To consider the submitted report on the above and make recommendations to the Cabinet.

The Director of Adult and Community Services - Anna Coles, the Head of Strategic Commissioning - Adam Russell and the Strategic Care Manager - Nigel Williams provided the background and overview of the submitted draft Adult Social Care Market Position Statement and responded to questions.

Members raised the following points:

·                Torbay had previously had lower numbers of people receiving direct payments for adult services than the national average, this seems to have improved, how has this been achieved;

·                would a person with a learning disability have to have a money manager for their direct payment;

·                does the Council have anywhere to support people with a learning disability to live together;

·                page 124 showed a large increase in the number of long-term residential and nursing home placements over the past 12 months, with the cost rising by 150%, what was being done to manage this; and

·                a lot of beds were being utilised by residents under 65 years of age and Torbay was a national outlier for use of residential care for working adults, what was the reason for this.

The following responses were provided by the Head of Commissioning Services, Strategic Care Manager and Director of Adult and Community Services:

·                The Council was developing the personal assistant model and encouraging Social Workers to work in a different way to look at the needs of the individual as they know best what they need and how the care package could be shaped around them. 

·                There was not a one size fits all in terms of managing direct payments, if a person has capacity to make decisions and the professional judgement was that this was ok then the person can manage their own finances, however if they do not have capacity or were unable to make safe decisions layers of support would be wrapped around the individual proportionate to their needs.  This could be a parent or guardian, but not a personal assistant. 

·                Personal assistants were currently not registered with the Care Quality Commission (CQC) and the Council was looking to protect individuals as much as possible.  Therefore, was introducing a Council Quality Mark for personal assistants to say to clients that they were Council approved, this created the opportunity to have quality assurance within the market.  Personal assistants were self-employed or employed by the Direct Payment User, if they register with the Council for the Quatliy Mark it would provide them a better route to work, advertise their offer and demonstrate that they were properly trained to fulfil their role.

·                There was a supported living framework which worked to empower more people with a learning disability to aspire towards independent and supported living, rather than requiring them to do so.  More individuals had explored their own rights and wanted to live in a home of their own, but some were happy to share with others.  There was a disconnect between the demand and provision with around 30 vacancies across the framework for shared accommodation and 24 people looking for accommodation on their own.  The Council was looking how to enable small groups of people to make elective decisions about living together and then matching those people together.  This relied on being able to commission suitable accommodation at pace and there was an overall shortage of housing across all sectors in Torbay.  Officers were working creatively with housing providers and developers who want to invest long term in the learning disability market.  There was also a Shared Living Shared Lives Scheme where people could open their homes to someone as a family member and be paid, and supported living schemes for a period of time, especially for those moving from Children’s Services living in general needs housing with support as and when needed.

·                One of the challenges for residential and nursing home provision was an externalised market in an integrated care system.  There was a need to manage the difference between what a market wants to sell and the service we want to buy and the price we want to buy it for.  There had been a huge escalation in the cost of delivery of care as inflation had increased, costs of care had gone up, a jump in minimum wage, indemnity insurance increased and a spike in utility costs which was why providers were demanding higher prices.  In addition, there was a five year spike in the population coming through from 2022 onwards.

·                As a system there were not enough alternatives to traditional residential or nursing home placements and possibly historically the decision to place in a home was made too easily.  The Team had started to introduce schemes such as supported living, better use of domiciliary care, better day services which had started to see numbers coming down.  Once someone was placed in residential care they would normally be there for life.  There was a need to create more alternatives such as extra care housing and multi-generational extra care housing, rather than place into residential care.  The Team was currently looking at those people in residential care to see if their care needs could be met differently.

Resolved (unanimously):

That the Cabinet be recommended to approve the Market Position Statement (MPS) 2025-2029 as set out in Appendix 1 to the submitted report.