,087 beds. The need for South Tyneside’s older person’s care homes can fluctuate, but occupancy currently sits at 89%. There are also 9 specialist care homes in the borough, 6 of which predominantly support people with learning disabilities and 3 predominantly supporting mental health. These homes provide 134 beds and current occupancy currently sits at 93%. At present there is an over-reliance on the use of residential care setting for older people and on out of borough placements for people with challenging and/or forensic behaviours.

Future Vision: It is envisaged that, where appropriate, people currently residing in out of borough residential settings will be supported to return back into borough. The intention is for more people to be supported at home for as long as possible; as a consequence, people entering into residential care are likely to be admitted later in life with increased complexity of need.

Intentions: Our intentions in relation to residential care are to:

  • Undertake a comprehensive review of the Care Home Market
  • Reduce the number of people residing in out of borough care homes
  • Support residents to return to South Tyneside where appropriate
  • Support people to remain within the community and their own homes for longer

Day Services

Market Summary: At present, day services are predominantly funded through direct payments or personal budgets. The current model of delivery is predominantly building-based with very little opportunity for innovation with regards to delivery. At present, South Tyneside has 1 commissioned provider delivering day opportunities for people with learning disabilities. There are 4 additional day services providers, delivering the majority of support for people with learning disabilities in the borough, these are accessed through direct payments and/or self-funding.
There is a current commissioned day service which supports people with more advanced dementia. This is delivered through a combination of building and community-based offer. The provider is utilising an ISF-based approach to serve as a broker for individuals to pursue interests via mainstream services.

Future Vision: The council intends to review the current day service offer for people with Learning Disabilities. This will ensure that there is a broad range of opportunities for people to make social connections, engage in meaningful activities and take part in community life in local inclusive settings wherever possible. Rather than simply providing traditional day services, the council aspires to commission a modern, person-centred, outcomes-focused offer.
There is also a longer-term aspiration to develop day services for people with broader needs including older people without a dementia diagnosis. The council will continue to explore innovative delivery solutions to achieve this.

Intentions: Our intentions in relation to day services are to:

  • Develop a framework of day services providers for people with learning disabilities
  • Move from a building-based to a community-based model
  • Reduce reliance on Learning Disability specific services and increase the proportion of people accessing mainstream services (with support if required)
  • Continue to support market diversity and choice for individuals
  • Develop day services for people with a broader range of needs

Domiciliary Care  

Market Summary: South Tyneside operates a prime provider model for the delivery of domiciliary care across the borough. The Help to Live at Home (H2LAH) domiciliary care contract comprises of a long term element (Home Independence Support Service- HISS) and a short term element which includes hospital discharge (Home Independence Crisis Support Service- HICSS). There are currently 4 providers with each provider supporting a defined geographical location within the borough. The contract supports 907 individuals through the HISS element and 108 individuals through HICSS. The current contractual arrangement is a long-term solution and expires in 2030.

Future Vision: There are plans to implement a reablement at home element within the HICSS function being delivered by each of the providers. This will be achieved through close partnership work with existing providers and collaboration with health colleagues to expand our reablement offer.

Intentions: Our intentions in relation to domiciliary care is to:

  • Work in collaboration with providers to further develop the H2LAH model
  • Develop the HICSS reablement offer in the community in close partnership with health colleagues

Accommodation and Extra Care

Market Summary: There are currently five Extra Care schemes in South Tyneside providing 177 units, only two of these schemes can support people with dementia, providing only 17 apartments. At present, much of the council stock is outdated; work is required to ensure the existing stock is suitable for a wide range of needs including physical disabilities and dementia.
South Tyneside has 28 council owned sheltered accommodation schemes providing 1018 units. In addition, South Tyneside has 20 Housing Association sheltered accommodation schemes providing 695 units.
It is recognised that the current market provides a lack of choice for residents with Mental Health needs, Learning Disabilities and/or Autism; resulting in an over-reliance on residential care. The present ISL model relies on the use of shared accommodation, which doesn’t align to residents aspirations of securing their own accommodation without shared facilities.

Future Vision: Signficiant work is being undertaken in relation to accommodation for people with care and support needs. The Council is working in partnership to build three new extra-care schemes to support people over 18. Planning permission for the first scheme of 95 units has been secured, with building work commencing in Hebburn in 2024. It is intended for a further two sites to be developed thereafter. An existing housing scheme has also recently been repurposed to improve
In order to address some of the challenges in relation to lack of suitable accommodation, the council has also progressed with developing two small-scale specialist supported housing developments. This will provide an additional 21 homes for people with Autism and/or Learning Disabilities. Work is also being undertaken to identify opportunities to developing accommodation options for people with mental health needs; the long term aspiration is to develop step-up/step-down provision and where appropriate ensure people residing in out of borough placements can return.

Intentions: Our intentions in relation to accommodation and extra care is to:

  • Develop an all-age Accommodation Strategy for people with care and support needs by 2024
  • Develop a landlord framework to work with housing providers to maximise housing benefit
  • Complete the development of specialist supported housing
  • Commence with building three extra care schemes

Independent Supported Living

Market Summary: South Tyneside currently commissions Independent Support Living services for people with learning disabilities, autism and mental health needs. Providers deliver support with properties which are owned or rented by the individual or on behalf of the individual.  South Tyneside currently has 15 providers in total. There are 120 properties with the space to support 145 individuals. Capacity varies, however, at the time of writing, capacity sat at 94% occupancy. Major barriers at present include the lack of suitable properties locally and the recruitment and retention of staff.

Future Vision: There are upcoming opportunities for delivering independent supported living to support people to live as independently as possible; supporting adults to access education, employment and social opportunities and exerting choice and control over their lives. The Council is currently reviewing its ISL provision to ensure the most appropriate model is in place. This may result in increased demand for such services.  We are seeking to ensure that the range of providers we commission comprehensively supports all of the needs in the borough including those of people with complex behaviours related to autism, mental ill health or offending.

Intentions: Our intentions in relation to ISL’s are to:

  • Review the existing model
  • Undertake a competitive tender exercise
  • Secure a more outcome-focused range of services

Housing Related Support

Market Summary: We currently commission non-CQC regulated supported accommodation for adults aged 18+. These services support individuals with a range of needs, including, homelessness, drug and alcohol issues, mental health needs, and those at risk of social exclusion. This support is commissioned from five providers across a range of shared and dispersed accommodation. We currently commission a total of 137 units.

Future vision: The council aspires to move towards a more outcome-focused model of supported accommodation for adults. This will need to have an increased focus on progression and independence. The aspiration is for services to be more outcomes-focused and holistic; supporting people to access community assets and Primary Care-based health support. There is also the intention to foster greater choice and control by securing more geographically dispersed accommodation across the borough.

Intentions: Our intention in relation to Housing Related Support is to:

  • Undertake a co-production exercise with residents, services, professionals, current providers and the wider market
  • Develop a new model of supported accommodation for adults
  • Undertake a full procurement exercise in 2024

 Specialist respite

Market Summary: South Tyneside currently commissions one specialist respite provision for learning disabilities. This provision provides six general respite beds and one emergency bed. At time of writing the service was supporting 36 individuals with respite care. A number of South Tyneside’s in-borough specialist residential homes also offer respite care, however, a number of residents are attending out of borough respite provisions due to complexity of need and the demands in the market.

Future Vision: A light-touch co-production exercise was undertaken following the pandemic to understand the views of residents and carers accessing specialist respite. Initial work with individuals and families identified the value of respite, as well as how the future could look for respite in South Tyneside. Based on the feedback from individuals, it is clear that there is an appetite for an improved model with a greater focus on outcomes and independence. Further work needs to be undertaken in co-production with individuals and their parents/carers to develop the future model. The intention is to undertake this exercise in the coming months in order to progress swiftly.

Intentions: Our intentions in relation to specialist respite are to:

  • Review the existing model
  • Undertake a competitive tender exercise

Shared Lives

Market Summary: Shared Lives is a family-based approach to support adults to live independent lives. In South Tyneside, Shared Lives carers predominantly support individuals with Learning Disabilities, providing both long term and respite arrangements. There are currently 72 individuals supported through a Shared Lives arrangement. South Tyneside employs a total of 68 long term Shared Lives Carers and 32 short break/enabling carers.

Future Vision: There are many flexible solutions for Shared Lives schemes; the approach is utilised variably across the country with many innovative approaches. A review of the Shared Lives offer is currently being undertaken with the intention to increase the number of individuals being supported by the service. There are aspirations to also diversify the offer to support more residents with varying needs, including people with Autism and Mental Health needs. The review intends to implement more creative approaches to improve outcomes and increase independence, choice and control.

Intentions: Our intentions in relation to Shared Lives are to continue to undertake a comprehensive review in order to:

  • Expand the Shared Lives offer with a focus on enabling
  • Adopt creative approaches to improve outcomes and independence (e.g. assistive technology)
  • Improve capacity for those going through life course transitions

Carers

Market Summary: The council has recently developed a Carers Strategy shaped by the voice and experience of carers. The themes identified throughout conversations have directly produced a number of strategic priorities for the next five years, these are to:

  • Recognise and support carers
  • Support young carers to achieve their full potential
  • Increase access to stable and supportive employment
  • Keep carers connected
  • Improve health and wellbeing of carers

Future Vision: The council aims to continually enhance the advice and support available to unpaid carers. The aspiration is to reduce the potential for carer breakdown; ensuring they are supported to look after their own health and wellbeing, and are able to remain in (or return) to employment as much as possible.

Intentions:

  • The council is currently undertaking a competitive procurement exercise to commission remodeled support services for Young Carers and Adult Carers
  • This new model has been fully co-produced and it is anticipated that the new contracts will be awarded in 2024

Advocacy

Market Summary: The council has a range of statutory duties under which advocacy services should be commissioned. These are:

  • Care Act 2014 (Care Act Advocacy)
  • Mental Capacity Act 2005 (Independent Mental Capacity Advocacy and Relevant Person’s Representatives)
  • Mental Health Act 2007 (Independent Mental Health Advocacy)
  • Health and Social Care Act 2012 (NHS Complaints Advocacy)

These services are currently commissioned via a range of block and spot contracts. A co-production activity has identified a range of issues with the current approach, including confusion amongst professionals around which provider to access, a lack of outcome-focus, and instability for providers.

Future vision: The council intends advocacy services in the future to be more outcome-focused, better coordinated, and aligned to current best practice (e.g., NICE guidelines etc).

Intentions: A remodelling proposal is currently being progressed through governance processes internally. Our intentions are to:

  • Undertake a procurement exercise in 2024 for a new service offer
  • Provide the market with more certainty and stability by commissioning a longer-term contractual arrangement

UPDATED APRIL 2024