Challenge 6: Working in partnership across the system
What is the challenge?
To work closely with the market to ensure sustainable provision for the next twenty years and beyond, supporting growth in capacity in the areas with the greatest demand.
A partnership approach
Since the Covid-19 pandemic, there have been multiple challenges to the stability of the adult social care market in Gloucestershire and across the country.
This Market Position Statement has identified several key strategic approaches and we recognise that these will involve working closely close with an engaged local provider market. In order to develop a more effective relationship between providers and commissioners, it will be necessary for us to re-evaluate and enhance our local offer to them which offers consistency and supports partnership working.
We also acknowledge that not all of our ambitions set out in the last Market Position Statement in 2018 were fully realised. Our intention remains to:
- Provide a clear picture of strategic intentions
- Work with providers around sharing risk
- Take a realistic approach to costs
- Move towards more outcome focussed commissioning
- Localise provision wherever possible
- Resolve systems issues with payments and call monitoring
- Co-ordinate our support offer to providers
- Enhance partnership working
- Improve our communication
Given the clear picture of increasing demand and limitations on our care workforce, we recognise that it is more important than ever to realise these ambitions.
Our local market is largely made up of small to medium enterprise (SME) care providers. To achieve the system changes that will be necessary, it is likely that some market consolidation will be required. We know that care provision has decreased in the last year and that we could lose more providers as they struggle to balance rising costs, a falling workforce and increasing complexity of needs. It is therefore possible that larger providers could be more likely to succeed where there are economies of scale.
This partnership approach will involve multiple stakeholders and the actions set out to meet this challenge will be led by various teams and form part of our on-going engagement work with the provider market. One of our clear aims is to change the culture where the independent care provider sector is recognised and respected as a key part of our integrated health and social care system.
We want to work with all parts of the market with providers whose strategic ambitions align with ours. We are particularly keen to work closely with those providers whose business model recognises workforce as the biggest challenge and want to invest in staff to address this.
To increase local provision in the next 20 years we recognise the need to enhance our approach to provider engagement and co-production. We aim to improve partnership working to develop additional capacity in commissioning models that are sustainable for providers and enable them to provide attractive terms and conditions for their staff.
In the community, we want to work with providers to further develop localised commissioning models in our most challenging areas and for overnight support to further reduce the demand for residential beds.
We want to further reduce spot purchasing from providers and use a consistent procurement approach through frameworks for all types of care services.
How are we planning on addressing this challenge?
The delivery of adult social care services across the county is entirely reliant on the care workforce and the pressures in this area are well known. For this reason, we are developing a ‘Working Well’ Integrated Workforce Strategy which will include analysis of:
- Recruitment and retention across the sector
- Training and development needs (including healthcare and digital skills)
- International recruitment and how providers and overseas recruits are supported
Our engagement with providers has identified four key areas for development:
Recruitment
We will need to ensure that providers are offering the best terms and conditions to their staff in terms of pay, career progression and job security. We propose to work with providers and the care workforce to find ways to achieve this.
We recognise that as the older population is growing faster than the working age population, staff are increasingly going to be drawn from a younger age group. This may require a shift in culture to ensure that they are attracted to roles in adult social care. We propose to work with staff and young people to understand what is important to them and what might have the most impact.
Retention
We will work with providers to develop ways that will make a difference to retaining our care workforce. These might include:
- Efficient recruitment processes to onboard staff quickly
- Training opportunities
- Recognition of transferable skills
- Access to career pathways
- Job satisfaction
- Development opportunities (for example, delivery of delegated healthcare activities)
- Staff wellbeing support in the preferred style or format
We will work on developing a culture shift to recognise providers and the care workforce as an important part of the integrated care system.
Training and development
We recognise that there are skills gaps in the market as people being supported have increasingly complex health and social care needs. Training and development for staff is key to providers being able to meet these needs.
We will work with providers to further develop the training offer in Gloucestershire and to find ways to make it more accessible for staff. This will include dementia care, delegated healthcare activities, complex behaviours, and digital skills.
We are currently reviewing proposals for the delegation of healthcare activities and seeking sustainable ways to enable this to happen.
We will continue to work with providers to enhance their digital capability and increase their use of digital solutions. Support is currently available to take up the “Digital Security Protection Toolkit” (DSPT) and use of digital social care records (DSCR). More work is proposed to explore how digital developments can further increase the efficiency and productivity of care provision.
International recruitment
We are working with local authorities across the South-west region to support international recruitment practice and there is a focus in Gloucestershire on providing pastoral care to international recruits.
We are also considering what the additional or bespoke training needs are for this group to ensure that they are as effective in their new roles as possible.
We recognise that international recruitment is not and cannot be the single solution for our workforce crisis but are keen to ensure that if used it is used effectively and
forms part of a strategic approach to workforce recruitment and deployment.
The work is being led by our Integrated Commissioning and will involve providers and their representative body. We will aim to publish in autumn 2024.
The delivery of adult social care services across the county is entirely reliant on the care workforce and the pressures in this area are well known. For this reason, we are developing a ‘Working Well’ Integrated Workforce Strategy which will include analysis of:
- Recruitment and retention across the sector
- Training and development needs (including healthcare and digital skills)
- International recruitment and how providers and overseas recruits are supported
Our engagement with providers has identified four key areas for development:
Recruitment
We will need to ensure that providers are offering the best terms and conditions to their staff in terms of pay, career progression and job security. We propose to work with providers and the care workforce to find ways to achieve this.
We recognise that as the older population is growing faster than the working age population, staff are increasingly going to be drawn from a younger age group. This may require a shift in culture to ensure that they are attracted to roles in adult social care. We propose to work with staff and young people to understand what is important to them and what might have the most impact.
Retention
We will work with providers to develop ways that will make a difference to retaining our care workforce. These might include:
- Efficient recruitment processes to onboard staff quickly
- Training opportunities
- Recognition of transferable skills
- Access to career pathways
- Job satisfaction
- Development opportunities (for example, delivery of delegated healthcare activities)
- Staff wellbeing support in the preferred style or format
We will work on developing a culture shift to recognise providers and the care workforce as an important part of the integrated care system.
Training and development
We recognise that there are skills gaps in the market as people being supported have increasingly complex health and social care needs. Training and development for staff is key to providers being able to meet these needs.
We will work with providers to further develop the training offer in Gloucestershire and to find ways to make it more accessible for staff. This will include dementia care, delegated healthcare activities, complex behaviours, and digital skills.
We are currently reviewing proposals for the delegation of healthcare activities and seeking sustainable ways to enable this to happen.
We will continue to work with providers to enhance their digital capability and increase their use of digital solutions. Support is currently available to take up the “Digital Security Protection Toolkit” (DSPT) and use of digital social care records (DSCR). More work is proposed to explore how digital developments can further increase the efficiency and productivity of care provision.
International recruitment
We are working with local authorities across the South-west region to support international recruitment practice and there is a focus in Gloucestershire on providing pastoral care to international recruits.
We are also considering what the additional or bespoke training needs are for this group to ensure that they are as effective in their new roles as possible.
We recognise that international recruitment is not and cannot be the single solution for our workforce crisis but are keen to ensure that if used it is used effectively and
forms part of a strategic approach to workforce recruitment and deployment.
The work is being led by our Integrated Commissioning and will involve providers and their representative body. We will aim to publish in autumn 2024.
From 2024, we will host dedicated quarterly in-person provider forums for each of the home care, care home and disabilities/mental health sectors to be attended by colleagues from across the local health and social care system. The forums will aim to consider and focus on issues raised by providers as well as those raised by commissioners.
We will engage with providers to ascertain what they need and expect from their representative body going forward with a view to going out to competitive tender for a new contract during 2025-6.
We will improve our support offer to providers by improving accessibility to information and commissioners in relation to both strategic and day-to-day matters.
This work will be led by Integrated Commissioning working with Adult Social Care providers, their representatives, and the wider system.
From 2024, we will host dedicated quarterly in-person provider forums for each of the home care, care home and disabilities/mental health sectors to be attended by colleagues from across the local health and social care system. The forums will aim to consider and focus on issues raised by providers as well as those raised by commissioners.
We will engage with providers to ascertain what they need and expect from their representative body going forward with a view to going out to competitive tender for a new contract during 2025-6.
We will improve our support offer to providers by improving accessibility to information and commissioners in relation to both strategic and day-to-day matters.
This work will be led by Integrated Commissioning working with Adult Social Care providers, their representatives, and the wider system.
How can providers support us to meet this challenge?
- Continue to engage with us at provider forums and other opportunities so your views and ideas are heard as we develop our ‘Working Well’ and other strategies
- Embrace digital and technological innovations and make your business ‘fit for the future’ as these will be an integral part of how care is delivered going forward
- Step forward to take part in pilots for any health or social care initiatives as we trial potential solutions to some of the system challenges we face
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