Market Position Statement policy context

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The Wandsworth context

The London Borough of Wandsworth is the eighth largest borough in London at 327,506 (2021 census). It is a vibrant borough, with two distinct groups of populaces, one being the transient young, who are affluent and in good health. The other group is distinctly those who have lived in the borough for a longer period of time, often those who are very young and those that are elderly (JSNA).

By 2029 this will increase to more than 373,000, reflecting that Wandsworth also has one of the fastest rates of population growth in London. Local population increase is currently driven by natural change (more birth than deaths) and migration from other parts of the UK and in the next 10 years will be driven by large new housing developments such as Nine Elms.

Wandsworth is generally an economically active area, with an employment rate of 80%, and having a lower-than-average rate of poverty compared to London.

More detailed demographic information from the 2021 census can be found on DataWand. 

Adult social care reform

Significant challenges ahead including budget reductions, technological changes, demographic changes leading to a rise in the demand for adult care services particularly as more adults with long-term and/or multiple health conditions and disabilities are living longer.

For some time, national policy, primarily the Care Act 2014, has emphasised the importance of personalisation and choice, prevention, support for unpaid carers, information/advice, market shaping and market oversight, and the integration of health and social care in promoting the health and well- being of service users and unpaid carers.

In December 2021 the government introduced its white paper entitled People at the Heart of Care: Adult Social Care Reform outlining its 10-year vision to transform support and care in England. This vision places people and their families at its heart, recognising the vital role of unpaid carers in our communities and offers people choice, control and support to live independent lives, access to outstanding quality and tailored care and support and adult social care that is fair and accessible. It promotes building on the following foundations for change: 

Shaping healthy and diverse social markets; addressing variation in the quality and safety of care; supporting our adult social care workforce; navigating the system to find the right kind of support; accelerating adoption of technology; expanding the choice of housing options; driving integration of health, housing, and care services.

How care and support is paid may also change. People contribute towards the costs of care if they are able to, however the proposed funding changes (now delayed) will provide a more generous safety net for those who are unable to pay, resulting in a reduction in the self-funder market for providers.

In April 2023 the Next steps to put People at the Heart of Care was published highlighting the first steps towards the 10-year vision. Key areas of focus over the next two years include:

Improving access to care and support:

• Increase capacity and make improvements through the Market Sustainability and Improvement Fund
• Support for international recruits ad volunteers

Digitising social care:

• 80% of social care records to be digitised by March 2024
• New digital learning offer
• Support to test and adopt care technologies

Improving social care insight:

• Improve data collections and data accessibility
• Strengthen monitoring of outcomes
• Introduce CQC assessment of local authority performance

Supporting people to remain independent:

• Increase the level of housing adaptation support
• Launch and Older Persons Housing Taskforce to improve housing options

Innovation and improvement:

• Support to trial and scale innovative approaches
• Improve strengths based assessments and user engagement
• Cross sector working to understand operational and regional challenges

Recognition of skills - adult social care workforce:

• Launch a new care workforce pathway and care certificate to strengthen career structures
• Increase uptake of learning and development
• Increase digital skills training
• A new digital hub for support, information and advice

Joining up services for people and carers:

• Encourage joined-up approach to addressing local issues through the Better Care Fund
• Build leadership skills to support integration
• Support for unpaid carers

Health and social care landscape in Wandsworth

This white paper was followed by the assent of the Health and Care Act 2022 which places duties on partners in health and social care to work more effectively together through the creation of integrated care systems (ICSs) which are geographically based partnerships that bring together NHS services with local authorities and other local partners to plan and deliver joined up health and care services to improve the lives of people in their area. These replace the old clinical commissioning groups (CCG) model.

Wandsworth is part of the Southwest London ICS which is responsible for how health and care is planned, paid for, and delivered across six authorities including Wandsworth, Richmond, Croydon, Kingston, Merton, and Sutton. Adult social care will continue to work with health partners to support the overall vision for integrating care and support around the needs of service users. 

We are also working together to manage the better care fund (BCF) which is a pooled budget for both the NHS and us which seeks to join up health and care services to support people to be cared for at home, avoid hospital admissions and reduce the length of stay in an acute setting. The BCF plan for 2023-25 is currently being developed. For providers, this will mean there will be more services commissioned jointly in the future to reduce duplication and support providers to work across the whole system. It is expected that services commissioned in this way will be more efficient, cost effective and achieve improved outcomes.

Housing

We work closely with our Housing partners to identify and deliver suitable housing for vulnerable residents and to support the building of inclusive and accessible homes. Affordable housing options are also likely to be required as set out in the affordable housing policies within the Local Plan.

Challenges:

• We understand the challenges residents face to secure good quality, affordable housing options and the key role housing plays to provide a foundation for physical, social, and mental wellbeing.
• The supply of affordable housing including specialist housing is insufficient to meet demand particularly with the growing number of people wanting to settle in the borough, placing increasing demand on social and private housing. This shortage combined with inflationary pressures is inflating private sector rents. With the cost of living crisis residents will increasingly be unable to afford these rents leading to pressure on the council’s housing queues and detrimentally impacting the health and wellbeing of residents.
• The current economic situation is also impacting housing development within the borough making it more difficult for private developers to deliver affordable housing as part of new developments.
• The new Housing and Homelessness Strategy 2023-28 (currently in draft) will set out the plan for housing and homelessness for the next five years to addresses the challenges facing the council including new legislative requirements on climate change and building safety.

Developers are encouraged to engage with the council’s planning, housing, and commissioning teams to ensure any proposals brought forward demonstrate how they meet local priority needs, ensuring they are in the appropriate location, and taking into account the latest baseline information.

The emerging Wandsworth Local Plan (2023) expects proposals should demonstrate they have been informed by discussions with providers and accord with the Council’s commissioning and housing strategies. It expects the Council’s housing and commissioning officers to be involved in discussions with providers, at an early stage, to ensure proposals will meet local identified supported housing needs, and evidence of these discussions submitted with the application. Applications are expected to be submitted with details of how the design and management will provide the necessary level of supervision, management, care and support, including operational management plans (incorporating minimum levels of care). A cascade approach will be sought to ensure the units will be first offered to eligible persons residing within the borough, for example for a minimum period of 3 or 6 months.

Providers and developers when designing accommodation are recommended to follow the requirements set out in the guidance Specification: Supported Housing Accommodation 2023, which provides further detail on the requirements of supported housing in the borough, ensuring developments reach a good standard and are safe and suitable for residents.

What do people want: outcomes that matter

The framework Making it Real is explicitly referenced in the Care Act 2014 as a mechanism to frame the outcomes that matter most to people to support their aspirations to lead a normal life.

1. Wellbeing and independence - Living the life I want to lead
2. Information and advice - Having the information I need when I need it
3. Active and supportive communities - Keeping friends, family, and connections
4. Flexible and integrated care and support - My support, my way
5. When things need to change - Staying in control
6. Workforce - The people who support me

The white paper highlights the importance of housing in what people want to achieve in their lives and that every decision about care should be a decision about housing. This supports the vision and outcomes advocated by Social Care Future, ‘We all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing the things that matter to us.’

We want people to have a 'life, not just a service' and we will commission services that are personalised, and outcome focused.

Our vision for residents

Our vision for residents is ageing well and living well.

Older people:

• We want older residents to enjoy the best quality of life. Through prevention and early intervention services such as rapid response, reablement at home, and step down beds in care homes, we will aim to maximise people’s health, wellbeing and independence and reduce the need for long term support wherever possible.

Adults with memory and cognition needs:

• Dementia is a key priority. We want residents affected by dementia, to live well and enjoy a good quality of life throughout their diagnosis with access to the right support and in an environment that maximises their independence.

Adults with learning disabilities:

• We want adults with a learning disability to lead as independent and healthy lives as possible, fulfil their potential and be able to be active citizens in their local communities, close to family and friends.

Autism:

• We want young people and adults with autistic spectrum conditions (ASCs) to live fulfilling and rewarding lives, within a community that understands them and with access to effective support and pathways to diagnosis.

Adults with mental health needs (18+):

• We want adults with mental health needs to lead as independent and healthy lives as possible and have the confidence and skills to thrive and be able to be active citizens within their local communities.
• We want to promote recovery and support people to achieve their aspirations, such as returning to work.
• We want to ensure that there are culturally appropriate services to deliver equitable outcomes for our Black, Asian and Minority Ethnic residents with a mental health need.
• We want to ensure that there is adequate support for those who are transitioning from children and young person’s social care services into adult social care services. 

Adults with physical and sensory disability needs (aged 18 to 64):

• We want adults with physical disabilities and sensory needs including younger adults to lead independent and healthy lives and have the same opportunities as others, with access to services that actively work with people to define and achieve their goals and consider the whole of a person's life.

Carers:

• We want carers to be identified at the right time and have access to the right information, support and networks to sustain their caring role and have a life outside of caring.
• We recognise and want to raise awareness of the vital role carers play in the prevention agenda and the local health, social care and wider economy.

Priorities for adult social care services in Wandsworth

The corporate objectives of Wandsworth Borough Council are: a fairer borough where we will ensure local people have a genuinely affordable place to call home and we support residents who have been affected by the cost of living crisis and the pandemic; a compassionate borough where we will create safer neighbourhoods, in which communities feel confident and victims and survivors are supported and we will be a council which truly listens, and is ambitious for all; a more sustainable borough where we will tackle climate change by working with our residents, businesses and communities and we will be carbon neutral as a council by 2030.

The Adult Social Care and Public Health directorate, in line with national policy and corporate objectives, has an aspiration to deliver the best for residents to enable them to stay as independent and well for as long as possible. We will ensure that residents can access care and support at the right time and the right place. We will endeavour to support people to live healthier lives, reducing health inequalities to address those with the poorest health outcomes and ensure equity in experience and outcomes using our prevention framework and a whole systems approach across the council, organisation and residents. We understand that placing people at the centre of all our work and working closely with our partners will deliver better outcomes.

Our priorities for the forthcoming year are:

• Strengthen involvement and engagement with service users, partners and providers to help develop and shape services
• Develop a robust performance, quality and learning framework to support standards of service delivery in line with the new CQC assessment of local authority performance
• Work with the provider care market to deliver a local workforce strategy across all adult social care in co-ordination with South-West London integrated care system (ICS)
• Work closely with our health partners towards more integrated health and care services across the locality
• Implement a new care home placement policy for older people with further roll out to adults with other care needs
• Continue with transforming our services to improve outcomes, with a focus on embedding digital technology both in the delivery of our services and in the way we work
• Continue to promote equality, diversity and inclusion in service delivery and the workplace
• Work with the care provider market to ensure sustainability and fair cost of care, including addressing workforce challenges
• Adopt a more integrated and joined -up approach to developing commissioning plans and commissioning new services
• Strengthen relationships with the voluntary and community sector to enhance our range of preventative services and build resilient and connected communities

Commissioning approach

To achieve the adult social care and council objectives and priorities, we aim to adopt a commissioning approach that is:

Person-centred and outcome-focused:

• Where services are co-produced with service users, their carers and the wider community. The individual and their community are front and centre of the decision-making process.

Well-led:

• Supported by the wider Council and partner organisations, adopting a whole systems approach, and using evidence of what works.

Promotes a sustainable and diverse market:

• Provides value for money, develops the workforce, and promotes positive engagement with providers.

Providers we want to work with in our local market

We want to work with providers who meet the values that underpin our ethos for service delivery and meet the following expectations:

• Understand and embed the principles of person-centred care in day-to-day practice
• Adopt a strength-based approach and focus on preventing, delaying, and reducing the need for care
• Ensure every contact counts and that every door is the right door for someone to access care
• Actively develop services in partnership with service users, fostering continual improvement
• Embrace and use digital technology in creative ways in delivering care and support to improve the quality of life for individuals
• Are outcome focused and measure success in outcomes identified by the individual and can evidence how and what outcomes have been met
• Deliver services which promote enablement, self-management, independence, choice, and control
• Understand the importance of considering the needs of unpaid carers in everything they do
• Provide safe, quality services which are cost effective and value for money
• Develop a ‘local offer’ so that people can get care and support close to home
• Invest in the development and retention of their workforce and provide attractive employment offers to support stability of the market and quality of service provision
• Consider social value when developing services to help build a resilient, healthy and economically strong local community
• Work closely in partnership with us, other providers as well as the voluntary and community sector to develop services and continue to learn about available local services and make links across the care landscape
• Commit to adopting climate friendly policies, and sustainable practices whilst implementing meaningful action to tackle climate change at a local level. The Wandsworth Environment and Sustainability Strategy 2019-2030 demonstrates our commitment to tackling climate change
• Work with us to drive up quality and safeguarding practices
• Offer inclusive and culturally responsive services and work in a person-centred way, tailored individually to meet the needs of people from all equality groups, for example lesbian, bi-sexual and transgender people. This includes supporting a diverse workforce that reflects the local communities we serve. This is linked to the wider Council’s equality objectives for 2021 to 2025. We value and celebrate diversity and believe it is essential to provide services which work well for all of us.