Page created by Jason Oconnor
MARKET POSITION       Working with Enfield’s
                            Health and Adult Social Care

      STATEMENT 2019-2022   Market to deliver change
in partnership with

                                       Market Position Statement 2019-22   1

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:
                                                                                        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


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
     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
• 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
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
 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                                  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
• 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

      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                              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            
                                                         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 2019-22

       3      Market Position Statement 2019-22   11
3.1 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 2019-22
what 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 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:

                                                        Market Position Statement 2019-22   13
Key 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 2019-22

      4       Market Position Statement 2019-22   15
4.1 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.
                                                          • 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 2019-22
These 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.

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   17
and Quality

     Market Position Statement 2019-22
5.1 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                                   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
• 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   19
Further 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
                                                                           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      
home grown. There are several broad categories                  content/safeguarding/modern-slavery/
of exploitation linked to human trafficking,
• Sexual exploitation
•    Criminal exploitation
•    Forced labour
• Domestic servitude
• Organ harvesting
• Child related crimes such as child sexual

20   Market Position Statement 2019-22

      6       Market Position Statement 2019-22   21
6.1 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.                                    
• 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_
                                                           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.                                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:
Wellbeing Strategy here.                                   • ensuring the best start in life

   • creating stronger, healthier communities

22   Market Position Statement 2019-22
6.5 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
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   23
whereby homes accept patients following others
     assessing potential residents, is expected to
• 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
• 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 2019-22

      7         Market Position Statement 2019-22 25
7.1 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


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

                                                            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 2019-22
borough. 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

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)

local challenge in terms of developing services to

                                                         0.1 to 0.2        (7)
meet future demand.                                                                                                     Palmers

                                                         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
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   27
good health and Enfield men are expected to live
Total percentage of residents aged over 65 by Ward 
                                                             census-and-socio-economic-information/                 66.2 years in good health.

18                                                                                                               • There are marked differences in life expectancy
                                                     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
                                                     • Enfield life expectancy at birth is 80.1 years for        • Over 70% of all deaths in Enfield are attributable to
                                                        males and 84.2 years for females.                          cancer, circulatory disease or respiratory disease
                                                     • 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


     Southgate Green
       Winchmore Hill
       Palmers Green


     Lower Edmonton
         Ponders End

     Upper Edmonton
     Edmonton Green


         Turkey Street
        Bush Hill Park

          Enfield Lock
      Enfield Highway


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 2019-22
greatest 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   29
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