HOUNSLOW MARKET POSITION STATEMENT

As the Lead Member for Adult Social Care, Public Health and Transformation, I am keen to work with the care market in Hounslow. It was good to meet so many care providers at the Provider Event in October 2023, to hear your questions and feedback as well as listen to the visiting speakers.

The 2024 Market Position Statement sets out how we continue to plan for the care market of 2024 and beyond. It describes where we are now and informs care providers of our commissioning intentions in 2024 and 2025. This document also provides details of market engagement events or forums planned for the future and provides details of how to contact us – we are keen for care providers to contact us.

It has been apparent for several years that there will be an increased demand for care services in Hounslow in the future. This document continues the process that is already underway, where we talk to the market about our commissioning intentions and listen to feedback about possibilities. The Council continues to welcome the development of new, good quality care provision into the borough – with a view to meeting this increased demand.

Care providers will be aware of the difficult financial position that faces local government. There are challenging times ahead, notably finding sustainable ways to commission quality care. However, this will only be possible with the engagement and commitment of care providers. We hope you can engage with us in the months aheadto ensure we meet the challenges of the future together.

 What is the Market Position Statement?  

 Promoting Wellbeing and Independence – A Joint Prevention Strategy for Adult Services in Hounslow  

 Who is the Market Position Statement for?  

 Key messages in the Hounslow Market Position Statement  

 The Care Market  

 Commissioned Services  

 Key Challenges  

 Commissioning Intentions for 2024  

 The Hounslow Care Market  

 Commissioning Intentions  

 Market Oversight – Supported Living  

 Commissioning Intentions  

 The Care Market  

 Key Challenges  

 Market Shaping  

 Commissioning Intentions  

 Mental Health - Accommodation Based Support  

 Carers Support  

 Community Based Services  

 Day Opportunities for Adults with a learning disability and/ or Autism  

 Hounslow Council commission day opportunities for Older People  

 Commissioning Intentions  

 Community Services 

 Market Sustainability  

 Quality Monitoring  

 Workforce  

 Further Information  

 Commissioning Intentions and Procurement Activity 2024/25 

Welcome to the 2024 Hounslow Market Position Statement.

The London Borough of Hounslow is located in west London. We are proud to be an ethnically diverse borough, which has a growing population of all ages. We are proud to commission and provide care and support to adults. We are fortunate to work with our adult social care clients, and to work alongside their carers, care workers and care providers. A detailed profile of the Hounslow population is contained on the  Hounslow Data Hub .

The  Hounslow Data Hub  contains information on the Hounslow population, economy, and environment. Information for care providers on care requirements and  projected future service demand for adult social care  is placed on the Data Hub and available for all. The Data Hub will be updated during 2024 and in future years. This information forms part of the Market Position Statement in a dynamic way.

Throughout this document we will use terms contained in the Care Act 2014. These include Market Shaping, which means using the levers available to a local authority or the wider NHS to promote market capacity and quality. Commissioning refers to the process of understanding the current and future needs for care and support by adults in the borough, of mapping gaps in service delivery and then ensuring such needs are met. Procurement is a formal, legal process for purchasing services, usually undertaken by Hounslow Council using the London Tender Portal. Contracting is the next stage, including specifying the service in a contract and monitoring delivery.

The Joint Prevention Strategy was launched in 2015 by Hounslow Council and the NHS and then refreshed in 2019. The goal of the Strategy has been to ensure residents are supported and encouraged to live independent lives. The Strategy focussed on promoting independence for people at risk or who were already accessing health and social care services.

The Council and the NHS have consistently followed the guiding principles of prevention in the commissioning of care services since the Strategy was launched. The objective has been to commission support to enable people to choose alternatives to permanent residence in residential or nursing care homes. For people living at home, the goal has been to enable people to rely less on mainstream services such as homecare through supporting their levels of independence for longer. Commissioning activity has included commissioning additional extra care units, a combined NHS/ local authority reablement service and integrated housing and housing related support at the front of the client journey. This has delivered floating support, housing options, increased carers support and advice, client advocacy and ensuring links to local multi-disciplinary teams.

The Council is currently developing a business case to evidence the demand for additional extra care schemes. We are engaging with developers of extra care schemes and may engage with the care market and housing providers in 2024.

In addition to statutory services, the Council, with our NHS partners, has developed a range of community based, grant funded services to support prevention across the borough. We have used this approach to commission a range of befriending, mental health support services and wellbeing services that underpin the Prevention Strategy.

Hounslow Council provides information on Council grants, funding and commissioning of services through its website:

   Council grants | Council grants, funding and commissioning | London Borough of Hounslow 

In addition, through the Transformation Programme, the Council has embarked upon a two-year programme to review how we respond to residents and to make more services available locally.

Throughout the document we set out key messages to the care market. These are:

• Commissioning intentions – throughout the document we refer to commissioning intentions. These could be a project to design a new service, the delivery of new funding to existing providers, a contract variation, or a procurement exercise.
• Planned engagement with the care market – during the document we refer to the opportunities referred to above:
• Care Homes Forum. This is a co-produced forum bringing together care homes with commissioners, the care home support team, public health, and other stakeholders.
• Provider events – We host provider events throughout the year. Recent examples are the infection prevention and control webinar in November 2023, or the in-person provider conference held in October 2023.
• A one-off provider event on a particular topic: for example, the home care visa workers webinar or the infection prevention and control webinar chaired by the Hounslow Director of Public Health.
• Engagement as part of the procurement process.
• Key challenges/ pressures in adult social care – during the document we set out our understanding of the current and future challenges faced by adult social care.

During 2022 Hounslow engaged with care providers during the Government ‘Cost of Care Exercise’ for care home placements for Older People and Home Care within the borough. A description of the Cost of Care Exercise and the outcomes is set out on the Council’s website. In March 2023 Hounslow Council published the ‘Market Sustainability Plan’ which described the current and future market challenges and financial challenges faced by care providers and the Council. There have been changes since the Market Sustainability Plan was published and these are described in the sections below, notably in home care, care homes and Supported Living. We are continuing to see the projected increases in demand in these areas, however, recruitment in the care sector has improved during 2023.

The Council is continuing to project future demand, assess market capacity and the financial sustainability of Adult Social Care services. This will lead to proposals for financial sustainability which will be considered as part of the 2024 Council Budget.

Population projections relevant to service demand

Care Quality Commission scores for registered providers in Hounslow

Good quality home care is a vital component of the care and support needed to enable people to live well and remain independent in their own home. Home care agencies are registered with the Care Quality Commission (CQC) and assist people with the tasks of daily living, usually in their own home.

The term ‘Extra Care’ housing is used to describe developments that comprise self-contained homes with design features and care and support services available to enable self-care and independent living. In Hounslow there are currently four Extra Care schemes. Greenrod Place has operated for more than a decade and has been joined by three newer Extra Care schemes developed under the Hounslow Prevention Strategy. The four schemes operating are shown on the map below:

All four schemes are fully occupied (flats either full or residents allocated to voids and in the process of moving in) and we are operating a waiting list. The care provided at all four schemes is rated Good by the Care Quality Commission. Only Bristol Court has areas allocated, but all schemes will take people with a learning disability or dementia as well as general needs.

The successful delivery of the strategy has increased the extra care capacity in Hounslow from 38 flats to 201 flats. This has delivered client choice and reduced demand on home care and care homes. Currently schemes are near capacity with waiting lists developing. Work is underway to develop and agree a business case to develop a pipeline of schemes, with an initial scheme of 50-60 units to be developed as a matter of urgency. The Council has started to engage with interested developers of extra care and will continue to engage with the market in 2024 to plan for future provision.

Case study: Two Bridges

In 2022 Hounslow Council oversaw the completion of the new Two Bridges scheme, which is supported accommodation for adults with learning disabilities and/ or autism and behaviours that challenge being run as a two-year pilot. The background is that a lack of suitable accommodation in Hounslow led to children and adults with learning disabilities and/ or autism being placed outside of the borough. Placing children or adults outside of the borough can be problematic because it may lead to:

• Isolation from family and the local community.
• A heightened risk of crisis and hospitalisation due to a lack of an integrated support system.
• Hounslow Council may find it more difficult to respond to emergencies or Safeguarding alerts.
• Care providers are harder to contract manage, and it is harder for Hounslow Council to ensure value for money.

Two Bridges is now fully occupied. There are eleven, purpose built, one-bedroom flats. Care is delivered using an integrated care model designed to enable and empower vulnerable service users to either sustain or move towards independent living and fulfilling lives. The pilot care providers are:

• Dimensions: a specialist learning disability and autism care and support provider, with high quality positive behaviour support.
• Hounslow and Richmond Community Services NHS Trust: multi-disciplinary support including Speech and Language Therapy, nursing care and psychiatric care.
• Octavia Housing: a specialist registered housing provider.

The services provided will be reviewed during the first two years of operation, leading to the development of a new service specification and procurement.

Case Study: Supported Housing

The Joint Commissioning Team source and contract manage a range of types of supported housing and related support services. Under the Joint Prevention Strategy, the ambitious LIFE Programme led to:

• Integrated support provision for adults, including floating support and carers respite. This service has been recommissioned as separate floating support and carers services with the new service aligned to Community Solutions, the Council’s Integrated Neighbourhood Services and the Public Health agenda. The new services are being introduced from January 2024.
• Social Inclusion Supported Housing delivered from 10 sites and 86 bedspaces across the borough for people who are homeless, have mental health or substance misuse problems and other complex needs by St Mungo’s.
• Young People’s Supported Housing delivered from six sites and 76 units across the borough by Look Ahead.

Case Study: Shared Lives

Hounslow Council supports Shared Lives. This is a scheme to support adults with learning disabilities, mental health or other needs that make it hard for people to live on their own. The current provider of Shared Lives is Certitude and the contract has been extended for a further year so that a review can take place on the current provision. The Council is currently working with the Shared Lives organisation to identify options for the future of a shared lives service. This includes clients of different ages and with a range of support needs.

Supported Living is a service that supports people with a range of support needs to retain their independence while still having that extra physical and emotional support needed to lead completely fulfilled lives in their own homes. In 2022/23 we commissioned Supported Living for approximately 295 people, within the borough and outside of Hounslow.

There has been a steady growth in demand for Supported Living and Hounslow Council project a significant increase in the future.

There are 56 Supported Living schemes in Hounslow. Providers are largely commissioned on a spot basis, meaning that the Council will commission care for an individual client and not purchase all available beds in a scheme. There is a range of provision in Hounslow for adults with a learning disability and adults with mental health needs.

Supported Living Schemes for people with learning disabilities and or autism have been commissioned under the LIFE programme, working to transform local accommodation-based services to meet the requirements of the Transforming Care agenda, reducing the need for out of area placements and enabling people with complex conditions to have their needs met locally.

Hounslow Council wishes to see Supported Living schemes operate in the borough that are high quality. We work closely with all providers and will maintain an oversight of the quality of provision even with schemes which are not commissioned by the Council. In recent years we have been concerned by provision that we have not commissioned, and we will continue to work closely with the Care Quality Commission to monitor care.

We encourage all new or prospective providers to contact the Council and we have recently introduced a policy to encourage all commissioners who are placing adults in Supported Living schemes in Hounslow to contact us using the ADASS referral route. This means that we will be informed of adults placed into Supported Living Schemes in Hounslow.

We have projected a large increase in demand for Supported Living places for Hounslow residents. Between 2024 and 2026 we project a rise of 85 clients, and we wish to offer suitable accommodation and support to all Hounslow clients in borough.

We are keen to talk to any good quality experienced provider who wishes to create new Supported Living provision in the borough. We are interested in talking to any good quality providers who have experience of providing Supported Living. If your organisation is interested, please contact us using the details below. Our commissioning strategy is to purchase spot placements and to manage the expansion of the local care market to meet local need and to ensure local health and community services are engaged with new provision and can meet need. This means that if a scheme is developed in the borough, we will not purchase spot beds if the building or the care provided does not meet the needs or wishes of the clients.

If you are a new or prospective provider please contact us at amy.gill@hounslow.gov.uk We will ask you to complete a questionnaire providing details of your facilities, care and support services and organisations policy and procedures. Please be aware that there is no guarantee that we will source care and support from a new provider even though demand is rising.

Demand for mental health placements of all kinds continues to grow and this is expected to continue. We are projecting a demand for nursing and residential care home placements for all adult age groups. We are projecting a demand for other types of accommodation, including supported living and supported housing.

Not only demand but also need is changing. Clients may have multi-faceted need, with provision needed to support physical needs, complex mental health and/ or leaning disability and support client choice.

Hounslow has an integrated team responsible for sourcing and managing mental health placements and for interfacing with the market to ensure supply is sufficient to meet demand. By combining these functions, we are working with live information about need as it evolves and can shape the market accordingly.

In terms of procurement, we have moved away from traditional block contracts as spot purchasing is a more flexible and efficient way to meet the diverse needs of our residents. We work with a wide and growing range of providers both within and outside the borough and are always keen to talk to new organisations interested in working with us, particularly those able to offer placements in borough. Organisations must be suitably qualified and experienced in working with adults with mental health needs and able to deliver high quality services which meet our standards.

In 2024 we expect to commission:

• Services providing a high level of support (24 hour on-site staffing) and geared to one of the following client groups:
  • People with complex Mental Health needs whose behaviour may be challenging, often including active substance misuse.
  • Young people with complex Mental Health needs, often on a background of Autism Spectrum Disorder and/or learning disability.
  • Older people with functional Mental Health needs, often accompanied by declining physical health and mobility.
  • For the first two client groups, supported living model is preferred although ability to provide personal care on an individual basis would be helpful. For the older client group, the Care Quality Commission registered care home model is preferred.
• Services offering step down from high support accommodation - for people able to take a first step towards greater independence but still requiring daily support and monitoring.
• Services offering self-contained accommodation (ideally dispersed) with visiting support that can be tailored according to individual needs.

Please contact Karl Mellor, Hounslow Council Placements and Brokerage Manager (Mental Health and Learning Disability) if your organisation is interested in working with us (karl.mellor@hounslow.gov.uk)

Hounslow Council and the North-West London ICB commission community-based services. Many of these are long standing and resilient services that are local to Hounslow. These include health advice, hospital discharge support and day services for adults. Hounslow Council and the North-West London ICB also jointly commission community equipment.

The current day care services for older people living in Hounslow:

Hounslow Council also commissions care from a wider range of day opportunities providers outside of the borough when a client has requested specific care. For example, for older people we commission  Nirvana Day Centre  in Hayes, which provides culturally specific day opportunities for older people from an Asian background.

In 2024 we will engage with the west London care market and review the current provision of day opportunities for all client groups. We will engage with clients and the adult social care market and the wider voluntary sector to understand what additional opportunities are required and available.

Under the Care Act, local authorities should promote a sustainable care market that meets the needs of residents. There are several ways this happens in Hounslow which are set out below. The Council engages with providers annually regarding inflation.

The Council commissions and receives independent advice on the impact of inflation on care staff wages and providers' non-salary costs. For care homes, most supported accommodation, and most community services the Council holds individual discussions with providers regarding inflation. For the Hounslow Homecare contract and SL home care providers, an annual survey of costs takes place, with this information informing the hourly rate for home care each year.

The Council works closely with care providers regarding business continuity threats in Hounslow. We maintain contact lists of care providers and pass on information when urgent risks materialise. We also promote vaccination for care staff against the effects of flu and covid.

Hounslow monitors the quality-of-care services commissioned by the Council and services operating in the borough that are not commissioned by the Council.

The Council and care providers are bound by the Safeguarding Adults legislation. If you are a care provider and you have identified that an adult is at risk of abuse and neglect you must contact Hounslow Council. The Hounslow Safeguarding adults service can be contacted via the Council website:

 Safeguarding adults at risk | London Borough of Hounslow 

Concerns about the quality of care, which are below the threshold for Safeguarding, are treated as ’Quality Alerts’. We encourage all care providers in Hounslow, or other professionals, to contact us using a quality alert form and via the generic mailbox below:

Contract.returns@hounslow.gov.uk

We investigate all quality alerts and customer complaints. We meet the Care Quality Commission each month and share intelligence. More serious concerns about care quality are dealt with under the Council Provider Concerns Policy and Procedure. This will usually lead to an improvement plan being developed by a care provider in consultation with the Council. It may lead to a time limited local authority suspension of new commissioning activity with the provider until quality improves. During 2024 we will engage with providers on a revised Provider Concerns Policy and Procedure, with the intention of listening to feedback from providers and potentially simplifying the process.

We meet the Care Quality Commission monthly to share intelligence on care providers operating in Hounslow and externally. This is termed the Provider Intelligence meeting.

We work closely with Skills for Care in west London and encourage all care providers to engage with Skills for Care, to be part of working groups or to access training and other staff support. We encourage all registered care homes and home care agencies to complete the Capacity Tracker webtool with their data monthly.

We are partners with the NHS in the new North West London Health and Social Care Academy. This has included supporting overseas recruitment and in 2024 will include local recruitment, staff support and training. This follows our recruitment campaigns that have run for the past two years to support local care providers.

Finally, if any care provider would like to advertise their vacancies through our Care for Hounslow webpage, please get in touch.

If you would like further information about market sustainability, please contact us: amy.gill@hounslow.gov.uk

Below summarises the Commissioning intentions that are mentioned in the Market Position Statement.

• Care Homes - Continue a conversation with the care market in the borough and close to the borough about rising demand
• Care Homes - Identify nursing respite beds
• Home care - Continue the ongoing review into quality and the application of electronic call monitoring data in supporting a quality home care service
• Home care - Complete the annual review of home care hourly rates
• Home care - Begin the commissioning cycle for the home care monitoring system that is due in 2025
• Care market - Promote stability in the care market in the context of the visa worker scheme
• Care market - Discuss inflation with commissioned care providers for the period 2024/25
• Care market - Continue to promote Registered Manager Networks and Provider engagement
• Care market - Implement the NWL Health and Social Care Academy recruitment
• Care Market - Continue quality audits and contract monitoring of care providers
• Care Market - To continue to engage with the care market prior to new recommissioning (procurement) of new services
• Extra Care - Develop the business case for future unit (s)
• Supported Living - To work with all providers, current and new, to meet rising demand
• Care market - To promote the delivery of the London Care Record
• Day opportunities - To review current provision and talk to the market about future provision
• Grants - To extend grant provision for hospital discharge and end of life advice services
• Healthwatch - To continue to monitor priorities for Enter and View and Deep Dives against the workplan for 2024/25
• Shared Lives - To develop and implement a new Shared Lives provision in Hounslow in 2024/25
• Recommissioning services - To continue to engage with key stakeholders when developing/ recommissioning services