Ten commissioning intentions for older people’s residential and nursing care in West Sussex

Some of these commissioning intentions focus on the provision which the Council commissions from this care market. It should be noted that around 60% of residents within services purchase their care directly. The Council has a duty to ensure that there is a range of quality solutions providing care and support for the whole population, and this document will focus both on the services commissioned by the Council for customers who are eligible for social care funding, as well as an overview of the demand for the population as a whole.

Overall provision is high and demand for standard residential care is reducing. WSCC will prioritise focus on developing other forms of support (e.g., Extra Care housing) over more traditional residential care provision.
Focus will be on geographical locations where there is limited provision of services, and different types of bed-based care.
Dementia prevalence will continue to grow and there will be more older people with learning disabilities. Focus will be on the development of services that can accommodate a varying range of complex care needs and support people who come into services later in life.
Flexible provision to manage changing care needs, and support at different times and for different reasons - e.g., long-term, hospital discharge, respite.
Importance of environment and changing expectations. Modern, dementia friendly environments that can meet the environmental requirements for managing more complex needs – e.g., with lifts and appropriate space for managing equipment such as hoists.
Supporting and enhancing quality of provision - ensuring high numbers of CQC-rated ‘good’ and ‘outstanding’ services and learning from good practice.
Commissioning of residential and nursing care - plan for future provision to meet future need and offer sustainable provision and affordable options.
Improve payment and processes for providers working with the council .
Improve joint working when planning and developing to ensure services are focused in the right location and with the right focus, confirming where developments may not be needed. Ensure engagement, co-design and partnership working with the NHS, voluntary and community sector, providers, customers, and other partners in planning and developing bed-based services.
Improve understanding of the diverse needs of people with protected characteristics and how best to support and include them in service planning and provision. WSCC commits to exploring this further, given the proportionately small number of people from ethnic minorities currently using bed-based care, and the needs of people with different protected characteristics.

Provision of information to support understanding of needs and market insight including demand and supply analysis, gaps in provision and location of provision to support providers, developers and planners within District and Borough Councils.
Commissioning, contracts, and brokerage expertise to place customers in care homes that meet their needs and to broker care arrangements with providers.
Good relationships with the NHS regarding commissioning and placements.
Support and advice with quality assurance and service improvement.
Communications on important health and social care announcements and developments
Access to learning and development for residential care providers and staff.
Support and links on developing technology and digital solutions within residential care services.
Access to information and advice on care options for people to choose from to support good decisions on choosing care.
Funded social care for people with below threshold funds and eligible social care needs as determined by a Care Act 2014 assessment with limited funds, support for people who lack capacity.
Commissioning and commissioning intentions with the aim of maintaining a sustainable care market for residents who need care.

The Council has a high number of residential care homes proportionately in relation to other local authorities. With a drive to support more people in their own home and a strategic intention to significantly increase the number of extra care services, the Council does not foresee the need for net growth in residential provision. However, it is anticipated that services will exit the market and new services will be developed over time. Therefore, the Council will want to engage with developers and providers who are looking to re-develop or develop new residential care and nursing services, and to support district and borough planners when considering planning for new services. This will ensure the ‘right size and type market’ that meets customer needs in different locations and is based on projected demand for the type of bed-based care needed for older people in West Sussex over the next 10 years.

We have been working with providers on the development of this market position statement through Provider Forums and a key market engagement event on this MPS. Discussions have focused on what providers need from us moving forward, meeting different needs, re-defining bed-based care, and ensuring a granular understanding of what different areas and different customers need and require from care provision.

The table below shows the key feedback from West Sussex providers on this MPS development and what is sought from us in terms of steers and action to support market development.

Some of the points raised by providers fall into the two or three categories of practice, commissioning and development: these are marked with an asterisk in the table.

Practice	Commissioning	Development
Integration and joint working between the ICB, WSCC and providers *	Invest more in intermediate care options and interventions	Invest more in intermediate care options and interventions
More information from the ICB on short stay, out of hospital needs and discharge *	Need for a fee structure for nursing dementia care	More discussions at district and borough levels on gaps, solutions between providers, commissioners, planners, VSCE
Trusted assessor model worked well for providers and provided real partnerships *	Outcomes focus and idea of an outcomes data set that is co-developed and used by all partners and providers	More agile approaches to filling market gaps, pilots, and shorter-term contracts to try new ways of working
Lack of recognition of complex care	Clearer definitions of different types of bed-based care	Early conversations for providers moving into the market
Creating the right environment for complex care at affordable rates	Importance of using networks such as WSPIC to co-design and engage	Help with planning – it can take 3-5 years to open a facility
Better understanding of service provision		Risk share and opportunity between commissioners and providers- support for providers to innovate
Staff training and investment in complex needs and needing staffing numbers for specialist provision	Co-produced needs profiles and more detail on demand to signal to providers	Share technology among partners and expand more into provision
Workforce development and strategic direction and support for providers from the system especially carer and nursing training	Co-production with providers on new pricing strategies and frameworks	Closer collaboration with DC/BCs to plan and resolve problems that are holding up development
Explore a DPS site for referrals		Capital funding to allow adaptation of existing provision to be fit for customer needs
Improved referral processes and an understanding of service provision to reduce inappropriate referrals
Communication with family prior to admission to bed-based care

This document is only the beginning of a journey of engagement, co-design, and co-production around re-provisioning existing provision, assessing provision in each district to meet projected needs and filling gaps in the market where there is a need for more specialist complex care.

We will build on people’s experiences of living in care homes and practitioners experience of placing customers and their needs, so that care homes of the future are jointly planned and designed with service users, families, providers, partners, planners, developers, and investors to deliver sufficient, high quality and affordable services. We will do this through learning from other examples of co-production in other commissioning areas, learning from other local authorities and working with our providers, to develop mechanisms for meaningful engagement and co-production with older people.

Partners will be engaged in further discussions on this Statement during 2024/25 on how we might collectively achieve these ambitions.

We welcome conversations with partners about the intentions set out in this document and joint work on new service models. We will continue to work constructively with providers to commission bed-based care, research alternative models, support quality and market development and to monitor sustainability.

For discussions about the development of residential and nursing care in West Sussex please contact: adultscommissioning@westsussex.gov.uk

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