MARKET POSITION STATEMENT 2019-2022 - WORKING WITH ENFIELD'S HEALTH AND ADULT SOCIAL CARE MARKET TO DELIVER CHANGE - MYLIFE ENFIELD
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MARKET POSITION Working with Enfield’s
Health and Adult Social Care
STATEMENT 2019-2022 Market to deliver change
www.enfield.gov.uk
in partnership with
Market Position Statement 2019-22 1
Contents 2
1. EXECUTIVE SUMMARY..............................4 7. UNDERSTANDING ENFIELD......................25 10.6 Specialist Housing ....................................................51
Key Messages.............................................................5 7.1 A place to do business..............................................26 11. PREVENTION, OUR UNIVERSAL
7.2 An area of opportunity...............................................26 OFFER AND ENABLING SELF
2. INTRODUCTION.........................................9
2.1 Purpose of Market Position Statement .....................10
7.3 Overarching Demographics.......................................27 DIRECTED CARE .....................................53
7.4 Public Health ............................................................28 11.1 The Role of Enfield Voluntary and Community Sector....54
2.2 Scope and Use of MPS.............................................10
7.5 Sexual Health and HIV...............................................29 11.2 Volunteering..............................................................54
2.3 Time for Change.......................................................10
7.6 Understanding who we support ...............................31 11.3 Technology and Prevention........................................55
3. LEGISLATIVE CONTEXT.............................11
7.7 Understanding our Self Funder Population................31 11.4 Independent Advocacy .............................................55
3.1 Legislative Impact......................................................12
8. UNDERSTANDING CURRENT MARKET 11.5 Information and Advice..............................................55
3.2 Care Act 2014...........................................................12
Supply..................................................33 11.6 Personal Assistants...................................................55
3.3 Care Act 2014 - Implications for Providers.................13
8.1 Residential and Nursing Home Services.......................34 12. A MARKET FIT FOR PURPOSE...................56
4. OUR VISION, OUR VALUES ......................15 8.2 Enfield Homes Sheltered Accommodation Services...36 12.1 Market Shaping.........................................................57
4.1 Enfield Council – Our Vision and Values.....................16
8.3 RSL and Private Provision of Sheltered and 12.2 Managing Provider Failure.........................................57
4.2 Equalities and Diversity..............................................17 Extra Care Sheltered Accommodation.......................37
12.3 Our Strategic Commissioning, Procurement and
5. SAFEGUARDING AND QUALITY ................18 8.4 Domiciliary Care Services..........................................38 Contract Management Approach..............................58
5.1 Safeguarding Adults..................................................19 8.5 Individual Service Fund (ISF)......................................38
13. WORKING WITH US TO DELIVER CHANGE....60
5.2 Modern Slavery.........................................................20 8.6 Voluntary and Community Sector..............................38
13.1 How the market might deliver change.......................61
5.3 The Safeguarding protocol........................................20 8.7 Small Projects Fund..................................................39
13.2 Developing our Social Care Workforce.......................62
8.8 Small Clubs Grant.....................................................39
6. WORKING WITH HEALTH TO IMPROVE 13.3 Support for your business.........................................63
HEALTH AND WELLBEING........................21 9. UNDERSTANDING THE FINANCIAL CONTEXT...40 13.4 Reviewing the Market Position Statement – A
9.1 Current Adult Social Care Resources.........................41 Partnership Approach................................................64
6.1 Health and Wellbeing Board (HWB)...........................22
6.2 Enfield’s Joint Strategic Needs Assessment..............22 9.2 Future Resources......................................................41 Appendix A:
6.3 Enfield’s Joint Health and Wellbeing Strategy 2014- 9.3 Adult Social Care net budget.....................................41
DEVELOPING A MARKET EQUIPPED TO DELIVER:
2019.........................................................................22
10. SERVICE AREAS IN FOCUS.......................42 AN OVERVIEW OF KEY AREAS FOR MARKET
6.4 Joint Commissioning Strategies................................22
10.1 Adults with Learning Disabilities.................................43 DEVELOPMENT...............................................65
6.5 Integration and Better Care Fund...............................23
10.2 Adults with Mental Health Support Needs ................46
6.6 Impact of Integrated Care System.............................23
10.3 Older People.............................................................47
10.4 Physical Disabilities and Sensory Impairment.............50
10.5 Carers ......................................................................50
Market Position Statement 2019-22 3
1.
EXECUTIVE
SUMMARY
4
1
MARKET POSITION STATEMENT KEY MESSAGES 2019-2022
Enfield’s MPS has been developed as a • Development of a care village with at least 300 support. ISF to be implemented in 2019
market guidance tool, to facilitate the strategic units of accommodation split across sheltered
development of a local market that is equipped to housing, extra care and nursing care provision • Expand our MH community provider market
respond effectively to the health and social care with and without accommodation) through the
needs of local people. It is intended to: • Ensuring that the accommodation/landlord introduction of an open Framework supported
functions are provided separately to the care by a Dynamic Purchasing System (already in
• set out the direction of travel of Enfield’s health and support services place for LD)
and adult social care services
• Development of a Wellbeing Hub/s to support • Develop a hospital stepdown service in the
• provide information to the social care market to joined up health and wellbeing/early intervention community for people with complex mental
facilitate the strategic planning and development support services health issues
of services aligned to local need
• Develop more day opportunities in-borough for
• encourage understanding and provide a basis Community Services: people with acquired brain injury and people
for constructive and creative dialogue with • Promoting personalised approach to supporting with learning disabilities and challenging
stakeholders and providers people by ensuring every person who receives behaviour
• set out opportunities for market development support, will have choice and control over the • Work to deliver training with providers working
including how providers can work in partnership shape of that support in all care settings and with people who have challenging behaviour to
with the Council to deliver change and what will continue to promote a self- empowering reduce and improve quality of life
support is available to enable this. environment where people have the freedom to
use their personal budget in the form of direct • Develop in-borough offer for diagnostic and
The Council, working in partnership with Enfield payment, Independent Service Fund (ISF), a post diagnostic support for people with high
CCG and other Councils across North Central managed service or a Personal Health Budget functioning autism
London will focus over the next three years on:
• Work to develop a vibrant and competitive
Personal Assistant Market (across all service Residential/Nursing Services:
Accommodation/Capital Projects: areas) with a particular focus on North, North • Increase the supply of nursing provision for older
West and North East of the borough people in the borough, including for people with
• The development of accessible accommodation
for independent living including shared • Work with the domiciliary care market to deliver complex needs and dementia
ownership schemes, for Enfield residents to more support in the North, North West and
include adults with physical disabilities, learning North East of the borough Voluntary and Community Service
disabilities and mental ill health
• Continue to increase the number of people (VCS):
• Development of at least 90 further units of extra care taking up direct payments (already at 60%) and • Roll out an annual programme of small project
accommodation in the South West of the borough Individual Service Fund options to manage their grants with a focus on improving health and
Market Position Statement 2019-22 5
MARKET POSITION STATEMENT KEY MESSAGES 2019-2022
wellbeing through increased use of digital
technology as part of a wider offer
• Award a contract for improved self-management
of long-term conditions, including mental-ill
health
• Increase the availability of IAPT accredited VCS
support available in the borough
Service Quality & Standards
The Safeguarding protocol aims to ensure that care
and support services used by adults in the London
Borough of Enfield (LBE) provide good quality care
and have dignity and respect at their core. When
LBE arrange a provider to deliver care and support
we have a responsibility to ensure that the provider
can meet the person’s needs and can do so safely.
The protocol is informed by the CQC standards and
the Care Act 2014.
When the LBE make placements, they will consider
the following
1. CQC Enforcement actions in place
2. An overall rating for the service as ‘inadequate’ 6. Information from service users, friends and family
members
3. Placed in Special Measures
4. If the home has a rating of more than 3 areas
that require improvement.
5. Information available via a range of professional’s
intelligence which highlights inadequate or poor
care
6 Market Position Statement 2019-22
It is a time of significant challenge for Enfield’s The Care Act 2014 emphasis is on the promotion • strategically appropriate services, aligned with
health and adult social care market. Our population of well-being and prevention for adults who have borough need, that prevent or delay the
is increasing year on year and projected to reach care and support needs and their carers. Enfield’s escalation of support and care needs.
MPS takes account of the Council’s responsibilities • accessible information and advice services
376,800 by 2025. People are also living longer.
in relation to the Care Act 2014 and this MPS has that enable people (including those who self-
The number of people over 65 years of age living in been developed as a market guidance tool: fund their care) to make informed decisions
the borough is set to increase 23% over the next about how they are supported to live their lives.
ten years. As at 2017, the estimated population • to facilitate the strategic development of a local
market that is equipped to respond effectively to • independent advocacy services, that empower
of 85+ year olds was 5,979. The ONS population the health and social care needs of local people. people to drive and shape the services they
projection of 85+ year olds for 2027 is 7,500 It is intended to: receive and make their voice heard.
which would represent an increase of 25% in • set out the direction of travel of Enfield’s health • a further developed Personal Assistant Market
10 years. This compares with a projected 9.4% and adult social care services to unlock the benefits of a truly personalised
increase in the overall population in the same workforce.
• provide information to the social care market to
period. facilitate the strategic planning and development • services that offer innovative and flexible
of services aligned to local need models of support and care that can be
Meeting an escalating demand for services at a tailored to individual need, and enable a person
time of financial austerity heightens this challenge. • encourage understanding and provide a basis to commission their support and care directly
the council has faced unprecedented budget cuts for constructive and creative dialogue with through direct payments or personal health
stakeholders and providers budget.
over the last parliamentary term. Nationally, it is
predicted that there will be a £5.8 billiion funding • set out opportunities for market • strategically appropriate services that provide an
development including how providers can integrated approach (across health and social
gap in adult social care by the end of the decade
work in partnership with the Council to deliver care services) to the planning and delivery of
(adult social care funding: 2017 state of the nation change and what support is available to support and care and deliver joint outcomes.
report 2017). Locally, Enfield’s adult social care enable this.
• move on and independent living
budget is set to reduce from nearly £82.8 million Detailed strategic commissioning priorities are accommodation (including cluster models
(net) in 2015/2016 to less that £65 million by identified for each key service area, and service to facilitate peer support and the pooling of
2018/2019. providers are encouraged to explore into the detail budgets) that enable people with support
of this – but we know there are some headline and care needs to live independently in the
LGA and ADASS, 2014, Adults Social Care priorities that reach across service areas, including community.
Funding: 2014 State of the Nation Report. Available the need for:
from: • flexible day opportunities that increase choice
• the need to reduce demand through improving and control and enable people with care and
lifestyles. This will need to come primarily from support needs to take part in activities on a
www.local.gov.uk ensuring healthier lifestyle changes are built into sessional basis.
everyday life • flexible respite, crisis and replacement
Market Position Statement 2019-22 7
care services, including accommodation
This market position
Working in partnership we wish to realise a
based services, and short term 24-hour ‘live-
in’ support services, that can be accessed in
vision whereby: statement is a snapshot of
an emergency and can be purchased by a self
funding individual or through a direct payment or
• the emotional physical and mental a moving picture. The needs
wellbeing of people in need of care and
personal health budgets. support, and their carer is maximised; and aspirations of our local
• dementia specialist and dementia friendly
services including specialist nursing care and • people are supported to maximise their population are not static
independence and feel in control of the
respite options for older people with complex
care and dementia needs. support and care that they receive; – neither is the legislation
• sheltered/retirement accommodation across • people experience an integrated approach to and guidance directing the
tenure type. the planning and delivery of support and care;
• extra care sheltered accommodation across
improvement and delivery
• people have a choice of a range of providers
tenure type prioritising west and central
borough areas for home ownership models.
offering high quality, safe and appropriate of services. There will be
services from a vibrant and diverse
• nursing care provision for older people in the marketplace; gaps in our knowledge
borough.
• services that identify, engage, support and
• people feel empowered to drive and shape of current supply, and
the services they receive and have the right
enable carers to maintain their health and
support to make their voice heard; strategic priorities will
wellbeing and continue caring, including
specialist information, advice and advocacy at • people feel able to maintain the social change as services develop
key transition points (e.g. hospital discharge). and support networks that are important
• Assistive technology has the potential to make to them and maximise opportunities for and provision evolves. We
community involvement, including meaningful
a huge difference to the way we deliver social
care enabling new approaches which improve engagement through, for example,
therefore ask that service
outcomes and deliver efficiencies. employment and education. providers talk to us, and
• To further build on our partnership arrangements
Enfield Council will be holding a series of
• we respect diversity and promote
independence by providing care and
encourage provider dialogue
provider forums. The purpose of these meetings
will be to inform providers about key issues
interventions that not only make a positive
difference but also do so in ways that respect
to help shape future
which affects Adult Social Care providers in
the borough of Enfield. They are forums for
and value the diversity of our local population services in partnership.
joint working and consultation and offer an
opportunity for providers to ask questions to
council officers.
8 Market Position Statement 2019-22
INTRODUCTION
2 Market Position Statement 2019-22 9
2.1 Purpose of Market Position • set out how providers can work in partnership The updated document also recognises the need
Statement with the Council to deliver change including for the Council and its partners to work more closely
what support is available for your business. with its provider markets to deliver services which are
This document has been developed as a market of high quality and which are sustainable. This will
facilitation tool for existing and prospective service Health & Social Care Act 2012. Available from: include Voluntary and Community Sector Provision.
providers who may be looking to set up and/or There will, therefore, be additional content on how
develop adult social care services in Enfield. It has www.legislation.gov.uk we plan to engage with our providers to ensure
been developed by Enfield Council’s Health and we deliver services that are needed, of high quality
Adult Social Care Strategic Commissioning and and which bring an increased focus on new and
Service Development Team to: innovative ways of responding to the health and
2.2 Scope and Use of MPS
social care challenges facing our community.
• set out our direction of travel including Our shared vision across people and health
strategic and legislative drivers that are services in Enfield
influencing change; 2.3 Time for Change
Enabling people to maximise their potential, delivering
• provide information to the social care market There has never been a more pressing need to work
joined up, efficient and high quality services which
on population needs, service demands, together to respond to the financial, demographic
focus on the whole person and family, treating every
commissioning priorities and resource availability, and lifestyle challenges ahead. We must work
contact as an opportunity to empower people to
to facilitate the effective planning and development innovatively and in partnership with our provider
make good choices, stay safe and bridging the
of services to meet the needs of our residents – markets and service users to achieve this, whilst
gap between our vision and people’s own personal
both now and in the future; driving up standards and keeping service users at
experience of working with us
the heart of what we do. Working with providers and
• encourage understanding and provide a basis This Market Position Statement has a wider scope neighbouring authorities to review and develop the
for constructive and creative dialogue with that those previously produced. Its focus has been efficiency of the services on offer will be part of this.
stakeholders and providers; expanded to include key areas of service delivery However, efficiency alone cannot deliver the scale of
across social care services for both children and savings required. We need to look at different ways
• set out opportunities for market development adults. There is also a focus of working closely of delivering services to meet shared objectives, to
and encourage the development of a quality with CCG, Mental Health Trust, Public Health and help manage demand whilst ensuring that working to
adult social care market that is innovative, our local acute hospitals. It is intended to add key keep people independent and safe remains a priority.
flexible, affordable, sustainable and diverse – information about some health service provision, We also need to promote lifestyle changes for the
offering a true choice for local people; underlining the importance of joint working and community as a whole
integrated service provision across health and
people. This document will, therefore, include LGA 2014, Under Pressure: How local councils are
links to information across health and social care, planning for future cuts. Available from:
including the Joint Strategic Needs Assessment
and Health Needs Assessments as well as some https://www.local.gov.uk/sites/default/files/
additional separate sections on the landscapes in documents/under-pressure-how-counci-471.pdf
children’s social care and health services.
10 Market Position Statement 2019-22LEGISLATIVE
CONTEXT
3 Market Position Statement 2019-22 113.1 Legislative Impact out a further fundamental shift in our health and 2020, the Government will have cut £16 billion from
social care landscape for people, with increased Councils’ core funding since 2010. In Enfield, the
The introduction of the Health and Social Care Act responsibilities for local authorities in relation to Government has cut £161 million from the Council’s
2012, established clinically led commissioning to prevention and wellbeing, information and advice, funding since 2010. By 2020 the amount of money
empower GPs to commission services on behalf advocacy, assessment, safeguarding, market the Council receives from central government
of their patients. Local Healthwatch organisations shaping, adoption, special educational needs, will have reduced by 60%. This poses significant
were created to drive service user involvement looked after children and more. challenges for the Council and difficult decisions
across the NHS and Council services. Public will need to continue to be made in allocating
Health responsibilities for health protection and These fundamental changes are being implemented resources to the services which the Council funds.
improvement also transferred to Councils with a at a time of substantial cuts in government funding.
renewed focus on local priorities. The Local Government Association has estimated
that councils face a funding gap of £7.8 billion by 3.2 The Care Act 2014
The Care Act (2014), the Children and Families Act 2025 just to maintain current service levels. By
(2014) and Mental Capacity Act 2005 (MCA) set The Care Act is built around people’s needs and
12 Market Position Statement 2019-22what they want to achieve in their lives. It seeks to
rebalance the focus of care and support towards
promoting wellbeing and preventing or delaying
needs, putting people at the heart of the system.
The Act places a number of duties on the Local
Authority including:
• Duties on prevention and wellbeing
• Duties on information and advice (including
advice on paying for care
• Duties on market shaping
• National minimum threshold for eligibility
• Assessments (including carers assessments)
• Personal budgets and care and support plans
• New charging framework
• Safeguarding adults
• Universal deferred payment agreements
3.3 Care Act 2014 – Implications For
Providers
Providers should be aware of the major changes
and opportunities as set out in LGA, 2015, Guide to
the Care Act 2014 and Implications for Providers,
London. Available from:
www.local.gov.uk
Market Position Statement 2019-22 13Key Areas that Providers should be aware of New Areas for Partnership Working with Providers New Opportunities for Providers
• Principle of wellbeing – understand the • Market shaping and commissioning – • Prevention, including intermediate care
principle of wellbeing and consider if there are consider involvement, and assess personal – consider what preventative services are
additional services providers might wish to knowledge prior to engagement in the currently offered and what could be delivered
supply. process. in the future.
• Managing provider failure and service • Independent advocacy – consider offering
• Assessment, including carers – understand this service to local authorities in future.
interruptions – understand local authorities’
how the process works, be able to explain
powers and duties when a care provider fails • Personal budgets and direct payments
it to people seeking care and support, and
or the provision of a service is interrupted. – providers should review their commercial
guide them to their local authority. terms to enable people using their services to
• Market oversight – note CQC’s new function
• National Eligibility Criteria – understand use personal budgets and direct payments.
to oversee the financial sustainability of
the criteria, be able to explain them to people providers that would be difficult to replace • Individual Service Fund Involves the delivery
seeking care and support, and guide them to were they to fail. of a personalised and flexible service i.e. the
their local authority. service user and the provider will develop the
• Statutory safeguarding – be aware of detail of the care and support plan; and the
• Care planning and review – be able to the need for adult safeguarding policies service user drive who, what, how and when
identify outcomes within the care and and procedures and the areas to cover; care and support is provided
planning process that will establish the benchmark against existing policies and
• Integration, cooperation and partnership
cornerstone of a subsequent care plan. procedures and draw up new ones where – provider to consider what services it might
required. Access Safeguarding Boards annual offer now and in the future as a result of
• Deferred payments – review commercial reports. integration.
terms to be able to explain to clients and • Information advice and guidance – have in • Smoothing transition to adult care and
potential clients how to access deferred place information about services provided so support – understand local authorities’ duty
payments in line with local authority policy. that individuals can decide if those services to conduct a transition assessment.
• Funding reforms – including intermediate are appropriate for them. Make this available • Delegation of local authority functions
care charging. to the local authority so it can be incorporated – providers should consider what existing
into its advice and guidance. services they might want to offer, and any
• Duty of candour – understand provider new services they might wish to develop,
responsibility to be open when things go that may fit with functions delegated by local
wrong and the action they are expected to authorities.
take. • Improving access to psychological
• Ordinary residence – understand which therapies (IAPT). Develop IAPT accredited
geographical local authority is responsible for VSC organisations with the appropriate
each service user. infrastructure to enable them to contribute
towards IAPT access to recovery targets
14 Market Position Statement 2019-22OUR VISION,
OUR VALUES
4 Market Position Statement 2019-22 154.1 Enfield Council – Our Vision and Sustain strong and health communities Enfield 2018
Values Despite substantial cuts in government grants,
• Protect those most in need by continuing Enfield Council remains a successful, high
Our vision is to make Enfield a better place to
to deliver the services and safeguarding performing Council, continuing to deliver high
live and work, delivering fairness for all, growth
measures they rely on. quality services across the borough. However,
and sustainability and strong communities.
Underpinning this commitment we have a number • Work smartly with our partners and other pressure to generate further savings through
of priorities, the delivery of which will contribute to service providers to enable people to live local government continues. and we need to
improving the quality of life for all residents in the independent and full lives. think now about how we do this.
borough.
• Build measures into all our strategies and A number of operating principles have been
projects that will help improve people’s health. identified that, together with our values, will
Good homes in well-connected deliver the efficiencies and changes we need to
neighbourhoods • Work with partners to make Enfield a safer make. These principles will be applied across the
place by tackling all types of crime and anti- Council to every activity we carry out. They are:
• Continue our pioneering approach to social behaviour, and protecting the local
regeneration to create thriving, affordable urban and green environment. • Do it once – and in one place
neighbourhoods and places. • Only do the things that make sense for us to
• Increase the supply of affordable housing do so (e.g. we won’t take on things that we
Build our local economy to create a thriving are not specialist in)
including ownership, private rent, council
place • Automate and self-serve nearly all
housing and other social rent.
transactional activity
• Drive investment in rail, roads and cycling • Work with local businesses and partners
to develop a strong and competitive local • Consolidate teams and create smaller, more
infrastructure to improve connectivity and
economy and vibrant town centres that focused centres of excellence
support economic development.
benefit all residents. • Enable work to be delivered with fewer
• Create an enterprising environment for • Support residents to take more responsibility resources
businesses to prosper with world-class digital and play a greater role in developing active • Empower our customers to help them resolve
infrastructure. communities. their own requests and thus managing
• Enable people to reach their potential through demand more effectively
access to high quality schools and learning; • Continue to partner with other organisations
and create more opportunities for training and and agencies to help deliver better services at
employment. a reduced cost
• Embrace our diversity, culture and heritage • Maximise income where it is cost effective to
and work on reducing inequalities to make do so
Enfield a place for people to enjoy from • To make the ‘healthy choice the easy choice’
childhood to old age.
16 Market Position Statement 2019-22These principles give us a clear direction to
become even more efficient, focused on our
customers and fit for an increasingly digital age.
4.2 Equalities and Diversity
The Council works towards equality of opportunity
for all and devotes its energies and resources to the
achievement of this aim. Service providers play a
central role in helping to deliver this vision. Service
contractors and sub contractors are responsible for
implementing The Council’s Valuing Diversity and
Equal Opportunities Policy when providing services
on the Council’s behalf. Further information on the
Council’s Equality and Diversity policy and objectives
can be located on Enfield Council’s website.
https://new.enfield.gov.uk/services/your-council/
equality-and-diversity/about-equality-and-diversity-
in-enfield/
4.3 Adult Social Care & Health Joint
Vision and Values
We aim to deliver good quality, safe, joined up
health and social care services that meet the
needs of individuals and their carers, with the right
intervention at the right time and in the best place.
Our focus is on prevention, but when care and
support is needed, we will provide this at home and
in the community, wherever possible using limiting
contractual arrangements ensuring service users
choice and control thorough their Direct Payments,
Independent Service Fund (ISF) and Personal
Health Budgets as way of delivering services.
Market Position Statement 2019-22 17Safeguarding
and Quality
18
5
Market Position Statement 2019-225.1 Safeguarding Adults • can evidence staff understand what abuse a decision then any action taken, or any decision
is, know how to recognise when it may be made for, or on their behalf, must be made in their
Safeguarding means protecting an adult’s right to occurring and are clear on how to report best interests.
live in safety, free from abuse and neglect. It draws concerns
together both our response to stop the risk and Providers of health and adult social care will need
experience of abuse and actions taken to prevent • have in place a whistle-blowing policy and to ensure they:
abuse in the first instance. All actions undertaken evidence this is publicised to staff
will be in the interest of promoting a person’s • understand and can work in line with the MCA
wellbeing and with regard to their views, wishes, Development of safeguarding in organisations
should be done in consultation with those who use • employers can support staff so that they can
and feelings in deciding next steps. help adults manage risk in ways that put them in
services, their carers or representatives.
Safeguarding is not a substitute for provider’s control of decision making if possible.
responsibilities to provide safe and high quality The Safeguarding Adults Board Safeguarding
Adults Strategy can be found online at: • regular face to face supervision to support staff
care and support. They have a duty not only to work in line with MCA
to the adults they deliver services to, but also
a responsibility to take action in relation to the www.enfield.gov.uk The Deprivation of Liberty Safeguards are for
employee when allegations of abuse are made people who lack mental capacity and may require
against them. care or treatment in a hospital or care home where
Providers of health and adult social care need to
their freedom may need to be restricted to the
Employers should ensure that their disciplinary be cognisant of the policy and procedures which
point of depriving them of their liberty. This can only
procedures are compatible with the responsibility to will be initiated by the Local Authority with partners
be done lawfully if appropriate authorisation for a
protect adults at risk of abuse or neglect. should there be significant safeguarding failings or
Deprivation of Liberty Safeguard (DoLS) has been
concerns which impact on the service as a whole.
Providers of health and adult social care should sought.
ensure they: The Care Act 2014 and statutory guidance
There is also a process for having such
with respect to safeguarding adults, wellbeing
• have due regard for the six key principles safeguards put in place for people in Supported
requirements and working in partnership to protect
which underpin safeguarding work; Accommodation or other settings than a care home
adults are key for providers. Providers will need to
empowerment, protection, proportionality, or hospital. These judicial DoL Safeguards have to
work in partnership and co-operate with the local
accountability,prevention, partnership be authorised by the Court of Protection who have
authorities and others in the interest of safeguarding
now streamlined the application process for these
adults.
• have clear operational policies and procedures cases.
that reflect the framework set by the Professionals and other staff need to understand
Safeguarding Adults Board Providers of health and adult social care must
and always work in line with the Mental Capacity
ensure they do not unlawfully deprive someone
Act 2005 (MCA). People must be assumed to
• understand and can work to the principles of of their liberty, have the skills and knowledge to
have capacity to make their own decisions and be
Making Safeguarding Personal consider least restrictive options, and comply with
given all practicable help before anyone treats them
the legislative.
• have safe recruitment practices as not being able to make their own decisions.
Where an adult is found to lack capacity to make
Market Position Statement 2019-22 19Further information on the Mental Capacity Act and exploitation, forced begging, illegal drug 5.3 The Safeguarding protocol
the Deprivation of Liberty Safeguards can be found cultivation, organised theft, related benefit
online at: frauds etc The Safeguarding protocol aims to ensure that care
and support services used by adults in the London
• Forced marriage and illegal adoption Borough of Enfield (LBE) provide good quality care
www.scie.org.uk/mca-directory/ and have dignity and respect at their core. When
Enfield Council has updated its standard contract LBE arrange a provider to deliver care and support
terms with providers of health and adult social care we have a responsibility to ensure that the provider
5.2 Modern Slavery concerning modern slavery. Providers must ensure can meet the persons needs and can do so safely.
that their staff understand:
The Modern Slavery Act 2015 was introduced The protocol is informed by the CQC standards and
to combat modern slavery in the UK and sought • Safeguarding the Care Act 2014.
to consolidate previous offences pertaining
to trafficking and slavery. Modern slavery • Equality & Diversity Code of Conduct When the LBE make placements, they will consider
encompasses slavery, servitude, forced and • Whistleblowing the following
compulsory labour and human trafficking.
These policies are key to ensuring that providers 1. CQC Enforcement actions in place
Traffickers deceive and force individuals against
their will into a life of abuse, servitude and of health and adult social care have appropriate 2. An overall rating for the service as ‘inadequate’
inhumane treatment. Many active organised crime channels to report any incidents of slavery and
groups are involved in modern slavery, but it is also human trafficking. 3. Placed in Special Measures
committed by individuals
Further information on modern slavery can be 4. If the home has a rating of more than 3 areas
Contrary to a common misconception, people found online at: that require improvement, contract monitoring
are not necessarily transported across borders visits will be made before using the home.
for trafficking to take place, much of it is now https://mylife.enfield.gov.uk/enfield-home-page/
home grown. There are several broad categories content/safeguarding/modern-slavery/
of exploitation linked to human trafficking,
including:
• Sexual exploitation
• Criminal exploitation
• Forced labour
• Domestic servitude
• Organ harvesting
• Child related crimes such as child sexual
20 Market Position Statement 2019-22WORKING
WITH HEALTH
TO IMPROVE
HEALTH AND
WELLBEING
6 Market Position Statement 2019-22 216.1 Health and Wellbeing Board (HWB) 6.2 Enfield’s Joint Strategic Needs • narrowing the gap in healthy life expectancy
The Enfield Health and Wellbeing Board is a forum Assessment • promoting healthy lifestyles and healthy
where the key leaders from the health, care and The joint strategic needs assessment (JSNA) is communities
other partners can work together to improve the a process by which local authorities and Clinical
health and wellbeing of the local population and Commissioning Groups (CCG’s) assess the current • enabling people to be safe, independent, and
reduce health inequalities. and future health, care and wellbeing needs of the well, and delivering high-quality health and social
local community top inform local decision making. care services
It was set up under the Health and Social care
Act 2012 and has 20 members including from The JSNA is concerned with the wider • The People directorate, in partnership with NHS
across the Council, NHS and voluntary sector determinants of health such as housing, income Enfield CCG, is currently completing a refresh
representatives. and employment; as well as looking at the health programme of its strategies, which are no longer
of the population with a focus on behaviours that current. This will take the form of a set of shared
Health and wellbeing boards are a key part of the affect health, such as smoking, diet and physical commissioning intentions. These will not replace
Government’s broader plans to modernise the activity; and identifying health inequalities and any plans within strategies that are still current.
health and care system and to: providing a common view of health and care needs
of the local population. https://new.enfield.gov.uk/healthandwellbeing/
• Ensure stronger democratic legitimacy and The JSNA offers a helpful provider resource that wp-content/uploads/2017/03/Enfield_Joint_
involvement can support the strategic development and delivery Health_and_Wellbeing_Strategy_2014_19_FINAL_
April_2014.pdf
of services to meet the needs of Enfield’s residents.
• Strengthen working relationships between health Further information on our Joint Strategic Needs
and social care, and, Assessment can be found by following the link: 6.4 Joint Commissioning Strategies
• Encourage the development of more integrated Enfield will be creating a set of Commissioning
commissioning of services. https://new.enfield.gov.uk/healthandwellbeing/jsna/ priorities for the next 3 years. The Council is
currently working with health partners to develop
• To make the ‘healthy choice the easy choice’ a Health & People Priorities document. The
6.3 Enfield’s Joint Health and Wellbeing document will detail headline priorities across Adult
The vision of the Enfield Health and Wellbeing Strategy 2014-2019 Social Care and Health, with a focus on joint work
Board is to give people in Enfield opportunities to and the advancement of integration. It is the current
live healthier, happier lives. We also want to narrow • Developed using information from Enfield’s
intention that the document covers a 3 year period,
the gaps in healthy life expectancy between those Joint Strategic Needs Assessment, our Health
to be reviewed annually.
living in our most deprived communities and those and Wellbeing Strategy sets out the following
who are better off. Please see our Joint Health and priorities:
https://mylife.enfield.gov.uk/enfield-home-page/content/
Wellbeing Strategy here. • ensuring the best start in life
policies/strategies-policies-and-reports/
https://new.enfield.gov.uk/healthandwellbeing/ • creating stronger, healthier communities
jhws/
22 Market Position Statement 2019-226.5 Integration and Better Care Fund function as a single system, providing a network deliver better coordinated high-quality person-
of care centred care within the CHINs:
The Better Care Fund is the only mandatory policy
to facilitate integration. It brings together health and • Provide joint assessment, care planning and • The development of multi-partner voluntary
social care funding, with the additional injection of interventions with patients and across the sector arrangements are expected to work
social care money announced at Spring Budget system with care professionals, including GPs, in the
2017. Integration is important because people CHIN to support people and carers, and help
need health, social care, housing and other public • Deliver high-quality care in the most appropriate them navigate the system, including promoting
services to work seamlessly together to deliver settings including out-of-hospital settings healthier lifestyles and helping them after
better quality care. More joined up services help they’ve developed a long-term condition, such
improve the health and care of local populations
6.6 Impact of Integrated Care System
as dementia, or after a crisis, such as a fall or
and may make more efficient use of available Health and social care commissioners in Enfield hospitalisation;
resources. have been working with care providers to establish
• A greater role for non-clinical staff, such as RSL
an integrated care approach for residents. Building
The Integration and Better Care Fund is a jointly staff or domiciliary health care assistants, in
on well-established developments for integrated
owned plan between the Local Authority and identifying and improving the health outcomes of
learning disabilities and mental health the focus is
Clinical Commissioning Group, working together individuals with whom they come into contact,
primarily on older people and adults with physical
with partners such as providers, acute trusts, and not just through Enfield’s Every Contact Count
disabilities.
the community and voluntary sector. It is built upon campaign which focuses on promoting healthier
feedback from those who use services and the Enfield’s Integrated Care Programme (ICP) was lifestyles, but having greater awareness of signs
clear understanding of local need. Importantly, it established to put the person at the heart of their of particular conditions, such as dementia,
has the appropriate oversight and scrutiny from the care; how it is planned, coordinated with an overall mental health or diabetes, their impact on an
Enfield Health and Wellbeing Board. Together, we aim to improve the effectiveness of the health and individual’s daily living and how their needs could
have an aim to deliver joined up health and social social care system. The ICP has been superseded be accommodated, and where to get help in the
care services that meet the needs of the individual by the Care Closer to Home Integrated Network integrated care network;
and their carers, with the right intervention at the (CHIN) work. The main aims are still to ensure care
right time and in the best place. Our focus is on • A greater emphasis in domiciliary care in
is delivered in a seamless way across the system promoting ongoing recovery from illness
prevention, but when care and support is needed (including the public, private and voluntary-sectors);
we will provide this at home and in the community, following on from an individual’s short period of
and that unnecessary admission to hospital is publicly-funded rehabilitation – an emphasis on
wherever possible. The principles underpinning our avoided.
approach to integration echo the aims of the NHS doing tasks with, rather than for, the patient;
Five Year Forward View, which are The key ways in which this will influence the • An expectation residential and nursing care
• To put patient and carers at the heart of care development, commissioning and delivery of care home providers and staff will work with the
planning and delivery with services integrated across the private - and voluntary-sector in Enfield CHINs in improving the management of their
around them are outlined below. The recent re-commissioning residents. Taking the excellent work of the
of the voluntary sector highlighted the approach. NHS nurse-led Care Homes Assessment Team
• Ensure that the components of the model Sectors will work in tandem with each other to (CHAT) towards the Trusted Assessor model,
Market Position Statement 2019-22 23whereby homes accept patients following others
assessing potential residents, is expected to
emerge
• Provision of formal and “on-the-job” training to
care staff, including nurses, to help staff improve
their skills and knowledge for all residents’ care
management.
• Opportunities for residential and nursing
care home providers to develop specialist
functions, such as short-stay rehabilitation units
(either step-up to avoid hospital admission or
stepdown to facilitate safe hospital discharge)
or longer-term specialist support for people with
more complex mental health and continuing
healthcare needs, such as those with advanced
dementia with potentially challenging behaviours.
24 Market Position Statement 2019-22UNDERSTANDING
ENFIELD
7 Market Position Statement 2019-22 25
257.1 A place to do business
Located 12 miles north of Central London, Enfield
offers a very attractive residential environment with
fine parks and open spaces, excellent schools,
good public transport and a wide range of leisure
facilities. Enfield is renowned as a business-
friendly borough and the Council understands and
promotes business success. It assists businesses
in recruiting local staff via our Invest in Enfield
campaign:
https://new.enfield.gov.uk/services/improving-
enfield/economic-development/invest-in-enfield/
The Council also promotes inward investment
activity. The Council aims to support businesses
(anywhere) recruit local (Enfield and surrounding
boroughs) residents through a partnership
approach with our partners who have funding to do
direct delivery of skills training, employment support
and job brokerage.
industrial space and excellent locational benefits through targeted and sustainable expansion.
The Enfield Business Centre is a one-stop shop
with road links into the city, to the M25 and to Enfield’s 85-hectare Meridian Water development
providing a range of advice and guidance and a
the main northern trunk routes, the M1, A1(M) is a key part of this Opportunity Area, being a £6
range of resources to support start-up and growing
as well as the A11 to Cambridge and England’s billion investment, which will create over 10,000
businesses. Enfield offers competitively priced
‘Silicon Valley’. There are four international airports new homes and thousands of new jobs by 2035,
business accommodation to meet all needs, from
and King’s Cross St Pancras all within one hour’s in addition to a new rail station with upgraded
start-ups to state-of-the-art buildings, and there
journey and new transport projects will make travel transport links. More information about Meridian
are excellent business support networks. Detail on
even more efficient. Water is available on its dedicated website.
Business Advice can be found:
The Upper Lee Valley is a designated Opportunity Enfield Council has made it a key priority to
Area as identified in the London Plan. At 3,900 help businesses launch and thrive. The Enfield
https://www.enterpriseenfield.org/
hectares it is the largest such area in London, Business Centre is a one-stop shop for commercial
and Enfield is a key link in the London-Stansted- enterprises, providing a range of advice, guidance
Cambridge-Peterborough growth corridor. Central, and resources to support start-up and growing
7.2 An area of opportunity local and regional government all support the businesses. It has helped hundreds of business
As a business destination, Enfield offers low cost vision for more housing and jobs in the area organisations to start up and grow in the
26 Market Position Statement 2019-22borough. The centre, located in Hertford Road,
accommodates several key organisations, including
the Let’s Go Business Hub, Enfield Business and
Retailers Association, Enterprise Enfield, and the
North London Chamber of Commerce. For more
information, see Support for Businesses in Enfield. Chase Turkey
Street Enfield
Lock
www.meridianwater.co.uk
7.3 Overarching Demographics Cockfosters Enfield
Town Highway
The demographic of Enfield is changing. The Highlands
population of the borough is increasing and people Southbury
are living for longer. Enfield is the fourth largest
borough in London. The total population is set Ponders End
to increase from 333,000 in 2017 to 376,800 in Grange
2025. The number of people over 65 years of age Bush
Southgate Hill
is forecast to increase by 23% in the next 10 years Park Jubilee
– from 43,900 in 2017 to 52,600 in 2025. This Deprivation – Position Nationally
increase is slightly above the overall percentage 0 to 0.1 represents the worst 10% nationally Winchmore
Hill Lower
increase of England (21%) and poses a significant 0.001 to 0.1 (3)
ry
Edmonton
local challenge in terms of developing services to
elbu
0.1 to 0.2 (7)
meet future demand. Palmers
Has
0.201 to 0.5 (4) Edmonton Green
Southgate Green
The most populous wards are currently Edmonton 0.501 to 0.999 (7) Green
Green, Upper Edmonton, Enfield Lock and Lower Upper Edmonton
Bowes
Edmonton Over the next 5 years Southgate Green
(up 12%), Ponders End (11%) and Bowes (8%) are
set to be amongst the fastest growing wards in
Enfield. In terms of older people populations, wards 34.8% of the borough’s population were of white largest Turkish, Turkish Cypriot, Greek and Greek
with highest populations of older people include British ethnicity in 2017 (down from 40.5% at the Cypriot communities in England, as well as sizeable
Highlands, Grange, Cockfosters. Just over 19% of time of the 2011 census). Enfield is notable for communities from a number of countries in eastern
people living these wards are 65 years of age and a particularly large ‘white other’ population. In Europe. 18.3% of the population were estimated to
above – compared to the borough average of 12%. 2017, 23.1% of the population came under this come from a black ethnic group
category which included what are probably still the
Ethnic Diversity – Enfield Council estimates that
Market Position Statement 2019-22 27good health and Enfield men are expected to live
Total percentage of residents aged over 65 by Ward https://new.enfield.gov.uk/services/your-council/
census-and-socio-economic-information/ 66.2 years in good health.
20
18 • There are marked differences in life expectancy
16
7.4 Public Health in different parts of Enfield, with life expectancy
significantly lower in areas of high deprivation
14 7.4.1 Understanding our Population and within the eastern wards of Enfield.
Predicted Changes
12
• Enfield life expectancy at birth is 80.1 years for • Over 70% of all deaths in Enfield are attributable to
10
males and 84.2 years for females. cancer, circulatory disease or respiratory disease
8
• Enfield women are expected to live 65.1 years in • Smoking prevalence is similar to the London
6 and national averages but smoking is still the
4
2
0
Southgate Green
Town
Winchmore Hill
Southgate
Chase
Palmers Green
Jubilee
Bowes
Lower Edmonton
Ponders End
Upper Edmonton
Edmonton Green
Grange
Cockfosters
Haselbury
Highlands
Turkey Street
Bush Hill Park
Enfield Lock
Enfield Highway
Southbury
Enfield is also one of the most highly deprived
Outer London boroughs. It ranks as the 14th most
deprived London Borough. Nationally, Enfield is
ranked 64th most deprived out of the 326 local
authority areas in England. Levels of deprivation
vary considerably across the borough, and there
is a stark east-west divide. Wards within the east
of the borough, including Edmonton Green, Upper
Edmonton, Lower Edmonton have been identified
as ranking in the most deprived 10% of wards in
England. Over half of Enfield’s wards fall within
the most deprived 25% of wards in England.
Conversely, areas in the west of the borough
including Cockfoster, Grange Highlands and
Winchmore Hill have been identified amongst the
least deprived areas of England.
28 Market Position Statement 2019-22greatest cause of death, disability and disease in • Enfield is in the ‘top five’ in London for both adult • Promoting 5 pieces of fruit and vegetables a
the borough. and childhood obesity and levels of physical day.
activity are far below guidelines
• Up to 28% of the population may not be • Supporting people to reduce sugar
sufficiently active to maximise their health. The environmental, social, and economic consumption.
circumstances of people’s lives also have a huge
• Around 46,000 adults (16 and over) in Enfield impact on health and ultimately life expectancy. • Promoting and encouraging flu vaccinations.
are estimated to drink at a level which may be Issues such as income and poverty, employment,
dangerous to health. housing, education, environment and crime are • Promoting Cycle Enfield.
• There are over 60 health conditions strongly referred to as the ‘wider determinants of health’.
associated with alcohol misuse and alcohol Inequalities in these areas are almost always 7.5 Sexual Health and HIV
consumption in Enfield is associated with reflected in inequalities in health and life expectancy
for different parts of society. 7.5.1 Understanding our Population and
approximately 1,600 (680 per 100,000
Predicted Changes
population) hospital admissions per year. Providers of health and social care services play • Regular testing of HIV and Sexually Transmitted
• Around 1330 people (416 per 100,000 a vital role in decreasing local health inequalities, Infections (STIs) is essential for good sexual
population) are newly diagnosed with a type of promoting the good health and preventing health.
cancer in Enfield each year. 33% of cancers are avoidable ill health, through:
linked to obesity. • The burden of STIs continues to be the greatest
• Encouraging healthy lifestyles including not in young people, men to who have sex with men
• Cancer is the second biggest cause of mortality smoking, healthy eating, physical activity and (MSM) and black ethnic minorities.
in people of all ages within Enfield. However, drinking alcohol responsibly (Moving, Eating,
more than two in five cancer cases could be Drinking, Smoking – MEDS). • Late diagnosis results in increased onward
prevented by lifestyle change, such as not • Encouraging self-management of health,
smoking. supported by healthcare professionals.
• There is a clear difference in the number of • Recognising and promoting smoking to be an
deaths occurring from cancer in the most abnormal thing to do so that young people do
deprived areas of Enfield compared with the not start.
least deprived areas.
• Supporting people to stop smoking (particularly
• Roughly 19,680 of Enfield people aged 17 smoking prevention and cessation services
and over (7.7% of registered population) are targeted at Turkish and Greek Communities).
diagnosed with diabetes.
• People living in the most deprived areas in the • Supporting people to reduce alcohol
UK are 2.5 times more likely to have diabetes. consumption (particularly amongst older people
aged 45+).
• There were 122 excess winter deaths in 2015/16.
Market Position Statement 2019-22 29You can also read
