Market Position Statement policy context

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The Wandsworth context

The London Borough of Wandsworth is the eighth largest borough in London at 327,506 (2021 census). It is a vibrant borough, with two distinct groups of populaces, one being the transient young, who are affluent and in good health. The other group is distinctly those who have lived in the borough for a longer period of time, often those who are very young and those that are elderly (JSNA).

By 2029 this will increase to more than 373,000, reflecting that Wandsworth also has one of the fastest rates of population growth in London. Local population increase is currently driven by natural change (more birth than deaths) and migration from other parts of the UK and in the next 10 years will be driven by large new housing developments such as Nine Elms.

Wandsworth is generally an economically active area, with an employment rate of 80%, and having a lower-than-average rate of poverty compared to London.

More detailed demographic information from the 2021 census can be found on DataWand. 

Adult social care reform

Significant challenges ahead including budget reductions, technological changes, demographic changes leading to a rise in the demand for adult care services particularly as more adults with long-term and/or multiple health conditions and disabilities are living longer.

For some time, national policy, primarily the Care Act 2014, has emphasised the importance of personalisation and choice, prevention, support for unpaid carers, information/advice, market shaping and market oversight, and the integration of health and social care in promoting the health and well- being of service users and unpaid carers.

In December 2021 the previous government introduced its white paper entitled People at the Heart of Care: Adult Social Care Reform outlining its 10-year vision to transform support and care in England.

Subsequently, the former government in April 2023 published Next steps to put People at the Heart of Care. Key areas of focus included:

• Improving access to care and support
• Digitising social care
• Improving social care insight
• Supporting people to remain independent
• Innovation and improvement
• Recognition of skills – adult social care workforce
• Joining up services for people and carers

The new government has announced an intention to create a 'National Care Service', and to improve NHS and social care integration as part of a 10-year plan for reform. Further details are due to be published.

Health and social care landscape in Wandsworth

The Health and Care Act 2022 places duties on partners in health and social care to work more effectively together through the creation of integrated care systems (ICSs). These are geographically based partnerships that bring together NHS services with local authorities and other local partners to plan and deliver joined up health and care services to improve the lives of people in their area. These replace the old clinical commissioning groups (CCG) model.

Wandsworth is part of the Southwest London ICS which is responsible for how health and care is planned, paid for, and delivered across six authorities including Wandsworth, Richmond, Croydon, Kingston, Merton, and Sutton. We have a strong track record of integration with the NHS and other Council directorates. Our collaborations across the SWL health and care system are aligned through our Wandsworth Health and Care Plan. We collaborate with Public Health colleagues and other departments to meet common objectives resulting in joint work on active lifestyles and our prevention framework, with housing around rough sleeping and corporately around the cost of living crisis. 

We are also working together to manage the better care fund (BCF) which is a pooled budget for both the NHS and us which seeks to join up health and care services to support people to be cared for at home, avoid hospital admissions and reduce the length of stay in an acute setting. The BCF plan for 2023-25 is currently being developed. For providers, this will mean there will be more services commissioned jointly in the future to reduce duplication and support providers to work across the whole system. It is expected that services commissioned in this way will be more efficient, cost effective and achieve improved outcomes.

We have aligned our Adult Social Care Transformation plans and commissioning intentions with the 9 key priorities set out in the Integrated Care Partnership Strategy, including tackling and reducing health inequalities and a positive focus on mental wellbeing and workforce. 

Housing

We work closely with our Housing partners to identify and deliver suitable housing for vulnerable residents and to support the building of inclusive and accessible homes. Affordable housing options are also likely to be required as set out in the affordable housing policies within the Local Plan.

Challenges:

• We understand the challenges residents face to secure good quality, affordable housing options and the key role housing plays to provide a foundation for physical, social, and mental wellbeing.
• The supply of affordable housing including specialist housing is insufficient to meet demand particularly with the growing number of people wanting to settle in the borough, placing increasing demand on social and private housing. This shortage combined with inflationary pressures is inflating private sector rents. With the cost of living crisis residents will increasingly be unable to afford these rents leading to pressure on the council’s housing queues and detrimentally impacting the health and wellbeing of residents.
• The current economic situation is also impacting housing development within the borough making it more difficult for private developers to deliver affordable housing as part of new developments.
• The new Housing and Homelessness Strategy 2023-28 (currently in draft) will set out the plan for housing and homelessness for the next five years to addresses the challenges facing the council including new legislative requirements on climate change and building safety.

Developers are encouraged to engage with the council’s planning, housing, and commissioning teams to ensure any proposals brought forward demonstrate how they meet local priority needs, ensuring they are in the appropriate location, and taking into account the latest baseline information.

The emerging Wandsworth Local Plan (2023-2028) expects proposals should demonstrate they have been informed by discussions with providers and accord with the Council’s commissioning and housing strategies. It expects the Council’s housing and commissioning officers to be involved in discussions with providers, at an early stage, to ensure proposals will meet local identified supported housing needs, and evidence of these discussions submitted with the application. Applications are expected to be submitted with details of how the design and management will provide the necessary level of supervision, management, care and support, including operational management plans (incorporating minimum levels of care). A cascade approach will be sought to ensure the units will be first offered to eligible persons residing within the borough, for example for a minimum period of 3 or 6 months.

Providers and developers when designing accommodation are recommended to follow the requirements set out in the guidance Specification: Supported Housing Accommodation 2023, which provides further detail on the requirements of supported housing in the borough, ensuring developments reach a good standard and are safe and suitable for residents.

What do people want: outcomes that matter

The framework Making it Real is explicitly referenced in the Care Act 2014 as a mechanism to frame the outcomes that matter most to people to support their aspirations to lead a normal life.

1. Wellbeing and independence - Living the life I want to lead
2. Information and advice - Having the information I need when I need it
3. Active and supportive communities - Keeping friends, family, and connections
4. Flexible and integrated care and support - My support, my way
5. When things need to change - Staying in control
6. Workforce - The people who support me

The white paper highlights the importance of housing in what people want to achieve in their lives and that every decision about care should be a decision about housing. This supports the vision and outcomes advocated by Social Care Future, ‘We all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing the things that matter to us.’

We want people to have a 'life, not just a service' and we will commission services that are personalised, and outcome focused.

Our vision for residents

Our vision is to support our community to lead healthy and fulfilling lives.  

Our overall vision as a department is to support people to have healthy and fulfilling lives. We put people at the centre of everything we do, promote independence, choice, and control. 

Prevention and early intervention are at the heart of our response, to facilitate people and their carers to build on their strengths, promote their wellbeing and achieve the outcomes they want, delaying and reducing the need for long term support from the Council.  

We listen to people and their carers, working together to develop and improve our services. We are committed to supporting residents to have equal access to an inclusive and diverse support offer, upholding people’s rights, and dignity at all times.  

We focus on achieving healthy people, places and communities and helping people to help themselves, using the wider resources available in the local area, including those offered in the community by the NHS and voluntary sector. We have shared ambitions with our partners and providers and offer a broad range of information, tools, and services to support people’s health and wellbeing. We want our staff to be empowered as leaders in our field, fulfilled and highly skilled in everything we do. 

Older people:

• We want older residents to enjoy the best quality of life. Through prevention and early intervention services such as rapid response, reablement at home, and step down beds in care homes, we will aim to maximise people’s health, wellbeing and independence and reduce the need for long term support wherever possible.

Adults with memory and cognition needs:

• Dementia is a key priority. We want residents affected by dementia, to live well and enjoy a good quality of life throughout their diagnosis with access to the right support and in an environment that maximises their independence.

Adults with learning disabilities:

• We want adults with a learning disability to lead as independent and healthy lives as possible, fulfil their potential and be able to be active citizens in their local communities, close to family and friends.

Autism:

• We want young people and adults with autistic spectrum conditions (ASCs) to live fulfilling and rewarding lives, within a community that understands them and with access to effective support and pathways to diagnosis.

Adults with mental health needs (18+):

• We want adults with mental health needs to lead as independent and healthy lives as possible and have the confidence and skills to thrive and be able to be active citizens within their local communities.
• We want to promote recovery and support people to achieve their aspirations, such as returning to work.
• We want to ensure that there are culturally appropriate services to deliver equitable outcomes for our Black, Asian and Minority Ethnic residents with a mental health need.
• We want to ensure that there is adequate support for those who are transitioning from children and young person’s social care services into adult social care services. 

Adults with physical and sensory disability needs (aged 18 to 64):

• We want adults with physical disabilities and sensory needs including younger adults to lead independent and healthy lives and have the same opportunities as others, with access to services that actively work with people to define and achieve their goals and consider the whole of a person's life.

Carers:

• We want carers to be identified at the right time and have access to the right information, support and networks to sustain their caring role and have a life outside of caring.
• We recognise and want to raise awareness of the vital role carers play in the prevention agenda and the local health, social care and wider economy.

Priorities for adult social care services in Wandsworth

Our Adult Social Care and Public Health values have been developed to align with our wider staff values as below.

Corporate objectives

The corporate objectives of Wandsworth Borough Council are:

• A fairer borough where we will ensure local people have a genuinely affordable place to call home and we support residents who have been affected by the cost of living crisis and the pandemic
• A compassionate borough where we will create safer neighbourhoods, in which communities feel confident and victims and survivors are supported and we will be a council which truly listens, and is ambitious for all
• A more sustainable borough where we will tackle climate change by working with our residents, businesses and communities and we will be carbon neutral as a council by 2030

Our objectives

Our new corporate values encourage us to think bigger and connect better. 

To achieve our vision, our overall departmental priorities for the forthcoming year are to: 

• Strengthen involvement and engagement with and gathering feedback from service users and carers
• Continue our focus on preventing and reducing health inequalities
• Work with the care provider market to ensure market sustainability and address local workforce challenges at Place level
• Work with partners across the Southwest London Integrated Care System towards more integrated health and care services with a focus on integrated locality teams, proactive care and reviewing D2A
• Build on improvements made to continue to develop the support we offer for unpaid carers
• Identify opportunities for further transformation of services with a focus on embedding digital technology in service delivery and using the latest technology to improve the way we work
• Proactively identify opportunities to better manage our demand and deliver savings to address budget challenges including implementing a new care home placement policy for older people with further roll out to other client groups. 

Our Transforming Social Care (TSC) Programme encompasses our improvement activity across ASCPH, including preparation for assurance, demand management, workforce, and market sustainability.

Commissioning approach

To achieve the adult social care and council objectives and priorities, we aim to adopt a commissioning approach that is:

Person-centred and outcome-focused:

• Where services are co-produced with service users, their carers and the wider community. The individual and their community are front and centre of the decision-making process.

Well-led:

• Supported by the wider Council and partner organisations, adopting a whole systems approach, and using evidence of what works.

Promotes a sustainable and diverse market:

• Provides value for money, develops the workforce, and promotes positive engagement with providers.

In challenging financial times and increasing demand for social care we need to model our values and think bigger, embrace difference, connect better, lead by example and put people at the centre of all we do.  

Our division will aim to commission services and deliver our priorities with the following approaches:  

• Relational perspective
• Innovation, equality, and integration test in all we do
• Be market shapers and commissioning specialists
• Make safeguarding everybody's business 

Through a CQS co-developed ‘Ways of Working’ method, we will collaborate and create ‘Thinking Spaces’ on each core priority to test our values and approach as we work up our deliverables.  

We will have a focus on our own professional workforce, our provider workforce and the integrated health and care workforce with actions that promote wellbeing, retention, and career pathways.

Additionally, the following are our current commissioning priorities: 

Top priority: 

1. Develop suitable accommodation options for people with mental health needs and wider supported housing offer 
2. Improve the efficacy and responsiveness of the integrated reablement offer 
3. Embed a consistent approach to co-production  

Wider strategic priorities 

1. Strengthen partnerships with local VCS partners 
2. Maximise the opportunities with partners to integrate 
3. Commission enhanced extra care services 
4. Address our workforce challenges 
5. Secure long term sustainable sexual health services 
6. Shape our offer more closely to reflect the diversity of our community 

Providers we want to work with in our local market

We want to work with providers who meet the values that underpin our ethos for service delivery and meet the following expectations:

• Understand and embed the principles of person-centred care in day-to-day practice
• Adopt a strength-based approach and focus on preventing, delaying, and reducing the need for care
• Ensure every contact counts and that every door is the right door for someone to access care
• Actively develop services in partnership with service users, fostering continual improvement
• We see ourselves as innovators, through our networks and in the way we commission services. Therefore, we encourage providers to embrace and use digital technology in creative ways in delivering care and support to improve the quality of life for individuals
• Are outcome focused and measure success in outcomes identified by the individual and can evidence how and what outcomes have been met
• Deliver services which promote enablement, self-management, independence, choice, and control
• Understand the importance of considering the needs of unpaid carers in everything they do
• Provide safe, quality services which are cost effective and value for money
• Develop a ‘local offer’ so that people can get care and support close to home
• Invest in the development and retention of their workforce and provide attractive employment offers to support stability of the market and quality of service provision
• Consider social value when developing services to help build a resilient, healthy and economically strong local community
• Work closely in partnership with us, other providers as well as the voluntary and community sector to develop services and continue to learn about available local services and make links across the care landscape
• Commit to adopting climate friendly policies, and sustainable practices whilst implementing meaningful action to tackle climate change at a local level. The Wandsworth Environment and Sustainability Strategy 2019-2030 demonstrates our commitment to tackling climate change
• Work with us to drive up quality and safeguarding practices
• Offer inclusive and culturally responsive services and work in a person-centred way, tailored individually to meet the needs of people from all equality groups, for example lesbian, bi-sexual and transgender people. This includes supporting a diverse workforce that reflects the local communities we serve. This is linked to the wider Council’s equality objectives for 2021 to 2025. We value and celebrate diversity and believe it is essential to provide services which work well for all of us.