The government wishes to see a diverse range of good quality care providers for people to choose from so that that they can access the right services for themselves and their families at the right time and the right place. The government has placed a duty on local authorities to realise this vision:
To strengthen this diversity, the Government will introduce a duty upon local authorities to promote diversity and quality in the provision of services (Caring for Our Future 2012)
Local authorities will also have to:
- Monitor local providers and ensure they offer a range of responsive care and support services.
- Commission services on the basis of quality, outcomes and value, and
- Develop a leadership role in terms of identifying the needs of local people, supporting communities, empowering people to take control and providing information and advice.
Local authorities are expected to shape or facilitate their market to ensure this happens. As a first step in this direction local authorities have to produce a Market Position Statement (MPS).
Local Authorities and their partners are therefore moving away from market management and moving more towards commissioning activities that facilitate a strong provider market that is able to respond to an increasingly diverse service user group consisting of privately paying individuals and people using their direct payments to purchase support. Market facilitation goes beyond normal arrangements for tendering, traditional supply management and capacity building though some of these activities will still be relevant depending on the local market and where Local Authorities with their partners wish to get to in terms of their market.
Market facilitation requires the following to happen:
Evidence based understanding of need and demand: The need to influence the market must be based on a sound understanding of need and demand.
Sufficient appropriate provision: To make sure there is sufficient volume of service for everyone who has assessed needs; also that commissioners have a good perspective on what works and what people want.
Right price: Right price from the perspective of the purchaser, whether that is the individual or the commissioning body, but also right from the perspective of the provider. For example, if a contract price is pitched too low then the long-term effect may be to limit supply and/or drive some providers out of business. ‘Right’ has to mean not just lowest but profitable, sustainable and capable of delivering the quality and outcomes required.
Deliver effective outcomes: Starting to move the focus of purchasing away from outputs, in terms of beds, days and hours, and onto purchasing by the outcomes that are desired from the intervention.
Now and in the future: The need to use an understanding of current demand to act as a baseline for future provision.
Market facilitation activities should start at an overall picture of the market and the demand it needs to meet. The various disparate views of the market will then need to be developed into a strategic approach to involvement. Finally, it will be necessary to use that knowledge to influence and sometimes intervene in the direction the market takes. Overall, these activities can be refined into a three stage model:
Market intelligence: The development of a common and shared perspective of supply and demand (including any gaps in provision), leading to an evidenced, published, market position statement for a given market.
Market structuring: This covers the activities of commissioners designed to give any market shape and structure, where commissioner and provider behaviour is visible and the outcomes they are trying to achieve agreed, or at least accepted.
Market intervention: The interventions commissioners make in order to deliver the kind of market believed to be necessary for any given community.
Sources of further help
Unlocking the potential 2014 A report from DEMOS that looks at possible developments of new options to address obstacles people face when making financial provisions for later life. It proposes two possible options built around housing equity which includes an incentivised ‘savings’ model and a discounted ‘insurance’ model or a combination of both. It suggests that a significant number of older home owners could benefit but recommends further exploration of these options with the finance sector, government and other key stakeholders.
Think integration, think workforce: three steps to workforce integration December 2013 The Centre for Workforce Intelligence (CfWI) has produced this paper with input from Institute of Public Care which considers the implications for the respective workforces of health and social care integration. The report is aimed at workforce leaders and senior workforce specialists and identifies clear steps to support integration. The report is based on a literature review and interviews with sector leaders and workforce specialists. It identifies steps for workforce leaders to promote integration from a workforce perspective.
Changes in the Patterns of Social Care Provision in England: 2005/6 to 2012/13 December 2013 A report from the Personal Social Services Research Unit (PSSRU) which aims to quantify what changes have taken place in Adult social care in net local spending and provision (recipients of care) between 2005/06 and 2012/13. It is a very comprehensive report looking in detail at national trends and statistics.
Licence to operate: winning trust in public service markets, September 2013 (Confederation of British Industry (CBI)) This report argues that the government should continue momentum and focus on managing and shaping services rather than delivering them themselves. It explores the potential for opening up the public service market further but states that public services providers have to build trust in open markets to deliver better results for less.
Developing Supportive Design for People with Dementia. January 2013 (King’s Fund). There is growing awareness of the importance of the environment within health care. The King's Fund's Enhancing the Healing Environment (EHE) programme encourages and enables nurse-led teams to work in partnership with patients to improve the environment in which to deliver care. This publication marks the completion of 26 schemes in 23 NHS acute, community and mental health hospitals in England to improve the environment of care for people with dementia. The programme was funded by the Department of Health as part of work to support the implementation of the National Dementia Strategy in England. This publication seeks to provide practical, value-for-money examples to encourage and inspire staff and their organisations to provide an environment of care that better supports people with dementia. As well as case studies it includes information about the development and evaluation of the assessment tool; design principles for creating a more supportive environment for people with dementia; and a project directory detailing the artists and designers involved in each scheme and costs involved.
Market Position Statements and Housing. December 2012 (Institute of Public Care). This Briefing Paper is the first of three produced by the Institute of Public Care (IPC) for the Housing Learning and Improvement Network to provide a concise overview of key issues highlighted in the joint IPC/ADASS/Housing LIN resource pack, 'Strategic Housing for Older People: Planning, designing and delivering housing that older people want'. This paper is primarily aimed at local authority commissioners and has as its focus how to ensure the development of a diversity of supply of housing through the use of Market Position Statements. It considers: the purpose and content of a Market Position Statement that focuses on the accommodation needs of older people; and how to develop a Market Position Statement that effectively involves and promotes a diverse quality market in housing suitable for older people.
Health, Wellbeing and the Older People Housing Agenda. December 2012 (Institute of Public Care). This Briefing Paper is the second of three produced by the Institute of Public Care (IPC) for the Housing Learning and Improvement Network to provide a concise overview of key issues highlighted in the joint IPC/ADASS/Housing LIN resource pack, 'Strategic Housing for Older People: Planning, designing and delivering housing that older people want'. This paper is aimed primarily at Health and Wellbeing Board members and seeks to support them in their understanding of: the impact of poor housing on the health and wellbeing outcomes of older people; the strategic approaches they can take to influence the provision of housing and housing related services to improve the health and wellbeing of their older population.
Making Best Use of our Sheltered Housing Asset. December 2012 (Institute of Public Care). This Briefing Paper is the third of three produced by the Institute of Public Care (IPC) for the Housing Learning and Improvement Network to provide a concise overview of key issues highlighted in the joint IPC/ADASS/Housing LIN resource pack, 'Strategic Housing for Older People: Planning, designing and delivering housing that older people want'. This paper is aimed at both providers and commissioners of housing for older people, to help them to: Understand and be clear how sheltered housing can help meet health and wellbeing outcomes of older people; Review their sheltered housing to assess its fitness to meet the future housing needs and aspirations of older people; Consider the range of options for change and decide on the best approach locally.
Housing in later life: planning ahead for specialist housing for older people. December 2012 (Published jointly by the National Housing Federation, Tetlow King Planning, McCarthy & Stone, Contact Consulting and the Housing LIN). This toolkit spells out the processes that could help the HAPPI objectives to be met - with particular emphasis on the role of local planning authorities. It has been designed for local planners and commissioners to use when planning for specialist housing for older people as part of an overall local strategy on older people's housing, care and support. The toolkit encourages local authorities to join up planning, housing and social care policy, both in the collection of evidence and the development of specialist housing for older people. It suggests a number of tools to help officers plan for this form of housing in their local policies, strategies, guidance and associated conditions as part of their local plans.
Findings from housing with care research: practice examples. December 2012 (Joseph Rowntree Foundation). This publication draws together practical examples of ways of working from two reports: Boundaries of roles and responsibilities in housing with care and Affordability, choices and quality of life in housing with care. It highlights ways of working in different housing with care schemes, drawing on the two studies and considering their implications in very practical terms. The practice guide is aimed at people managing frontline housing with care schemes, commissioners and senior managers in housing organisations, social services and health, and frontline staff, older people and their relatives. The practice guide identifies five key topics in housing with care which could benefit from improvement; summarises what older people and their relatives say they value in housing with care; and presents practical examples.
Board Assurance Prompt – Supporting vulnerable adults. November 2012 (Good Governance Institute). Many providers of social housing have within their range of provision, accommodation offered to adults, or households with a vulnerable person, who may be experiencing a range of vulnerabilities, including people living with mental health issues, learning disabilities, those recovering from alcohol or substance misuse, and people fleeing domestic violence. These notes are intended to assist the leaders of organisations offering this sort of provision, providing prompts by which they may ensure that their organisation is taking full benefit of the opportunities presented by telecare and telehealth. Drawing on examples of good practice, this guide suggests how these technologies may support and enhance the offer that their organisation is able to make, ensuring tenants are receiving the most appropriate assistance to support their recovery or rehabilitation, enhancing their capacity to live independently and move along a pathway toward reintegration within the wider community.
Volunteering: Unlocking the real wealth of people and communities. July 2012 (Think Local Act Personal). This report explains that people's voluntary and unpaid contributions are crucial to enabling them and others have maximum choice and control over their lives. It calls for continued development of social action in local communities and responds to the Government's Care and Support White Paper, which stresses the value of supportive communities and community connections to improve people's health and wellbeing. The report recommends building on the excellence practice already going on across England. It includes examples drawn from a range of government, third sector and private providers that illustrate the importance of thinking beyond traditional health and social care services when creating opportunities for volunteering and building community connections.
Commissioning the Future: Workshop materials to start a new conversation. July 2012 (Think Local, Act Personal). This series of five workshop scenarios have been designed to help those involved in strategic commissioning to rehearse and explore new ways in which the public care market might develop. The ‘Commissioning the Future’ pack offers all those involved in strategic commissioning - including providers of services, people, carers and commissioning officers - an opportunity to: rehearse the issues they face; do this outside the context of a particular negotiation, contract or agreement; play different roles than they do in 'real life' to explore issues from a range of perspectives. Each exercise represents real issues faced by all involved in commissioning public care and will support commissioners, providers and people who use services and carers to adopt the key skills and behaviours advocated in ‘Stronger Partnerships for Better Outcomes’.
Stronger Partnerships for Better Outcomes: a protocol for market relations. July 2012 (Think Local Act Personal). This paper promotes a set of principles and behaviours that will enhance the environment in which good adult social care and support is developed and sustained. It outlines a protocol which could be adopted by all key parties to enable more productive local market relations. The protocol is designed to assist commissioners and providers alongside people using social care with the local delivery of Making it Real: markers of progress towards personalised community based support. October 2011 (Think Local Act Personal).
On the Pulse: Housing routes to better health outcomes for older people. June 2012 (National Housing Federation). This report features analysis of current health and care priorities and explores how housing associations can work with health and social care commissioners to: enable older people to manage changes in their health; help people live as independently as possible; reduce the need for more costly care. Six case studies are featured which describe some innovative solutions members have developed. These include support for patients with dementia, use of telecare, home from hospital services, short-term intermediate housing and end of life care.
Leeds City Council’s Adult Social Care Market Position Statement 2012 sets out the rationale for the first Market Position Statement for Leeds Adult Social Care and how it will help them and their partners facilitate an Adult Social Care market for Leeds which delivers affordable quality outcomes for their citizens.
A number of other Council's Market Position Statements can be accessed from the Local commissioning page, including those of Bradford, Calderdale and Wakefield, as well as Kirklees’ Market Position Statements for older people and for people with learning disabilities, and North Yorkshire's Vision for social care for adults at risk, for people with learning difficulties and its Market statement for daytime activity services.
Identifying the health gain from retirement housing. June 2012 (IPC). The need to find a better approach to supporting the health and wellbeing of older people will become imperative over the next twenty years if the country is to be able to manage the demographic shift towards an ageing population. This report published by IPC highlights that one of the best options lies in a substantial growth in the development of owner occupied housing suitable for older people. It emphasizes that despite the fact that three quarters of older people are home-owners, choices in accommodation for this group are severely limited and often seen as unattractive. Measures to stimulate the development of housing suitable for older people could reduce expenditure on health and care services, stimulate local economies through building development, and free up family housing.
Market assessment of housing options for older people. April 2012 (New Policy Institute). If an older person is thinking about moving, do they have a wide enough choice of housing? What is the impact on their well-being and quality of life? How far do such moves free up housing for families? This study seeks answers to these questions for England using original analysis of official data, interviews with key players and a focused literature review.
A better fit? Creating housing choices for an ageing population. April 2012 (Shelter). England’s population is ageing; by 2030 one in three people are projected to be aged 55 and over. Older people will be a diverse group, ranging from economically powerful ‘baby boomers’ to over-85s with high care and support needs. This report looks at how the housing market needs to respond to this demographic change, and whether we have the right kinds of accommodation for older people, and in the right places.
Market assessment of housing options for older people. April 2012 (New Policy Institute for Shelter and the Joseph Rowntree Foundation). Recent messages from Government have included the suggestion that some older people are over-occupying properties, and the suggestion is made that they may need to downsize. However, this paper suggests that there is limited choice for older people who want to move to both specialist and alternative mainstream housing. There is a tendency for housing providers to look at retirement villages and housing with care when thinking about housing for older people, the paper suggests that this is not necessarily what people want. The paper is clear that what is needed are better choices for older people. In addition to the issue of freeing up larger homes, there is evidence that older peoples’ health can benefit from moving to more suitable housing, providing it is an informed choice and they remain in control. For many, staying put can also be the right choice.
The characteristics of residents in extra care housing and care homes in England. Health and Social Care in the Community (2012) 20(1), 87–96. This paper presents findings on the characteristics of the residents of 19 Extra Care Housing Schemes, and a recent comparable study of residents who moved into care homes providing personal care. The results suggest that, although extra care housing may be operating as an alternative to care homes for some individuals, it is providing for a wider population, who may be making a planned move rather than reacting to a crisis. While extra care supports residents with problems of cognitive functioning, most schemes appear to prefer residents to move in when they can become familiar with their new accommodation before the development of more severe cognitive impairment.
Follow-on study: Older people who pay for care. January 2012 (Think Local Act Personal). This is a follow-on study to the Putting People First Consortium's publication, People who pay for care: Quantitative and qualitative analysis of self-funders in the social care market (2010). Undertaken by the Institute for Public Care on behalf of Think Local Act Personal (TLAP), it is a more in-depth analysis of the local factors which may influence self-funded and unregulated care. The project explored the extent to which there are local variations in the rate of self-funding across the country related to factors such as affluence, levels of owner occupation, and level of FACS criteria in operation. A second element of the project was the collection of data on self-funded and unregulated care in the home to identify what type of assistance, if any, may be needed to enable the smooth running of this section of the social care market.
Strategic Housing for Older People (SHOP) Resource Pack. December 2011 (Housing LIN, ADASS, IPC) Are we providing the kind of housing that older people want? The SHOP Resource Pack offers a sector-led approach to meeting the housing demand and supply challenges for an increasingly ageing population. It is intended to influence local strategic commissioning, planning and investment decisions and help transform and improve the range of housing choices for older people over the next 20 years. SHOP provides a framework and accompanying tools for councils, public and private sector developers and providers.
Improving housing with care choices for older people: an evaluation of extra care housing. December 2011 (The Personal Social Service Research Unit (PSSRU) and Housing LIN). This report summarises the results of a Department of Health (DH) funded evaluation of 19 extra care housing schemes that opened between April 2006 and November 2008, and which received capital funding from the Department‘s Extra Care Housing Fund. It details the key findings on improving outcomes, achieving greater care efficiencies and cost effectiveness and delivering more qualitative factors around improvements to older residents' wellbeing.
Evaluation of the extra care housing initiative: PSSRU technical report. December 2011 (The Personal Social Service Research Unit (PSSRU) and Housing LIN). This report provides substantial technical analysis of the evidence base relating to the process and impact of the DH's Extra Care Housing Fund and the resultant implications for new approaches to providing accommodation and care for older people.
Age, Home and Community: A Strategy for Housing for Scotland’s Older People: 2012 – 2021. 20 December 2011 (the Scottish Government). The National Strategy for Housing for older people was established on 20 December 2011. Agreed by the Scottish Government and COSLA (the Convention of Scottish Local Authorities) it has been developed in partnership with the housing, health and social care sectors and in consultation with older people. It presents a vision for housing and housing-related support for older people in Scotland, the outcomes to be achieved and a framework of actions to be taken.
Adult Social Care Outcomes: handbook of definitions. November 2011 (DH). This handbook sets out the technical detail of each measure used in the Adult Social Care Outcomes Framework (ASCOF). Each outcome is listed with rationale, definition, formula, a worked example, frequency of collection and data sources amongst other features. The handbook is offered as a support to minimise confusion and inconsistency in reporting and interpretation of measures. The intention is that an updated handbook will be published alongside each year’s ASCOF (in March) and an update issued in autumn if required. The ASCOF and the handbook will be co-produced by the DH, LGG and ADASS.
Hoarding of Housing: The intergenerational crisis in the housing market. October 2011 (Intergenerational Foundation (IF)). This report provides clear evidence that there is an intergenerational crisis in how we use our housing stock. It argues that the current housing crisis is not principally about Britain having enough housing but about the way it is shared between older and younger generations and under-occupation of housing stock.
Boundaries of roles and responsibilities in housing with care schemes. October 2011 (Joseph Rowntree Foundation). Commissioning and delivering housing with care (HWC) services can be complex. Different organisations provide a range of services while external agencies guide, regulate and inspect what they do. Since residents’ quality of life can be affected by the way in which these diverse organisations work together, clarity over boundaries, roles and responsibilities is likely to be crucial. There is no single model of HWC. Schemes vary enormously in size and scale, location, services and cost; they are run by private companies and not-for-profit housing associations and charities; and there are significant. Since residents' quality of life can be affected by the way in which these organisations work together, clarity over boundaries, roles and responsibilities is crucial. This Viewpoint outlines contested roles among HWC providers; explores the different expectations of residents, families, providers and professionals; investigates how interaction between parties can create challenges; and provides a draft framework for a future report and guide for providers.
Establishing the Extra in Extra Care Housing. September 2011 (The International Longevity Centre - UK (ILC-UK)). Extra care housing is a model that combines purpose-built and ergonomically designed housing for older people with onsite flexible care that adapts to residents‟ changing needs. This research draws on the data collected from three providers of extra care housing and examines the outcomes for residents. It explores some of the factors associated with more successful outcomes among the residents, and also compares some of these outcomes with those of residents who share similar characteristics but who reside in general-purpose housing in the community. This is one of the first studies to examine the outcomes for extra care residents using longitudinal data, tracking the outcomes for residents who in some cases moved into extra care housing as long as 15 or more years ago up to the present day. In this study, the focus is upon outcomes related to health status, usage of health services and usage of institutional accommodation.
Living Well At Home Inquiry. July 2011 (All Party Parliamentary Group on Housing and Care for Older People). Over the next 20 years all industrialised and developing countries will experience a demographic shift with longer lives and fewer babies and therefore from predominantly younger populations to older ones. As a result, current care models are unsustainable and inadequate in terms of efficiency and effectiveness. Change is a necessity and innovative approaches will be needed to improve quality of life and provide better housing, health and social care for people as they age.
Adult Social Care. May 2011 (The Law Commission). This report sets out the Law Commission's recommendations for the reform of adult social care. The Government has announced that it will introduce legislation in 2012 to implement recommendations that it accepts in this report. Under reforms proposed, older people, disabled people, those with mental health problems and carers will, for the first time, be clear about their legal rights to care and support services. Local councils across England and Wales will have clear and concise rules to govern when they must provide services.
Housing markets and independence in old age: expanding the opportunities. May 2011 (Henley Business School, University of Reading). This report highlights that there are only 100,000 specialist private retirement homes in the UK, yet by 2033, there will be an extra 3.5 million households aged over 65 years, a 60% increase on today. Without suitable and affordable accommodation, these demographic changes could result in significant housing problems for the elderly. The report’s author, Professor Michael Ball, said: "Britain's population is ageing, but its housing options are shrinking. Many older people wish to downsize because their garden or home become too difficult to maintain, or because of the loss of a loved one. But the limited supply of the right type of retirement accommodation means there are few alternatives, and what is available can be expensive because supply and land costs are so high. Without the right policies in place, these problems will only grow as our population ages. The solution is simple: changes to public policy will allow private market developers to increase supply without any contribution from the public purse. It's vital that we get these housing policies in place now". The report outlines the findings of a major piece of research on housing for older people who live in specialist private retirement accommodation - 'owner occupied retirement housing'.
Evaluating the impact of the 2005 OFT study into care homes for older people. May 2011 (Office of Fair Trading) A report following an independent evaluation of the Office of Fair Trading 2005 report Care Homes for older people in the UK: A market study. It looks at the impact of the original report on the care home market such as the provision of information to potential and current customers of care, local authority obligations, price transparency, contracts, complaints and also competitive neutrality. It also looks, in some depth, at changes in demand and supply in the care home market and provides a summary of key findings of market operation. A key document for all relevant organisations when considering what constitutes good consumer practice and fair trading in relation to care homes.
Viewpoint on downsizing for older people into specialist accommodation. February 2011. Housing Learning and Improvement Network (LIN). This paper highlights the need for specialist and suitable housing for older people such as sheltered accommodation, extra care housing and assisted living given evidence that suggests that older people who live in unsuitable housing may have a lower quality of life which impacts adversely on social care and health costs. The paper includes a number of recommendations including the need for housing developers to be aware of market opportunities for growth in the retirement housing sector; for the planning system to be more akin to the housing requirements of older people and encourage more housing developers into the market. Other recommendations include key partners to find innovative ways of providing downsizing alternatives for older people especially those with lower value assets such as shared equity/ownership, equity release and relevant insurance products.
People who pay for care: quantitative and qualitative analysis of self-funders. January 2011 (Putting People First Consortium/ SCIE). A useful research paper that highlights the growing number of self-funders and the need for councils to ensure that self funders have access to information and advice so they are informed of the options available to them so they can make the most appropriate choices to meet their needs and requirements. The research shows that many self funders are reluctant to go to their local authority for this advice and looks at the challenges for both commissioners and providers in shifting their buying and selling activities to more appropriately meet the needs of people who pay for their care. The research provides some useful estimates on the numbers of self funders living in care homes and also their own homes as well as estimates on the total size of the self funding market.
People with Learning Disabilities in England 2010. January 2011 (Improved Health and Lives: Learning Disabilities Observatory (IHAL)). A statistical report that brings together information, in a single document, of the characteristics of people with learning disabilities, the services and areas of support they access. It provides information on health, education, adult social care, employment and benefits for 2009 -10.
Dartington review on the future of adult social care: Overview Report. First published in 2010 (RIPFA). This report aims to offer an authoritative and evidence-based assessment of the development of adult social care between now and 2020. The review is in four parts: an overview report and three supplementary evidence reviews (see below).
Dartington review on the future of adult social care: Evidence Review 1 - What can England learn from the experiences of other countries? (RIPFA) This paper discusses the future funding, organisation and delivery of adult social care by drawing on the experiences of other advanced welfare states, both in Europe and further afield.
Dartington review on the future of adult social care: Evidence Review 2 - The future adult social care workforce (RIPFA). Expectations of the adult social care workforce in England will change significantly by 2020. This review examines what these changes are likely to be and the steps required to respond to demographic and social challenges.
Dartington review on the future of adult social care: Evidence Review 3 - Personalisation, sustainability and adult social care: strengthening resilient communities (RIPFA). This paper explores the implications for adult social services of two key variables, climate change and energy. These complement the three key social variables identified in the Dartington Review as having the greatest potential to influence social care over the coming decade.
Private rented Extra Care: a new market? November 2010 (Housing Learning and Improvement Network (LIN)) – factsheet No 32. This Factsheet explores the question of whether there is a market for extra care housing in the private rented sector. Currently there is only a small few extra care housing schemes that offer private rental arrangements. The fact sheet looks at the relatively large percentage of renters in the age bracket 25 – 34 years old (31%) compared to the smaller group of private renters over 65 years old (5%) and asks questions about how this may affect future housing requirements with private renters getting older.
Market profile, quality of provision and commissioning of adult social care services Briefing. November 2010 (Care Quality Commission) This report provides an national analysis of the regulated adult social care market. The report looks at care homes, home care services, nursing agencies and shared lives schemes since 2004. However it does not include the unregulated market. It examines the profile of the adult social care market, looking specifically at capacity, growing pressures and regional trends. There is also a section on quality and trends in the commissioning for care. There are also two technical reports: The adult social care market and the quality of services and The quality of care services purchased by councils – 2010
The National Market Development Forum produced five briefing papers on market development which explore key challenges and develop approaches to improve the social care market. These have been developed from workshops with commissioners and providers from across the public, private and voluntary sectors.