Challenge 3: Increasing our community support offer

What is the challenge?

To increase and enhance services to support people to live at home.

Access to support at home from a variety of different services

Strong community links have been shown to help people retain independence and reduce their need for health and social care services. We engaged with care homes across Gloucestershire to find out what voluntary and community sector organisations they work with to support their residents. Most the care homes worked with multiple community services including library services, churches, local schools, pet shelters and individual volunteers.

It is our ambition for all of our home care providers to have similar links with the voluntary and community sector. This, however, creates a challenge as providers are generally paid to provide a set number of hours of care, regardless of the number of people they support or how those people chose to retain their independence. This gives no incentive for providers to engage with voluntary and community organisations to help support people at home.

For home care providers, it could look something like this: linking together multiple people receiving care to help avoid isolation, supporting people to access their community and/or actively involving volunteers or neighbours to help support people.

Local provision of home care

It is our intention to continue to support people to live at home and maintain their independence for longer wherever possible. The growing older population means demand for these services is increasing and given our limited workforce capacity, there is a need to ensure that every part of the system works effectively to maximise the resources we have.

Gloucestershire County Council has developed a market mapping tool using existing data to enable the ‘hyper localised’ commissioning of home care. Small block purchase arrangements have been put in place with participating providers to facilitate maximum capacity at a local level. The market mapping tool enables us to ascertain where blocks will be effective by identifying clusters of demand that could be picked up by a single provider and to ensure that all work in that area is commissioned with the relevant block provider.

This initiative has been very successful in increasing the capacity of providers at a post code level and has underpinned an 8% increase in home care provision. Providers who have participated so far have reported that it enables them to build capacity by reducing travel time and keep staff in a local area which gives continuity for the people receiving care and job satisfaction for their staff.

Care services can meet people’s needs at home

We want to build on the success of ‘hyper localised’ commissioning, but we recognise that along with an increase in numbers of people requiring care, there is also an increase in the complexity of need being supported in the community. Professor Chris Whitty points out that:

“With older age comes an increasing probability of an accumulation of chronic diseases, sometimes called multimorbidity. These diseases can interact, meaning that an older adult who could have maintained independence and quality of life with one of these diseases struggles to do so with the combination.”[1]

In order to support people at home with complex health needs, we recognise that adult social care workforce will have a key part to play alongside community health services. By delegating some healthcare tasks to care staff with the right training and support, people can benefit from a level of continuity and responsiveness that is not possible from community healthcare services alone. Work is being undertaken across the country to facilitate this. For example, Skills for Care worked with The National Care Forum and their members to develop a sample policy which aims to support adult social care providers to evidence their decision-making and governance when considering delegation. They also offer policy information for the delegation of clinical observations, simple wound and catheter care.[2]

Remaining independent with a choice of support

We want to ensure that people living at home are supported to live well and to maintain or increase their independence. We want to take an ‘outcome-based’ commissioning approach and expect to place an increasing focus on reablement in the provision of both home care and supported living.

There will also be increased demand and use of aids and adaptations to make homes more accessible. Equipment and technology-enabled care will also contribute to people’s ability to live more independently.

How are we planning on addressing this challenge?

How can home care providers support us to meet this challenge?

• Participate in the roll-out of further local blocks under our hyper-localised commissioning model
• Work with us to build stronger and deeper links with the VCFSE sector in Gloucestershire, sharing existing local connections, good practice and what’s working well for you