Knowsley Adult Social Care - Market Position Statement 2020-2025
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Knowsley
Adult Social Care
Market Position Statement
2020-2025
Contents
Foreword 5
Introduction 6
Part One 8
Transforming Adult Social Care
Part Two 14
Future projections for adult social care services
and support in Knowsley
Part Three 46
Expectations of providers of care and support
Part Four 34
The future levels of resource
Part Five 36
Working Better Together
Glossary 40
3
Foreword
I am pleased to present the Knowsley Market Position Statement for Adult
Social Care 2020-2025. We received a lot of positive feedback about the first
statement, published in 2016. This version builds on much of that feedback
and includes additional improvements as requested by our communities,
providers and other stakeholders. The publication of this statement sets
out our continued commitment to working more closely with all of the
organisations that support people with adult social care needs in Knowsley.
In line with the ambitions of Knowsley Better Together, intentions for further integration with health will
we believe that working together with our residents, need to be developed and the impact of services
providers and community and voluntary organisations and support will need to be published through
is the only way we can ensure that services meet this statement.
people’s individual needs and aspirations, whilst also
ensuring that adult social care is sustainable now and All stakeholders will be encouraged to comment on,
in the future. We have engaged with a wide range of and challenge, the form and content of the statement
stakeholders to help shape and develop the latest with the aim of continuous improvement and
Statement to ensure that it is reflective of current developing common ownership. There is also a range
and future need and demand, and is as inclusive of support options and services available to help
of as many people’s views as possible. I would like providers to compete in the ever evolving social care
to thank our stakeholders who have taken the time market. This offer is outlined within the document for
to support this process and have helped to shape your reference.
this Statement.
Finally, I would like to personally acknowledge and
This Statement also sets out clearly the future thank all those who work to support adults with social
resource requirements for the borough and outlines care needs in Knowsley. You do an amazing job!
how we will spend these limited resources. We are I hope that you find this a useful read.
all aware that the model for social care services will
need to continue to transform to remain sustainable.
To make this happen we will need to change the way
in which services are delivered and some services
will no longer be commissioned. We want this
document to be the basis of a continued conversation
around our future commissioning intentions and
we want to work with providers and community and
voluntary organisations to help them understand Cllr Donnelly
what is needed. Cabinet member for
Health and Social Care
We acknowledge that there are some gaps that will and Deputy Leader
be addressed in future revisions. In particular, our of the Council
4 5
Introduction
Background What is a Market Position In keeping with Knowsley Better Together, Knowsley
How it has been developed? Council has worked alongside a number of
Statement? stakeholders in order to co-produce the Market
The transformation and sustainability of Adult Social
Care is a priority for Knowsley Council. Like many This Market Position Statement has been developed Position Statement and ensure it is reflective of local
A Market Position Statement (MPS) is a published need. This has primarily been achieved through a
areas of the country, Knowsley has an ageing document intended to support current and future in line with the principles of Knowsley Better Together,
population with increasing numbers of people with with the views and experiences of residents and number of engagement methods that took place with:
providers of adult social care services to develop
complex care needs which will increase the demand their businesses in line with the needs of local stakeholders central to its development and content.
for and cost of Adult Social Care services. As a result • Knowsley’s Carer’s Partnership Board
communities and the vision for social care services.
of austerity, Knowsley Council has had to make cuts This is the second publication of the Market Position The production of Knowsley’s Market Position • Knowsley’s Engagement Forum
in its budget of over £100m since 2010. The model of Statement in Knowsley - It provides detailed Statement sets out our continued commitment to
Adult Social Care Services and support has needed • Knowsley’s Learning Disability Partnership Board
projections of expected demand for services over working more closely with all of the organisations
to adapt and evolve in order to continue meeting local a five year period, supported by a 10 year view of that support people with adult social care needs • Knowsley Disability Concern
needs and deliver a modern and progressive care the council’s commissioning intentions. It identifies in Knowsley and is a product of that continued
model, all whilst funding for the sector has reduced • Your Voice Your Choice
the priorities and gaps within the market where the consultation. It sets out to summarise important
significantly and remains uncertain. development intelligence explaining how we intend to commission • Healthwatch Knowsley
of a more diverse range of services can be and encourage the development of quality services
• Knowsley’s Clinical Commissioning Group
considered, and gives a platform upon which that create a much more sustainable and modern
Context providers and the local authority can engage in model of delivery. We believe that taking this • Elected Members
dialogue about the types of service that will be approach supports a forward thinking, innovative • Local Government Association
Our strategy for social care services and support commissioned by the council and the expected adult social care market where we will achieve better
in Knowsley is focused on early intervention and standards of all service provision. outcomes for our residents. We would like to thank those stakeholders for their
prevention. We need care providers to support valuable contribution.
people to maintain and regain independence through
personalised approaches to enabling care. This will Who is it aimed at?
mean we no longer commission models of care
which do not deliver these outcomes. For people with The MPS is aimed at both existing and potential
complex needs or deteriorating health conditions, providers of adult social care services as well as
our aim will be to maintain their independence for as the community and voluntary sector. It will also be
long as possible and when they are no longer able to of value to those who are interested in how the
live independently, we will ensure that there is good Council and providers more generally commission
quality care available to meet their needs. services including carers / families and people that
use services.
This approach offers a large market opportunity
for providers of quality care services as more than
£67m is to be invested in care and support services
this year, including health investment to fund local
community services, and from residents themselves
who continue to fund or part fund a proportion of care
and support provision.
6 7
Part One
Transforming Adult Social Care
The transformation and sustainability of Adult Social Care is a priority for Principles for transforming the
Knowsley Council. market for care and support
Key to achieving this will be a continued focus on Commissioning in Knowsley Commissioning for outcomes
early intervention and prevention. The approach will
Services will be commissioned to achieve agreed
be underpinned by the commissioning of services
“Commissioning
outcomes - moving away from focussing on outputs.
that embody this ethos. This will be essential in is an intelligent This will encourage commissioned services to
supporting people to maintain and regain their
independence whilst ensuring they receive the right
process to deliver needed consider the difference that they will make to people’s
outcomes for our local lives. Prevention and early intervention is now the
support at the right time. When more acute care
communities. The process underpinning principle of care and support. At every
services are needed these will be high quality and
stage of a person’s journey through social care,
provide value for money. will consider achievement of consideration is given to how independence can
priorities, co-production, social be maintained or retained and health and wellbeing
People will have more choice and control over the
services they receive, giving them better access to
value, intelligence, resources, optimised. People will receive the right support in
collaboration, markets, review
“ the right place at the right time. We have already
services that better meet their needs. This will help
and learning. transitioned to an asset based assessment and
to support people’s independence and ultimately
support planning model which identifies the assets
improve their quality of life. (Knowsley Commissioning Framework) that people already have and identifies how these can
be connected and used to achieve their aspirations
The resources we have will be focused on
and meet their needs. Services meeting eligible
commissioning services that we know from evidence
needs will also be expected to adopt models of care
achieve the best possible outcomes.
that maintain and retain peoples independence and
At the very heart of the council’s decision-making this will be facilitated through new contractual and
and the services it provides are the needs of our payment arrangements that ensure services are
residents and customers. Commissioning is simply meeting these expectations.
an approach to service provision that makes the best
use of the resources available to meet those needs.
Ways we will do this
Commissioning asks the fundamental questions of: • Utilise all the support available in local
communities to support people with care needs -
• What needs to be achieved?
an asset based approach
• How is this best achieved with the resources
• Develop and enhance partnership working with
available?
the local community and voluntary sector
• Who is best placed to deliver it?
• Develop outcome based commissioning models
• Commission services that support people to
and explore opportunities for payment by results
maintain and regain independence
(PbR)
• Encourage uptake of training for front line staff in
• Develop housing support options which
brief interventions, health promotion messages
maximise independent living such as extra care
and community signposting to universal service
and modern supported accommodation
provision
8 9
Promoting Co-production Shaping the Market Maximising Social Value Working Intelligently
As the amount of money the Council has to spend We want to ensure there is a strong, sustainable The Council is committed to try and get as much Understanding the current and future needs of
on adult social care reduces, it is more important and vibrant adult social care market in Knowsley. benefit for local communities as possible when our communities is essential to ensure the council
than ever that the services we do commission are We want to actively encourage new providers to commissioning services. There is a drive to improve commissions services to meet needs. To achieve
effective and evidence based and that we get it enter the market, particularly small, local providers the economic, social and environmental well-being this the Council is working with key partners and
right. That means working with the people who use who know the area and can deliver truly personalised of Knowsley through commissioning and stakeholders to take a more collaborative and
services and the providers of those services to ensure outcomes for people. By working with providers and procurement activity. We will ensure that creating co-ordinated approach to commissioning health and
that services and support are designed to meet residents we aim to enable innovation and creativity. social value is always a key consideration throughout care services. The development of a ‘place-based’
people’s needs and are sustainable. We will support this by designing new models of care the commissioning process. We will focus on plan - Partnership for Health, Care and Wellbeing in
which reflect the “Knowsley Better Together” way of social value priorities that are most relevant to Knowsley - will support a greater collaboration from
Ways we will do this working. We also understand that there are significant Knowsley, depending on the nature of the specific key partners across the borough when developing
challenges in relation to recruitment for social care commissioning exercise, including: and commissioning health and care services. The aim
• Plan and design new service models in jobs. We will work with regional partners to develop is to improve efficiency, avoid duplication, develop
partnership with local residents through • Local Employment: creation of local
a strategy for encouraging more people to work in services that better support people to maintain
established links with local communities employment and training opportunities
the sector. their independence to avoid hospital admission or
• Design new service models and specifications • Keeping the £ local: buying locally where admission to long term nursing or residential care.
with providers through market engagement Ways we will do this possible to reduce unemployment and raise
activity local skills (within the funding available and whilst Ways we will do this
• Increase the uptake of Direct Payments so clients minimising risk to the Council)
• Evaluate the success of new models of delivery can choose the services they want to meet their • Commission more services through pooled
by actively seeking the views of the people who needs health and social care funding arrangements
use them and their families
Ways we will do this
• Encourage the use of Individual Service Funds • Increased joint planning between health and
• Supporting small businesses to grow and
(ISPs) to support flexible support options and social care about what services are needed
develop locally by providing general support,
accountability for delivering outcomes
such as helping to establish governance and • Commission more services that that meet both
• Work closely with micro enterprises and providers organisational structure, committee development, health and social care needs
who offer more personalised approaches to care policy development (safeguarding, equality and
• Collaborate with key partners to take a
and support diversity, volunteering, employment etc.) and
collective approach to service development and
providing peer support, as well as investing in
• Support the development of social enterprises commissioning
schemes that support local priorities
and community interest companies
• Integrate services across education, health and
• Advertise providers businesses through Live Well
• Support providers to work in collaboration to social care to support the SEND agenda
Knowsley - the online directory of services for
further meet the needs of communities and
people in Knowsley
individuals
• Working with regional partners to develop a social
care workforce strategy
10 11
Evaluation and Learning Governance, Resources,
We will regularly assess the effectiveness and quality Transparency, Regulation and
of services. Developing positive relationships with
existing and potential future providers is important to
Consistency
ensure that the market is delivering the quality and
All commissioning in Knowsley will operate under
standards of care that is expected by the Council
the ethical principles of transparency, fairness
and those who use services. This will also ensure that
and equality. This avoids any preferential or partial
the market develops to meet changing expectations
treatment of bidders for example, to ensure a
of care and support services. The Council has a key
professional and impartial approach at all times
role in ensuring the effectiveness of these services
to reduce corruption and fraudulent activity.
is closely monitored both in terms of quality and
Our commissioning will be consistent and to a
their financial sustainability. As a commissioner we
standard that will support improved outcomes for
will need to act early should those standards not
our communities.
be maintained. Moving forward there will be an ever
increasing need to demonstrate that services are
value for money and can deliver the outcomes that
are expected.
Ways we will do this
• Use an assessment framework to monitor the
quality of high risk services
• Work closely with the Care Quality Commission
(CQC) to identify and address poor practice
• Invoke sanctions for providers of poor quality
services but also provide support for providers to
improve quality
• Our expectations around quality and
safeguarding will be embedded in all service
specifications and contracts
• Engage with providers about quality through the
contract review process, quality assessments
and provider forums
12 13
Part Two
Future projections for adult social care services and su pport in Knowsley
Population projections Residents aged 65 and over Projections for social care services and support
There will be a significant increase in the number of
Population projections and the trend for service older people aged 65 and over living in Knowsley. Overview of projections for Key Service Areas
demand has been analysed to develop a baseline for There are currently around 26,000 older people
the demand for social care services. The projections across the Borough and this is expected to increase Table 1: Projected demand for social care by 2024
have been adjusted to reflect the transformation by 10.4% by 2023 (around 28,300 people) and 24.6%
agenda for social care and support to arrive at by 2028 (around 32,000 people). The overall growth
a comprehensive set of demand projections for within the 65+ age group is steady, reaching a peak Demand Area (Adjusted Projected
services between 2019-2024. in 2026/27 after which the growth continues but at a Service Instances) 2018 2019 2020 2021 2022 2023 2024 Direction
slower rate.
Residents aged between 18 and 64 Shared Lives 42 42 45 48 50 53 56
Population forecasts indicate that there will be a In contrast to the 18-64 population, the prevalence
small reduction in the number of people aged of mental health problems, learning disabilities Complex Group Support 309 271 195 121 121 121 123
18-64 with support needs in Knowsley by 2028. and physical disabilities amongst older people in
However, it is anticipated that there will be a Knowsley is expected to increase between now Direct Payments - 87 88 88 89 90 90 89
proportion of people with learning disabilities that and 2028. For example, the number of older people Homecare Agency
will have very complex needs as a result of the expected to have a physical disability (currently
successes of medical intervention meaning that around 17.4% of the older population) is set to Direct Payments 470 509 587 665 665 669 671
they are living longer. Support for this group is a increase by 10.4% by 2023.
key area of transformational activity, with a focus Direct Payments - 579 579 580 582 584 585 588
on transitioning the existing client group to more This increase in the older population and the Personal Assistant
independent living options which deliver better prevalence of mental health problems, learning
outcomes and are more cost effective. disabilities and physical disabilities amongst older Extra Care 129 149 254 260 314 317 319
people will have a significant impact on demand for
services, with projections suggesting an additional Home Care 835 836 796 795 792 808 824
270 clients requiring support by 2024 and an
Small reduction in the additional 670 people by 2029. Dementia Nursing 79 81 81 83 85 87 89
number of people aged
18-64 with support Standard Nursing 226 232 235 238 243 248 252
needs in Knowsley by
2028.
23% 25% Dementia Residential 212 215 219 223 228 234 239
Increase in Increase in
the number of the number of Standard Residential 227 214 194 179 170 162 164
people with older people
There will be a Supported Accommodation 264 273 280 290 301 312 316
dememtia predicted to
proportion of
by 2030. have depression Total Services 3,919 3,954 4,020 4,041 4,115 4,160 4,204
people with learning
by 2030.
disabilities that will
have very complex
needs. Older people said that
they would like more
social contact and
are concerned about
isolation.
14 15
Commissioning Services - Prevention The Chart below illustrates the utilisation of advocacy Future Projections 2.1.2 Community Navigation
and Early Intervention services across Knowsley.
It is expected the demand for advocacy support
This section will outline the market opportunities will increase proportionally with population growth. The current market
in specific service areas, detailing the current There is also anticipated to be an increase in The Council wants to ensure that a person’s care and
commissioning arrangements, likely investment demand for Independent Mental Health Advocacy support needs are met in the right place, at the right
and future service models. as a result of increased availability of provision in the time, and in the right way. For some, this will mean
borough for people with Mental Health supported in support from statutory health and care services, but
hospital settings. for many, it will be possible to meet their needs in
alternative and more appropriate ways.
2.1.1 Advocacy Future Service Model
A central hub model is likely to continue as long The terms social prescribing and community
The Council is legislated to provide advocacy as there is no change in guidance or legislation. navigation are often used interchangeably, and
services. The service is key to supporting all Under the model, advocates in Knowsley will whilst there are many similarities and overlaps
residents to have a voice to enable them to express continue to be provided with the appropriate training, between the two concepts, there are also some
views, wishes and feelings in relation to care and supporting them to provide high quality advocacy differences. Social prescribing and navigation
support needs. and apply the principles and standards of good schemes both direct patients or service users through
advocacy. This will ensure that they take a person an increasingly complex health and social care
The current market centred approach, supporting people’s individual landscape, generally away from clinical treatment and
needs, and provide flexible support in order to statutory service provision and towards community-
A single provider is commissioned to deliver all based services, however as a general rule, social
statutory and non-statutory advocacy across address the expected fluctuations in demand.
prescription refers from general practice and other
Knowsley utilising a central advocacy hub model. primary health care professionals, whereas navigators
The model facilitates Care Act 2014 guidance to allow 148 60 44 218 45 87 68 16 Anticipated Investment can take referrals from a range of sources including
a continuity of advocate (where someone may qualify The Council currently spends £0.250m on advocacy self-referrals from the community, and from other
Care Act Advocacy
DOLS / Paid RPR
Independent Mental Capacity Advocacy
Independent Mental Health Advocacy
NHS Complaints Advocacy
Non-statutory - Citizen / Volunteer
Non-statutory - Crisis / Issue based
Non-statutory - Parental Advocacy
for different advocates under different legislation). support. This level of investment is likely to continue health and social care professionals.
until 2023 when the Council will retender the contract
for advocacy services. Knowsley Council has a contract with Innovate
Volunteering to deliver Community Navigation
Market Opportunities Services in the borough. This contract is jointly
funded with Knowsley Clinical Commissioning Group.
The contract for advocacy will be retendered in
February 2023 via the Council e-tendering system The Community Navigation Service is a volunteer led
“The Chest”. service which offers a flexible approach to supporting
people with a range of needs to connect or reconnect
with their communities, through signposting, warm
signposting - which could involve a volunteer
attending appointments or a community group with
the person - or a broader support package, tailored
“Advocacy
to the needs of the person, but designed to help
and access to advocacy
services should form part of the
diagnosis package to support
“
both individual and family.
(Knowsley resident, 2018)
16 17
them gain or regain confidence and independence in Future Projections
relation to community support and access. Innovate Community Navigator Service
There has and continues to be a steady rate of
The Community Navigator Service accepts referrals in to the Community Navigation Service, Volunteer Community Navigators help people discover and become more involved with
self-referrals, and referrals from statutory services and this trend looks set to continue for the remaining local people, opportunities, activities, and services. They offer a flexible approach to
including the Council (both at the point of contact and contract term. supporting people depending on how much support is required, including:
assessment), NHS providers and General Practice. 1. Signposting - provide residents with information about what support is available
Since October 2017 the Community Navigation Future Service Model
2. Warm Sign Posting - provide information about what is available and the support of a
Services has received 496 referrals. Of these 235 Knowsley Council and Knowsley Clinical volunteer to attend an appointment or the first couple of sessions with the resident
were self-referrals and 261 were referrals from Commissioning Group have commissioned Liverpool 3. Support Package - Each resident will be allocated their own Volunteer Community
statutory services. The age of people entering the John Moores University Public Health Institute Navigator who will work with them over a period of 6 to 8 sessions to:
service ranged from 18 (38 people under 35) to to conduct a thorough evaluation of the wider
85+ (27 people). The greatest proportion of people • explore ways to become more involved with their community, people,
community navigation and social prescription offer
supported (23%) were in the 75 - 85 age bracket. activities or services
in Knowsley. This evaluation, which will conclude in
In addition to the Community Navigation Service, late 2019 will inform the future model or models of • review their existing support / social network and how this can
there are a number of initiatives that have been delivery which in turn will inform future commissioning be built on
launched in the borough over the course of the last intentions. • identify and break down barriers that might be getting in the
3 years aligned to this and the wider social way of accessing activities and / or services. This can also
prescription agenda. This includes:
Anticipated Investment include more practical support like completing application
• A Kirkby based GP practice that has introduced forms, referral forms, phone calls, and support to develop
The Community Navigator contract has demonstrated these skills
a social prescription offer for its patients - this
value for money both in terms of cost avoided within
scheme seeks to engage patients in group
the statutory sector and improved quality of life for
community activities provided by the practice
such as yoga and mindfulness. The costs for
those accessing the service. Future investment into Local case study
such services remains unknown beyond the end of
the scheme are currently being met by the GP
the current contract term however investment in some S lives alone and up until 6 months ago was very active and
practice always out. After suffering pneumonia in October he lost
form is likely to continue with the evaluation through
• A Lottery funded scheme called Wellbeing Liverpool John Moores University informing the size confidence, experienced difficulty breathing and was fearful
Enterprises Social Prescription - this scheme of the investment alongside options for future delivery of falling.
supports people to meet one of their “5 ways to models. In addition, as part of place based care. S really enjoyed the visit from the Community Navigator
Wellbeing” through group activities. The scheme who explored the idea of him visiting the Veterans group.
has a paid prescriber who co-ordinates 6-8 week Market Opportunities S was matched with a male volunteer who was going
courses for people who are referred by their GP to meet him at the veterans group. The Community
or who self-refer The evaluation by Liverpool John Moores University Navigator introduced him to lots of other veterans and he
will inform the future model or models of delivery really enjoyed his time there and made plans to go to the
which in turn will inform future commissioning group with another veteran for the following session. The
intentions. Market opportunities in this area will exist service will continue to try to work with another befriending service
so that S can access other outdoor activities and have made a referral to
from March 2020.
falls team.
18 192.1.3 Assistive technology Future Projections Anticipated Investment
Local case study
There has been a steady increase in the number The Council will continue to support the provision
The current market of people using assistive technology over the last of assistive technology services through revenue Within Adult Social Care, assistive technology is
Assistive Technology can support people to live 3 years with a total increase of 237 service users resources. Additional capital investment will be regularly used to improve people’s lives and in
independently whilst reducing demand for more between January 2018 and March 2019. It is hoped achieved through joint funding of new schemes some cases with life-changing effect.
intensive and expensive forms of support. that this upward trend will be maintained over the next together with the Knowsley CCG. One local service user who suffers with spinal
two years through a continuing focus on marketing cord compression and has no mobility at all which
Assistive Technology is available to all people to and promotion of the service. Market Opportunities permanently confines her to her bed now has
meet a range of different care and support needs. greater control of her home environment and can
The renewal of the assistive technology contract
The vast majority of current users of Assistive Future Service Model by 1 December 2019 presents a significant market
stay in touch with her family through the provision
of an Alexa virtual assistant.
Technology are older people who may suffer from a A re-commissioning exercise will take place opportunity for suitable providers.
physical impairment or conditions such as dementia Staff from the Council’s assistive technology
throughout December 2019 with an external provider
which affect their ability to remain living independently service provider Home Care Link installed the
continuing to deliver the service on behalf of the Going forward this will not be about a standard kit Alexa device and connected it to the client’s
at home. We aim to change this in the coming years. council. The service will continue to offer a traditional offer but a tailored offer based on individual needs telephone, television and radio so that she can
assistive technology offer complete with alarm and circumstances made available at the earliest now change her television channel, listen to
The majority of current assistive technology receiving centre, but will also need to respond to a possible time. music and phone her family through the use of
services in the borough are provided by a single growing demand for truly preventative technology voice commands. Previously, the lady relied on
provider who is responsible for assistive technology that uses data analytics to prevent incidents from We are also keen to work with sheltered and the visits of carers eight times a day to do these
assessments, installations of kit and maintenance. occurring, not simply providing a response when an supported living providers to ensure they are very basic tasks.
The current provider also operates an alarm receiving incident occurs. This will involve identifying trends, ‘future proofing’ homes with this solution in mind, Through Home Care Link and the Council’s
centre. There are currently 3,068 users of assistive predicting behaviours, and minimising deterioration. and ensuring they are adopting new models Adaptations Team a Hive system has recently
technology services living in the community, with a for properties. been installed which enables her to control the
further 826 in sheltered accommodation and other heating and lights through voice commands.
supported living settings also supported by the same We are aware that technology is changing all the time Mrs M commented, “the Alexa means I can now
provider. In addition to these users, several of the and there are new equipment items on the market. listen to music when I want to and I can connect
social landlords in the borough provide community to people and see their faces using Face Time.
We therefore require our commissioned services
alarm services to their residents, including those living Previously, I had to wait for the carers to do this
to offer a choice of flexible options that offer value for me”. Mrs M’s son said, “it’s great that I can
in Extra Care housing schemes. for money. have face to face contact with my mum which
gives me great reassurance that she is alright”.
The Council will continue to use its website and the
online directory Live Well Knowsley (see section 5) to
provide residents with information about the services
that are not currently provided by the Council, but
may assist those who want to arrange their own
support to remain living independently. The Council
will therefore be inviting providers of these types of
services to provide information about what they
have available so that this can be included on the
websites mentioned.
20 21“There is not enough choice of
employment for people with “
disabilities in Knowsley.
(Knowsley resident, 2019)
2.1.4 Community support and • Providers who can identify the barriers to
progression and employment for people with a
employment
The current market
“There is a lack of training around
independent living for people with “
Learning Disability or Mental Health condition and
to work to actively overcome these barriers with
people and their families
Community support and employment services largely learning disabilities in Knowsley.
• Providers who can support peoples individualised
support people with a Learning Disability or Mental (Knowsley resident, February 2019) aspirations, skills and abilities and deliver truly
Health condition to access meaningful activities, personalised support plans
work, volunteering or learning opportunities.
There have been an increasing number of these • Community interest groups, voluntary
preferable option for young people transitioning from organisations and social enterprises
services and support options start up in Knowsley
children’s to adult services in Knowsley. Therefore it is
over the last few years and we see this as a
anticipated that there will be an additional 186 people Anticipated Investment
continuing growth area particularly as the Council
who will require some form of support from providers
begins to transition away from traditional day There will be continued investment in Community
of community support and employment.
service models. Support and Employment services as the
Councils transforms its model of Adult Social Care.
Future Projections Future Service Model The Council will increase its commissioning activity
There is a need to identify short and long term in this area but residents will also be supported to
We anticipate there to be significant growth in this
employment opportunities for adults with a Learning take a Direct Payment to choose the support which
area as the Council transitions away from supporting
Disability and Mental Health condition in Knowsley. Your Voice Your Choice best meets their individual aspirations.
people in traditional day services. People who
Efforts will continue through local partnership
use services, our partners and the Council are all
arrangements to support employers in Knowsley Your Voice Your Choice is an alternative to Market Opportunities
in agreement that for the majority of people, the
to recruit adults with a Learning Disability or traditional day services based in Halewood that
traditional model of services no longer fits with the was set up to make a difference for all adults There is a significant market opportunity for providers
Mental Health condition in to permanent, temporary,
aspirations of our residents who use these services. with complex needs by providing choice and a who can support the future model of delivery for
or voluntary vacancies, and to ensure that
We know that people want to develop skills for voice on what is important to them. Their aim is to Community Support and Employment Services.
employers have the necessary skills and training
independent living and have access to training enhance the lives of individuals who have autism, This will be both commissioned by the Council but
to provide their staff with the support they need to
which will support them to gain employment disabilities or learning difficulties, providing will also be commissioned by individual service
sustain employment. experiences that promote independence and help
opportunities or support to access further education. users who are supported by the council via a
Therefore, the Council is currently conducting a people live life to the full.
We are particularly interested in working with: Direct Payment.
review of its provision for day services with an They provide employment opportunities through
expected outcome that people will be supported in a • Local organisations who can provide alternative creating mini enterprises and employment The Liverpool City Region Local Authorities are
different way that better meets their aspirations and support to day care based activities. An example of this includes collaborating on the development of a Complex
personal outcomes. paid gardening work with Associated British
• Local organisations who can support people to Care Flexible Purchasing System. This will introduce
Ports Garston to design landscape and maintain
further develop independent living skills and / or a garden. This is completed with St. Helens
a mechanism for the Local Authorities to procure
There are currently 309 people in Knowsley who services to support people with both Learning
support people to develop skills for employment College providing certification work horticulture.
receive support from day services. We expect this Disabilities and Mental Health conditions. Included
The gardening work also continues within the
to reduce to 123 by 2024 as the Council refocuses • Providers who develop a progression pathway local community providing paid and voluntary in this will be a lot for Support for Independent Living
this model of care on supporting only the most which takes account of emerging best practice opportunities. and Progression. Providers will be encouraged to
complex. We anticipate that this will also be the and can deliver outcomes apply to be included in the framework in August 2019.
22 232.1.5 Community Response Future Service Model
A full integrated service review will take place over
The current market the course of the next 12 months with decisions
Established in January 2018, the Community taken about the future model of community response
Response Service supports people home from services as part of this.
Accident & Emergency where admission is not
required, provides short term overnight support Anticipated Investment
at home to support hospital discharge, mitigates Investment in the current community response service
Upcycling project crisis and prevents unnecessary emergency respite will continue to September 2020 with any future
placement as well as avoiding ambulance call outs. investment aligned to the future model of community
At Knowsley Council’s Adult Disability Day Service in Stockbridge
Village, service users are developing valuable upcycling skills response services, post integrated service review.
refurbishing unwanted furniture and other household goods. Since going live in January 2018, The Community
The scheme provides services users with different skills and Response Service have received a total of 266
referrals from across the Acute Trusts, Social
Market Opportunities
qualifications, supporting them to be more independent.
Care Prevention Services, Emergency Duty Out of The integrated service review which will take place
Hours Services, Community Health Professionals over the course of the next 12 months will determine
and Home Care Link, providing a combination of what, if any, market opportunities may exist in this
crisis intervention, early supported discharge and area. These will be communicated to the market
StedyChefs admission avoidance. In relation to early supported following this review.
discharge this again equates to a reduced length
StedyChefs Learning centre has a centre in Kirkby and works with of stay of 3 days per person and approximately
students to empower choice and help them gain knowledge within £0.250m in avoided costs to the health and social
hospitality. It provides pathways to employment for all with an insight care system.
into hospitality, and also has courses and alternative provision for adults
with disabilities. During their time at StedyChefs, students will have the The Community Response Service has a complement
opportunity to learn the correct skills, policies and procedures that are
of two Reablement Officers and six Reablement
expected within a commercial kitchen.
Assistants providing overnight cover for care and
support from 10 pm to 6am, seven days a week.
Future Projections
The service is currently temporary in nature and is
subject to continued evaluation with decisions about
the future of the service being made over the course
of the next 12 months.
24 252.1.6 Reablement the end of reablement, 22 (32%) exited the scheme for those meeting the criteria, for up to six weeks. 2.2 Carers support
with a reduction in their support requirements, and Investment will reflect this continued commitment.
39 (56.5%) exited the scheme with no ongoing
The current market The Current Market
support need. 8 people (11.5%) had no change or an Market Opportunities
The Council has a duty under the Care Act 2014 to increase in support. Almost 18,000 people who live in Knowsley identified
prevent, reduce and delay the need for care and The future model of Reablement may involve much themselves as a carer and provide more than one
support through early intervention and prevention Of the people accepted on to the scheme since closer working alongside the domiciliary care hour’s care per week (2011 Census). It is likely
defined under three headings - primary, secondary, September 2018, the average package reduction sector, with support from the sector to provide short however that the actual figure is much higher due
and tertiary prevention. on exit was 10.2hrs per week. The average amount term care and support interventions alongside the to a number of unidentified carers and the fact that
of time spent in reablement was five weeks and the Reablement Service who will focus on supporting this data is now 8 years old. The 2011 Census data
Reablement Services are a form of tertiary prevention, average functional improvement score was -8.8. people to regain and relearn the required skills of shows that 18% of unpaid carers in Knowsley provide
designed to promote independence and maximise Only one person has returned to reablement since daily living. 20 to 49 hours of unpaid care a week and the
recovery potential after an incident, injury or period exiting the scheme. majority (32.9%) provide 50 hours or more of unpaid
of illness. The regulations require that Reablement care a week.
Services must be provided free of charge for up to Future Projections
six weeks. Knowsley Carers Centre is an independent, local
The Reablement Service will continue to work with registered charity and network partner of Carers
The Council’s Reablement Service supports those people who are deemed to have true recovery Trust. They provide a range of services to support
who: potential, as outlined within the criteria for the service. and enhance the lives of unpaid carers throughout
It is anticipated that those who meet the criteria will be Knowsley. Knowsley Carers Centre provides,
• Are over 18 those people stepping down from hospital, and those phone-in, drop-in, home visits (Kirkby, Huyton and
• Reside in Knowsley and / or registered with a entering the service as a means of avoiding hospital Halewood) and facilitates the following core services
Knowsley GP admission or short term placement in a residential to carers:
bed. It is anticipated that the number of people
• Reside permanently in the community - as • Information and advice
accessing the service who meet the criteria outlined
opposed to a residential or nursing setting will be in the region of 270 people per year. • Emotional support
• Have experienced a recent incident, illness or • Promoting a holistic sense of well-being
injury from which it is anticipated they can recover Future Service Model • Community consultation
in full or part • Empowering Carers
The future service model will change to reflect
• Have clear rehabilitation, recovery and the change in focus of the Reablement Service.
improvement goals Proposals outlining the future model of service All carers providing necessary care are able to
delivery are currently out to consultation and will be access prevention and wellbeing services at the
• Have not had a previous reablement intervention Carers Centre. The different and wide ranging needs
confirmed later in 2019.
relating to the same incident, period of illness or of carers are reflected in the scope of services that
injury are provided through prevention and wellbeing
Anticipated Investment
services, these include:
Since September 2018, 204 people have been The Council remains committed to providing • Advocacy
referred to reablement of which 80 (39%) have been a Reablement Service, designed to promote
accepted on to the scheme. Of those accepted on • Holistic therapies
independence and maximise recovery potential after
to the scheme 69 have fully progressed through to an incident, injury or period of illness, free of charge • Young adult carer support worker
26 27• Young adult carer wellbeing activities In order to better meet the needs of carers in Market Opportunities
•
•
Counselling
Dementia carers wellbeing activities
“ Organisations like the Carers’
Centre are a lifeline - some had no
Knowsley, we want to specifically focus on:
• Increasing the availability and choice of
The Council is particularly interested in working with
providers who can provide respite and regular short
awareness this existed until it was personalised and regular short breaks for carers. breaks in a variety of settings to support carers.
• Targeted Male carers dementia wellbeing
“ We will work with providers and carers in order to
activities needed - it should be advertised Market opportunities for Carers services and support
co-produce good breaks that are personalised, will be advertised to the market following the refresh
• Targeted Male carers wellbeing activities better. planned, offer flexibility, a positive experience and of the Carers services and support in 2020.
• Carer and cared for wellbeing activities (Knowsley carer, 2019) are enjoyable
• Carer skills and development • Increasing the availability of respite for carers in
• Supporting community peer groups people’s homes or Extra Care facilities
My time - managed by Liverpool
• Carer Involvement and engagement • Extending the choice carers have to meet their Carers Centre, Local Solutions
• Carers emergency card scheme To make sure that we better meet the needs of our care and support needs, using our community
• Assistance for carers in the workplace carers in the right way and at the right time, there is assets Liverpool Carers Centre looked at how best to
a need to focus on promoting and developing the respond the high demand for respite in Liverpool.
• Chance for a break from caring • Developing new ways to support carers to
right support services. Some of these will need to be Contact was made with a hotel and it offered
• Support to help carers into work or education formally commissioned by the Council and some will maintain their caring roles whilst enabling them complimentary bed and breakfast for a carer and
• Welfare Benefit advice require us to work with partners and the community ‘to have a life of their own’ a guest.
• Carers Passport to facilitate the development of these services locally. • Using Assistive Technology to maximise the It now has 30 hotels and 32 other organisations
Carers across the Borough may have different needs independence of the person requiring care and providing offers to carers. This includes overnight
• Carer GP Identification and health assessment
and we recognise that tailoring services to individual support and therefore reducing the impact of stays in hotels, and access to restaurants,
• Carer social groups (Kirkby and Prescot Caring circumstances, preferences and communities is key. caring on a carer’s health and wellbeing theatres, universities, leisure and tourism, football
Companions) clubs, watersports centre and Aintree Racecourse.
• Relief Care We also need to ensure fair and equitable distribution 1,300 carers are now registered with mytime,
Alternative provision which is run by 1.5 paid members of staff plus a
• Carers Awareness training of support across the Borough, alongside supporting
The Council, in partnership with carers, the Carer’s manager and two volunteers who were themselves
the local community and voluntary sector to increase carers. Carers chose the name and design of
the availability of support across the borough. We are Centre and the Carer’s Partnership Board will be
Alongside the prevention and wellbeing universal mytime. They are also involved in the development
also keen to harness the opportunities that assistive refreshing the Carer’s Strategy in 2019. Following
support offer, Knowsley currently provides targeted of offers. This project was recently recognised
technology can offer in helping carers. the refresh and once the strategic direction for by Nesta and the Observer as one of their ‘New
support to 800 carers who have been assessed
carer’s services has been agreed, a review of carer’s Radicals’.
as requiring additional support from social care to
services and support will be initiated in 2020 and
continue in their caring roles. Evaluation gained from the project shows an
“Should
an action plan developed for the redesign of carer’s
be more well-being increase in carers health and wellbeing. Carers are
services and support. reporting back that the services have helped them
Commissioning Projections services spread out over the
“ to remain in their caring role.
There is a range of support available for carers in Borough. Anticipated Investment
Knowsley through universal services (those available (Knowsley carer, 2019) The current budget for carer’s prevention and
to the general public), targeted services and also
wellbeing universal services is £0.475m per year.
through the community and voluntary sector.
However, we know that there are gaps in provision
and that some carers are not getting the support that
they need.
28 29Commissioning Services - The split of hours across the eight contract areas of Commissioning Projections
the borough is as follows:
Targeted Support
Table 3: Projections for people with social care needs accessing domiciliary care
Table 2: Domiciliary care hours in geographical areas per week
Year 2018 2019 2020 2021 2022 2023 2024
Domiciliary Care Local Authority CHC hours
Area Hours per week per week Number of people Supported 835 836 796 795 792 808 824
Domiciliary care is provided to people who still
live in their own homes but who require additional Centre Huyton 1,200 300
support with household tasks, personal care or
any other activity that helps them to maintain their Halewood 1,400 300
independence and quality of life. Domiciliary care Over the next 5 years we are expecting a slight Future Service Model - 10 Year View
may be provided to people with learning disabilities, North Huyton 800 50 decrease in the number of people supported by
mental health problems, sensory impairment or domiciliary care in their own homes. This is as a direct We want the primary focus for domiciliary care to be
physical disabilities and older people. Northwood 1,000 100 result of the development of new Extra Care facilities on maintaining and retaining people’s independence
in the borough and the expectation that a number of and supporting as many people as possible to live
The current market Prescot 1,400 100 people will transition from their own homes to these at home for longer. To do this, we expect our lead
newly developed facilities. Therefore, we expect providers in particular to have a much closer
Knowsley Council currently commissions South Huyton 1,000 100 working relationship with both social care and health.
approximately 10,500 hours of domiciliary care the current number of hours commissioned in the
borough from domiciliary care providers to remain To support this we will continue to roll out approaches
services per week, including 1,500 hours per week Southdene and 1,000 100 such as the role of Trusted Assessor. During 2020 we
funded by Continuing Healthcare (CHC). Packages static at the current commissioned hours or a slight
Knowsley Village decline in the hours commissioned overall. will also be exploring ways we can move to a more
are commissioned to meet the needs of a variety of outcome focused model of commissioning and the
service users. Westvale 700 50 potential for delegation of tasks currently undertaken
We expect to work with providers who:
by health professionals to domiciliary care providers.
During 2017/18, the Council in partnership with • Deliver good quality care and take proactive
Liverpool and Sefton re-modelled the way it delivers action to address performance or quality issues
domiciliary care. The new model divides Knowsley
into 8 geographical patches with approximately 1,000 • Can respond effectively to emergency or crisis In 2019, Knowsley Council introduced
hours in each patch. The new arrangements also care demands and periods of high demand the role of Trusted Assessor within
introduced a new model of service delivery. • Can respond quickly to support people leaving domiciliary care. This allowed
hospital agencies to make referrals to social
The majority of these hours are commissioned with
four main providers who operate as lead providers
• Can work effectively with other agencies such as care where a judgement had been
health and housing to deliver whole person care made that a change to the level of
across the 8 geographical areas. The remainder,
approximately 4,000 hours per week are delivered • Can provide flexible support to carers who require care was necessary. This approach
across all areas by spot providers who are registered a break from caring will be further rolled out to include
on Knowsley’s Dynamic Purchasing System for referrals for Assistive Technology and
Domiciliary Care.
Community Equipment in 2019/20.
30 31“There are not enough things to do
in the community - need to have
more options and activities in
the community available that are
accessible and flexible (evenings,
“
Anticipated Investment Complex Community Support weekends).
The London Tri-Borough model
The Council and Knowsley CCG spends £8 million (Knowsley resident, February 2019)
on domiciliary care annually and commissions
(Hammersmith & Fulham, The Current Market
approximately 10,500 hours per week. Westminster & Kensington &
There are currently 309 people in Knowsley who
Chelsea) receive group support in traditional day care settings.
Market Opportunities The vast majority of these services are delivered by
Domiciliary care and integration with the Council with a smaller proportion delivered in the
The lead provider contracts in place are not due
to expire until 2021, following which there are two health private sector. The majority of people who access day
extension options available to the Council(s) for services in Knowsley are aged between 18 and 64
Integration with health was an important aspect and have a Learning Disability or Physical Disability.
a period of 12 months each. However, there is
the ability to join the PDPS as a spot provider.
of the domiciliary care model across the three There are also a small number of older people with Future Service Model
councils that make up the London Tri-Borough.
Providers can register to apply to be a spot provider dementia who also receive support in group settings. Knowsley Council will deliver the majority of support
The aspiration was to create a blended care
on the Council’s e-tendering system “The Chest”. worker role where low level health care tasks were for people in need of complex community support
Applications can be made all year round and will provided by the care and support worker when Commissioning Projections during the day using its in-house services.
be evaluated periodically throughout the year. working with complex care scenarios.
As referenced in the section on Community
Spot providers are able to pick up business across West London CCG were invited to consider Support and Employment Services, the traditional Anticipated Investment
all zones in both Knowsley and Sefton that lead whether to be part of full specification design and model of day services is no longer fit for purpose
providers are unable to deliver. service provision at the outset or come on board There will be a reduction in demand for this area as a
for a significant proportion of people. Therefore, result of the priority to transition away from traditional
at an agreed point in the life time of the contract.
the Council is currently conducting a review of its day care models and therefore a reduction in spend
They chose the latter but wanted to be involved in
shaping the service in the initial phase.
provision for day services with an expected outcome in this area.
that people will be supported in a different way
As a way into a more integrated environment, the that better meets their aspirations and personal
development of the Enhanced / Hybrid worker outcomes. Some capacity for traditional day care Market Opportunities
role was essential in the initial phase. Within the
will remain and will be re-focused to support those There will be no market opportunities for traditional
first year of the contract the CCG’s funded and
delivered a training programme to facilitate the
people with the most complex needs and to support day care over the course of this MPS. There remains
training of care staff on the areas of health care carers to take regular breaks from their caring roles. a significant market opportunity for providers of
that was safe and permissible for non-nursing staff It is therefore anticipated that there will be a reduced Community Support and Employment Services who
to carry out. need for day care support as the Council moves can support residents in alternative ways as detailed
towards more personalised support in this area. in Section 2.1.5
Table 4: Projections for people with social care needs accessing day services
Year 2018 2019 2020 2021 2022 2023 2024
Number of people Supported 309 271 195 121 121 121 123
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