Foreword by our executive Director for adults and communities

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 things that matter to us.

That’s the social care future we seek. #socialcarefuture

Our vision

Our 2030 vision is Barnsley - the place of possibilities. By 2030 we want everyone to benefit from and contribute to making our borough a thriving place of possibilities.

Our new council plan identifies five priorities:

• Healthy Barnsley
• Learning Barnsley
• Growing Barnsley
• Sustainable Barnsley
• Enabling Barnsley - we're a modern, inclusive, efficient, productive and high-performing council

Figure 1: The five council priorities.

Adult social care priorities

The priority for adult social care and our communities across these plans is that we want people to live independently with good physical and mental health for as long as possible. Our Better Lives programme will make sure vulnerable adults and those with support needs are also safe, protected and able to lead full, active and healthy lives.

 Outcomes set out in the council plan include: 

• People are safe and feel safe.
• People live independently with good physical and mental health for as long as possible.
• We've reduced inequalities in health and income across the borough.
• People have access to early help and support.
• People are supported to have safe, warm, sustainable homes.
• People live in great places, are recycling more and wasting less, feel connected and valued in their community.

We've identified five key priorities for improvement and change:

1. front door - review of our first points of contact and online channels for self-help and signposting
2. prevention and early intervention
3. strength-based practice
4. integration and partnership working
5. market shaping

Aligned to these priorities are a set of service and organisational enablers that play a key role in achieving the outcomes aligned to this programme: 

• engagement model
• digital
• performance framework
• workforce (including new structures)
• development of a new adult social care narrative

Working with our partners and providers, we'll be working on these areas to put in place new ways of working and achieve better outcomes for the people we support.

Find out about our Better Lives programme.

Executive summary

• Offer 1: help for people to help themselves – early intervention, prevention, healthy population.
  
  
• Offer 2: help when you need it – help focused on supporting people to regain levels of independence.
  
  
• Offer 3: personalised support to address health and wellbeing for on-going support needs.

Figure 2: Diagram showing offers 1, 2 and 3.

Living well

Please note: the supply and demand for each service shown in the table below is based on commissioning plans and the expected direction of travel in that area.

Ageing well

Please note: the supply and demand for each service shown in the table below is based on commissioning plans and the expected direction of travel in that area.

Our data

Barnsley's demographics

In Barnsley, the population size has increased by 5.9%, from around 231,200 in 2011 to 244,600 in 2021

• 0 to 19 year olds make up 22% (54,400) of Barnsley's population.
• 20 to 64 year olds make up 58% (142,800) of Barnsley's population.
• 64+ year olds make up 20% (47,400) of Barnsley's population.
• The number of residents 65+ is predicted to reach 60,500 by 2030.

Find out more about how life has changed in Barnsley.

Figure 3: Graphic showing Barnsley's demographic figures as detailed above.

Ethnic minority groups

There are small pockets of older ethnic minority groups across Barnsley. Based on 2019 ONS population data by ethnic group Barnsley has 1.7% of those aged 50 to 64 from ethnic minority groups (excluding white minorities), and 0.7% for those aged 65+.

The health inequalities that exist within ethnic minorities have been exacerbated during the COVID-19 pandemic, with all ethnic minority groups at an increased risk of mortality due to COVID-19. However, those of black African and black Caribbean descent are at greatest risk (PHE, 2020).

Older LGBTQ+ Adults

The census 2021 estimates show that Barnsley people aged 16 years and over identified as:

• 91.57% straight or heterosexual
• 1.50% gay or lesbian
• 0.91% bisexual
• 0.07% pansexual
• 0.03% asexual
• 0.01% queer
• 0.09% another sexual orientation
• 5.83% did not answer the question

3.07% of people in Yorkshire and Humber identify as gay or lesbian, bisexual, or other sexual orientation, compared to England at 3.2% (ONS, 2022).

Carers

• The number of family (or unpaid) carers recorded in Barnsley by the 2011 census was 27,167.
• By 2015, a national research study stated that the number of carers in Barnsley had increased by 4.6% to 28,429 (Valuing Carers 2015 - the rising value of carers’ support, Lisa Buckner University of Leeds, Sue Yeandle University of Sheffield). By 2037, Carers UK have calculated that the number of carers in the UK will increase by 40%, meaning we would have approximately 39,800 carers in Barnsley.
• In 2023 1158 carers received a carers assessment from the local authority, this is a 35% increase from 2022.
• As at the end of March 2024 1121 carers received a service following either an assessment or review.
• There are 1428 carers registered with the carers service.

Find out more in our Carers' Strategy.

Figure 4: Graphic showing carer figures as detailed above.

Coronavirus (COVID-19)

Barnsley was in the top five of UK local authorities with the highest death rate from COVID-19 in January 2021.

In Barnsley we have an older population, a higher number of care homes and greater levels of chronic disease and deprivation compared with the rest of the country. This means the population of Barnsley are susceptible to infection, serious illness and death during the pandemic.

Education and health care plans

In 2023, 2554 young people had an education health care plan. This is a 15% increase from 2021 with the figure expected to increase to 3520 by 2028.

Figure 5: Graphic showing EHCP and primary need forecasting against 2020 Barnsley population growth for 0 to 25 year old children and young people.

People accessing support

2022/23

• In 2022/23 Barnsley had 1164 social care users per 100,000 population aged 18 to 64 and 6358 per 100,000 aged 65+.
• During 2022/23 there were 22,667 contacts made with adult social care.
• 12,782 were new contacts (people not in receipt of long term support at the time of contact).
• 2153 assessments were completed and 2110 new care plans were created.
• In total adult social care funded 4815 packages of care/support during the year and as at the 31 of Mar 2023 2669 remained in receipt of a long term package of care.
• A further 336 packages were funded by Barnsley ICB (data as at December 23).

2023/24

• In 2023/2024 Barnsley had 1271 social care users per 100,000 population aged 18 to 64 and 6010 per 100,000 aged 65+.
• During 23/24 there were 25,801 contacts made with adult social care (124% increase from 20/21) (figures up to March 2024).
• 13,723 were new contacts (people not in receipt of long term support at the time of contact) (figures up to March 2024).
• In total adult social care funded 5552 packages of care/support during the year and as at the 31 of March 2024, 2776 remained in receipt of a long term package of care.
• 233 packages were funded by Barnsley ICB (figures up to March 2024).
  

Figure 6: Graphic showing people accessing care and support figures as detailed above.

Personalisation and direct payments 

As of 31 March 2024, 20% of adult social care service users received a direct payment to pay for their care and support.

Continuing healthcare funded services

Data as of 11 December 2023.

Fast tracks

Market overview

Residential care

Barnsley currently has 68 care homes operating across the borough. 41 care homes are registered to support those people aged 65 and over with the remaining 27 care homes offering specialist provision to working age adults and/or those people with more complex needs.

Older people's care homes

Of the 41 care homes, five are registered to deliver nursing care. The average size of a care home is 43 beds, the smallest is 12 beds and the largest 87 beds.

The 41 care homes operating under our framework contract have a total of 1751 CQC registered beds.

Average occupancy has increased following a 10 to 15% reduction during the pandemic and now averages at around 82%.

CQC ratings:

• Outstanding - 2 (4.9%)
• Good - 27 (65.8%)
• Requires improvement - 12 (29.3%)
• Inadequate - 0 (0.0%)

Figure 7: Graphic showing CQC ratings for older people's care homes as detailed above.

There remains excess capacity across 65+ residential care. Providers operating below 90% occupancy are at increased risk of failure as the revenue generated from placements may not cover both long and short term costs resulting in provider exits from the market.

There are currently 22 care homes operating in Barnsley at less than 90% occupancy with a total of 289 vacant beds. (April 2024)

We purchase approximately 40% of current provision meaning that 60% of occupied beds are occupied by people funding their own care or people placed from out of Barnsley.

Specialist care homes

Specialist care homes have an average bed number of 12 beds; the smallest is two beds and the largest is 46 beds.

CQC ratings:

• Outstanding – 1 (3.7%)
• Good – 21 (77.8%)
• Requires improvement – 5 (18.5%)
• Inadequate – 0 (0.0%)

No provider has more than three homes operating in the borough. However, several of our specialist homes are part of larger organisations operating both regionally and nationally.

Figure 8: Graphic showing CQC ratings for specialist care homes as detailed above.

Typically, occupancy rates in specialist care homes in Barnsley have been higher than those in care homes for people aged 65+. However, as of April 2024, occupancy rates were around 82%, broadly in line with homes for older people. There are a total of 366 beds across the 27 specialist homes with 31 vacancies.

8 care homes are operating with occupancy levels less than 90% with a total of 26 beds vacant.

No provider has more than three homes operating in the borough, however a number of our specialist homes are part of larger organisations operating both regionally and nationally.

Home care

Barnsley currently has 49 home care providers registered to operate across the borough.

The majority of providers are small, local, independent organisations operating solely in Barnsley. However, a number of providers also deliver home care in other local authority areas.

30 providers are part of the council's framework contract for home care. This includes 9 of the 49 providers registered in Barnsley with the remainder registered in neighbouring authorities. 19 agencies are operating on a spot purchase basis.

CQC ratings (for agencies registered in Barnsley):

• Outstanding – 0 – (0.0%)
• Good – 28 (93.33%)
• Requires improvement - 2 (6.67%)
• Inadequate – 0 – (0.0%)
• Not yet inspected – 0 (0.0%)

Figure 9: Graphic showing CQC ratings for home care as detailed above.

As of May 2024, there were 1088 active packages of home care with a total of 16,630 hours of care per week.

59.5% of hours (9,895) are delivered by 25 of the framework contracted providers. 40.5% (6,735) are delivered by 29 of the spot contracted providers.

Finance

Barnsley adult social care budget and spend 

Total gross spend in 2023/24 on adult social care services/provision was £89 million, of which £81.9 million (representing 92%) relates to spend on direct care provision, eg. residential/nursing care, domiciliary care, etc.

The above was partly funded through contributions from service users, Better Care Fund and government grants. The table below summarises the total net spend on direct care provision within adult social care in 2023/24.

Actual spend on people in Barnsley is lower than national averages across all age groups.

The adult social care budget for 2024/25 has been increased by £6.6 million to take account of expected increased cost pressures arising from demographic changes and care provider fee increases due to national living wage and other inflationary pressures. The budget increase has been mainly funded from the following resources: Council Tax adult social care precept, market sustainability and improvement grant; social care grant and wider efficiencies across the Council.

Looking forward to 2025/26, the economic conditions facing the Council is one of increased uncertainty due to the following: rising pay costs (e.g., national living wage), high inflation and interest rates, rising service demand and a cost of living crisis (exacerbated by the energy crisis). The funding outlook is also uncertain with Government funding not keeping pace with rising inflation and demand pressures facing adult social care – resulting in the need to find efficiencies (approved savings for ASC is £0.2m for 25/26).

Average fees paid for care services

Nursing rates for residential care and residential EMI (including enhanced service) are as above, plus funded nursing care within that financial year.

Workforce

In Barnsley there are an estimated 6900 jobs in adult social care, with 6400 of those posts filled leaving approximately 500 vacant posts.

Of the 6400 filled posts 5100 are in the independent sector and 475 in the local authority.

Skills, recruitment and retention

Skills for Care estimates that the staff turnover rate in Barnsley was 29.6%, which was lower than the region average of 33.2%.

Data as of October 2023.

We're continuing to work with partners to develop a Health and Social Care Academy that will offer support to the care sector in improving workforce skills, recruitment and retention.

Through the Better Lives Programme there will be development work for all staff to embed asset based approaches, using strength based conversations and improve the quality of care across the borough.

The local authority continues its commitment to ensuring direct care staff working as part of council contracts are paid £1 above the national living wage.

Commissioning intentions: living well

Individuals and families are healthy, resilient and have the confidence and skills to thrive and achieve their full potential so that collectively our communities achieve the best possible outcomes for themselves, their families and each other.

Support to individuals and families will be offered within their community and as close to home as possible.

Early intervention and prevention

Early intervention and prevention is at the core of our approach to reducing the overall need for high cost social care and crisis services, and improving overall outcomes and health inequalities. The authority aims to commission services that promote health, wellbeing and independence, enabling people to have choice and control as well as reducing the risk of people reaching crisis point and/or needing future intensive care and support.

Barnsley wants to make sure that everyone has the ability to live happy and healthy lives. To do this we'll work with our communities and organisations involved with communities to develop support that makes sense to them. Our approach will be to work with groups of people and organisations to develop, design and where necessary change the way support is provided. This approach should help people get support early and avoid people escalating into a crisis.

We recognise that most of our resources are used to provide reactive support for people when things have got really challenging for them. We want to target more resources to support earlier on in people’s lives.

Our plans are to commission services which:

• empower people and communities to build capacity and resilience, so they can do more for themselves
• address the underlying causes and ensure people have access to early help and support around things that impact on physical and mental wellbeing (housing, mental health, substance misuse, caring)
• look at solutions to address the risks of social isolation in older people or other vulnerable adults highlighted through the pandemic
• operate a home-first model, where possible ensuring support is offered in a way that allows people to remain living in their own homes for as long as possible.
• maximise people’s independence; doing with and not for.
• support the view of 'lives not services', are asset based, and form part of an individual’s wider circle of support including the community in which they live.
• are progression focussed, moving away from long term maintenance wherever possible.
• identify opportunities for early intervention and prevention.
• reflect Barnsley’s public health agenda focussing on the wider determinants of a person’s health and wellbeing which may impact on their need for support.
• supports seamless pathways and links to other services.
• promotes the use of technology to meet individual needs.

To do this, commissioners will: 

• work with partners and the market to develop support that promotes early intervention and prevention, and support that reduces risks of harm and prevents or delays admission into hospital or long term residential care.
• commission high quality services that deliver value for money ensuring that the Barnsley pound is maximised.
• work with providers who can clearly demonstrate a commitment to delivering high quality care and who place service users at the centre of what they do.
• work with providers to ensure Barnsley has a diverse and sustainable market which can continually grow to meet the needs of the borough in future years.
• support providers to continually improve services and to ensure that both national and local standards of care continue to be met.
• co-design services with partners, staff and service users to ensure they are fit for purpose.
• develop a market that offers service users a choice in how and from whom they receive their support.
• identify gaps in service provision through the monitoring of data available and ensure these form part of future commissioning intentions.
• continue to promote community based services and reduce admissions to long term residential care.
• develop services to ensure people can be discharged from hospital in a timely manner and with the right support avoiding unnecessary admissions into residential care.

Our approach to prevention will be based on a better understanding of our local populations health needs and we will work closely with colleagues from Public Health to understand how we can commission services that support the wider determinants of health.

We'll continue to develop stronger partnerships with the third sector and build on existing networks such as Age Friendly, the Dementia Alliance and Good Food Barnsley.

Our Age Friendly Barnsley partners are:

• Age UK
• BMBC
• Berneslai Homes
• South Yorkshire Passenger Transport Executive
• South Yorkshire Fire and Rescue
• Barnsley U3A (University of the Third Age)
• Barnsley Dementia Third Sector Alliance
• South Yorkshire ICB Barnsley Place

Personalisation - direct payments

Barnsley currently performs well in the number of service users accessing direct payments to manage their support arrangements compared with our neighbouring authorities.

However a number of direct payment holders are using their funding to purchase traditional models of care such as home care. We'd like to see our service users be more creative with their budgets using community assets as part of their care plans.

An area we'll look to develop in 2024 will be personal assistants. This is a recognised gap currently with a small number of service users waiting for PA’s to be recruited to progress their care plan.

We'll also look to introduce more flexible arrangements for people using direct payments to allow them greater control over their care arrangements and promote the use of community resources, so communities can become more resilient.

Recognised provider list

The council hosts a recognised provider list (RPL) to support those people who self-fund their care or those wishing to arrange their own care through a direct payment. Providers on the RPL are given a quality kite mark which offers some assurance to purchasers that the provider has been through a quality checking process.

Reablement

The reablement offer in Barnsley has largely been based on discharge from hospital and intermediate care. The service aims to enable individuals redevelop daily living skills and reduce the long term need for paid for care.

Planned roll out of the reablement service into the community has progressed, and the service now provides community support to North, Northeast, Penistone, South and the Dearne. The service supports anyone aged over 18 with an assessed need.

Whilst the maximum length of time the service is delivered is six week the average number of days individuals require the service is currently 20.

Moving through 2024 and beyond we aim to further extend the offer to include support to specialist and mental health teams.

Ongoing recruitment will enable the service to reach its maximum capacity, which will enable us to further increase the role of reablement to ensure that all service users are offered a period of reablement prior to long term care.

Financial impact

The service has contributed to the delivery of over £1.035 million in savings. This cost saving relates to all the work undertaken by reablement and front door teams that has reduced purchasing costs within adult social care.

The processes and systems currently in place are planned for review, which are anticipated to further increase the savings achieved in future financial years.

Learning disabilities

Strategically Barnsley is part the South Yorkshire Integrated Care System (ICS) and we also enjoy a good working relationship with our West Yorkshire Transforming Care Partnership (TCP) colleagues.

We have six ambitions for Barnsley people who have a learning disability:

• starting well
• preventing well
• diagnosing well
• supporting well
• living well
• dying well

Supported Activities for people with a learning disability

The offer for day opportunities is known as supported activities and is part of our offer to people with a learning disability. The service provides person-centred, outcome focused support which is tailored to individual needs. The offer can be accessed through a range of community venues or one of the Council’s four buildings which are located across the borough. Approximately 110 individuals are currently accessing the service from one to five days each week.

There's a gap for people with autism accessing the supported activities offer, the service is looking to develop and pilot a new offer during 2024.

Respite for people with a learning disability or autism

Following consultation with families, Commissioners have refreshed the service ask for our Silver Street respite service and are currently in a procurement process for a new service provider.

We are working with our SYICS colleagues to procure a new crisis/safe space service for South Yorkshire aimed at reducing admissions to specialist hospitals for people who have a learning disability and/or autism. We hope this will be open by Spring 2024.

We have identified a gap in services for people who have behaviours that may challenge. We're hoping to work with our South Yorkshire colleagues during 2024 to explore how we can address this gap.

Autistic spectrum conditions

Barnsley is working hard to co-produce our all-age autism strategy, which has the same six themes as the national strategy:

• improving understanding and acceptance of autism within society
• improving autistic children and young people’s access to education, and supporting positive transitions into adulthood
• supporting more autistic people into employment
• tackling health and care inequalities for autistic people
• building the right support in the community and supporting people in inpatient care
• improving support within the criminal and youth justice systems.

This will form the basis of our commissioning intentions for 2024 and onwards.

Adult community support and enablement service (supported living)

In 2017 the local authority moved away from using supported living to define support offered to working age adults in their own home. The current contract for this type of support is described as ACSES (Adult Community and Enablement Service) and separates support from individual tenancy agreements.

A number of supported living schemes continue to operate with small numbers of service users sharing accommodation and support.

The current ACSES contract ends in 2022 and commissioners will be going out to the market to re-tender this contract.

A gap we'll seek to address as part of this procurement is around support to those people with a mental health diagnosis. Barnsley currently has a limited number of providers who support people with issues associated with mental health and this is an area we'll look to grow.

Mental health

Barnsley is currently refreshing its all-age Mental Health Strategy. This strategy will inform future commissioning intentions and these will be published as part of the market position statement.

Specialist residential care

We know that there is a gap in our current contracting arrangements for the provision of specialist residential care and that the current service specification does not reflect the needs of some adults.

This will include, but is not limited to, those people with a learning disability and/or autism whose needs may be complex and/or challenging and people with mental health issues.

During 2024 we will be working with our SYICS colleagues to develop a shared specification that better reflects our aspirations and the qualifications, skills and experience necessary to support people in the best possible way. It is likely to include a process for agreeing a fair fee. We will want to engage with the provider market during 2024 to progress this and opportunities will be flagged on Yortender and Atamis.

Working together across South Yorkshire

The South Yorkshire Integrated Care System (ICS) has recently identified a need for more supported living for people with learning disabilities and autism over the next ten years.

Their market position statement is focused on how we can work together to build the right homes. This approach will give the people we support greater choice to help them access the right home and support at the right time.

Their plans will also give people more choice over where they live and who they live with to make sure they’re supported in housing where they can feel safe and happy.

You can read more about how we will work together to help people with learning disabilities and autism in the South Yorkshire Integrated Care Board’s market position statement.

Housing and accommodation

We know we need more supported living opportunities for people with learning disabilities and/or autism over the next ten years in Barnsley. This is approximately 10 new homes a year - in a managed and phased manner.

We want to work with the right housing providers to build the right homes in the right places and welcome early engagement with providers about potential plans. We are working with our colleagues in planning and housing benefit so that our input is strategic and joined up and helpful to potential providers.

We want people to have more choice over where they live and who they live with to make sure they’re supported in housing where they can feel safe and happy. To support this we are drafting an Accommodation and Housing Plan that we will be engaging providers with during 2024.

The key priorities of the plan are:

• Increase the supply and range of quality supported living within Barnsley to meet the needs identified in the South Yorkshire MPS.
• Reduce the use of inappropriate out of borough placements.
• Better understand the future housing needs of young people coming through transitions.
• Improve the management of the residential care market to deliver more specialist and fit for purpose supply of quality options within Barnsley.
• Increase access to general needs housing for people with learning disabilities and autism.
• Improve the use of data and intelligence on existing placements and costs to inform future commissioning decisions.

The key principals underlying the plan are:

• New housing solutions are delivered in genuine partnership with providers, people with lived experience and South Yorkshire ICB commissioners and social care colleagues.
• Working only with regulatory compliant social housing providers
• Supported living providers will be on the ACSES framework
• Rents are affordable within housing benefit limits and allow the council to reclaim the full subsidy from DWP
• Own front door rather than shared accommodation
• Residential providers will be encouraged to use the Care Cubed tool to determine a fair fee
• The location of existing supported living services and residential care services will be taken into account when developing future options

You can read more about how we will work together to help people with learning disabilities and autism in the South Yorkshire Integrated Care Board’s market position statement.

Working together

We're taking both the Barnsley Learning Disability Delivery Group action plan and the housing plan to a check and challenge event with people who use our services and their families in the spring of 2024.

Through our Provider forum structure we engage, consult, inform and work with our local providers. Please contact us at Adult Joint Commissioning adultjointcommissioning@barnsley.gov.uk if you want to find out more about these forums and meeting details.

Adult Community Support and Enablement Service (Supported Living)

Adult Community Support and Enablement Services (ACSES) reduce the reliance on residential care. The service provides progression-based support to help people to live independently with supported housing options and/or enablement support.

The ACSES framework was originally commissioned in 2017 and over the years the contracted service providers have continued to develop proven specialisms to support the changing needs of people with a learning disability, physical disability, mental health and ASD and achieve the outcomes for people using the service.

A new ACSES framework has been commissioned for five years, which commenced on the 1 March, 2023.

There remain opportunities for providers on the ACSES framework to deliver supported living services in Barnsley, although the number of commissioned support hours is not guaranteed.

It is anticipated that the support required will continue to increase steadily over the term of the contract.

The previous gap in ACSES provision related mainly to supporting people with a mental health diagnosis. The are an additional eight service providers who are contracted to support this service group. Commissioners will work with providers to ensure the right level of service is available to support the varying complexity of needs for people with mental health.

There are also specific service groups where further provision is required especially in relation to people with challenging behaviours and young people in transition to adult supported living.

There are now 17 service providers on the ACSES framework, and it is expected this will be sufficient to support current needs. However, its still early days, and some providers still need to move into Barnsley. Commissioners will continue to support providers and monitor the capacity to support the needs of Barnsley residents.

Mental health

A significant amount of consultation was undertaken as part of the development process of Barnsley’s all-age Mental Health and Wellbeing Strategy 2022 to 2026. This strategy directly contributes to improving mental health and wellbeing across the Borough.

Read the Barnsley Mental Health and Wellbeing Strategy 2022-26.

In relation to the implementation of the strategy, a mental health strategy delivery plan and mental health dashboard has been developed and the Barnsley Mental Health Forum (a service user and carer group) have also developed several quality standards against which progress is being measured.

The all-age mental health and wellbeing strategy is also a key enabler of a 'healthy Barnsley' and will also impact on delivery of the overall Barnsley 2030 vision.

As a strategy it covers a wide range of mental health needs from perinatal, young people, prevention, such as suicide prevention, eating disorders, through to older people with dementia, with the overall aim of helping people to live independent lives.

The mental health social workers specialise in helping people with mental health conditions to live independently in the community with a recovery focus where possible, adopting a strengths-based approach and ensuring each person is engaging in an active life, addressing issues of inclusion and diversity, ensuring equal access and opportunities and getting rid of discrimination and intolerance.

The services commissioned by Barnsley Adult Joint Commissioning enable adults to have greater choice and control over their care, and to live well in their community. In Barnsley there are a small number of specialist residential care homes and supported living units that provide mental health support. The commissioning plans are to increase the number of specific mental health supported living placements by approximately 15 over 2024/25, to include 24-hour support. There are also capacity issues in relation to care and support for specific diagnosed mental health such as eating disorders, dementia and behaviours that challenge. The needs analysis to be completed will identify the level of support required to be commissioned further.

Digital innovation

There are now an increasing range of digital tools to support the way care and support is assessed and delivered that would support better outcomes for people.

Digital innovations can improve the way we use information about how people live their lives, so they can have more meaningful support plans.

We will be engaging with providers to trial new approaches and where possible future commissioning will be based on the following principles:

• Increased support available to back office functions through the automation of tasks.
• Increasing expectations that a digital option is available eg to keep people in their own homes.
• The offer of web based information, advice and self-support.
• Information sharing to support more joined up care and support.
• Monitoring and reporting of health conditions.
• Use of video meetings and consultations.
• Apps to support information sharing and support planning.
• Robotics to support care workers around manual handling.

Figure 11: Graphic showing the relationship between digital, housing, innovation, and aids and adaptations.

Unpaid carers

Whilst it is acknowledged that not all carers will want or require support, it is imperative that we take steps to identify those that do and provide an offer of both early intervention and more intensive support where appropriate to meet their wide range of needs.

Our Barnsley All Age Carers Strategy strategic vision; ‘Carers are identified and recognised and have access to information and practical and emotional support to help them achieve the outcomes which matter most to them’.

The Barnsley All Age Carers Strategy Steering Group will work in partnership to:
ensure processes are transparent, maintain and update the Barnsley Carers and Young Carers Strategy, and review, develop, and contribute to the delivery of the Carers Strategy Delivery Action Plan.

The focus will be on all the priorities of the Barnsley Carers Strategy as detailed below:

• raising awareness to increase the identification of carers
• working with carers
• assessing carers’ needs
• carers’ health and well-being
• carer breaks
• helping carers stay in work
• young carers
• parent carers

Work on the key priorities will help us shape and inform our future carers service offer.

Commissioning intentions: ageing well

In Barnsley we'll support our ageing population by offering person-centred, flexible, integrated care and support in their community or at home.

Through early interventions we'll aim to maximise people’s health, wellbeing and independence and reduce the need for long term support wherever possible.

Residential care

The proportion of 65+ people with needs met by residential care/nursing is high in Barnsley; 787 (22/23 figure) compared to 560.8 nationally and 643.7 regionally per 100,0000 population. This will be a key area to improve. The 23/24 figure for Barnsley has reduced to 707.9.

Barnsley has generally had an oversupply of residential beds within the market, with current occupancy rates averaging at around 83% (as at Jan 24).

In November 2021 the council went out to tender for a new Residential and Nursing care home framework. The new service specification outlines a number of key outcomes expected of providers whilst also outlining the support available from health and social care partners to enable providers to deliver against these.

During 2023 a new quality improvement team has been developed to further enhance the support offer to providers. This is a multi-disciplinary team that includes service manager, clinical quality lead, social worker, and nurse. The aim of the team is to deliver proactive and preventative support and guidance that will Improve customer experience, reduce safeguarding enquiries, support patient flow and develop best practice.

Capacity

Following the COVID-19 pandemic Commissioners have work with Residential and Nursing care home providers to increase occupancy rates, to support the financial viability of the market. The table below shows year on year the combined occupancy and vacancy rates for all Residential and Nursing care homes in the borough.

Vacancies

The table details vacancy rates annually against each of the types of residential care provision.

Dementia care

Barnsley has 32 care homes who are registered with CQC to provide dementia care, however only 24 of these self describe as EMI.

As of Mar 2024 the council had 529 service users in residential care with a recorded status of dementia.

19 placements were out-of-area with the average cost of a placement £993.77 per week. (82% increase in costs from April 21/37% reduction in OOA placements).

During 2023/24 we have seen an increase in requests for one-to-one support for individuals with more complex needs in residential care.

During 2024 Commissioners will be reviewing the needs of individuals with more challenging and complex behaviours and how these are met within residential care settings. Following this an assessment of current local provision will be undertaken to identify future commissioning intentions.

Our vision will be to commission dementia care that can support residents throughout their diagnosis including any deterioration and increase in needs and to ensure that they continue to enjoy a good quality of life in an environment that allows them to maximise their independence.

Intermediate care (IMC)

A review of the Barnsley Intermediate Care Service (IMC) has highlighted several opportunities for service development focussing on improving service user outcomes, quality of care and sustainability.

One element of service development was to review the current estate where the Acorn unit was located. The Acorn unit is the IMC bed-based provision used for service users with the greatest need on the IMC pathway located in the Highstone Mews Care Home. The current estate was deemed no longer fit for purpose for what service users of the Acorn unit required and therefore work was undertaken to identify a suitable alternative location.

Service users of the Acorn unit, with the help of Healthwatch Barnsley, were engaged to understand the requirements from a future site. Following a review of all health and social care sites in Barnsley, it was evident that Ward 12 at Barnsley Hospital was the only available site that met the needs of service users when considering the service requirements and service user feedback.

Although the Barnsley Hospital site is the current best available option, best practice has identified that IMC facilities are most effective when housed outside of the hospital site. The move to the Hospital site will therefore be a temporary move until a long-term location for the Acorn unit is available.

The demand for IMC services has increased and currently the service provides up to 50 beds across a mixed economy and 170 services users at home who would otherwise be in a care home setting.

Service users, IMC workforce and the wider community will be further engaged and invited to help shape the future estate of the IMC service.

Day care

Barnsley currently commissions a buildings-based dementia wellbeing day service for those people with a dementia diagnosis.

Service users with other needs can access other health and wellbeing services, including building-based centres, delivered by providers in the community.

The overall aim of the health and wellbeing centres (day services) is to promote healthy lifestyles, reduce isolation, stimulate interest and regain skills to promote and increase independence. It provides respite and a break for both the carer and the cared for person.

A review of day services has identified a range of issues including demand for the service and transport arrangements.

Commissioners will continue to review the health and wellbeing model for older people throughout 2024. The current view is that day services should form part of a community model so that people can be supported in an area that is familiar to them and with access to community assets. It is currently proposed to develop a framework of services from which people with assessed care needs can choose their care and support. It is envisaged that procurement will be undertaken for this framework during the summer of 2024.

Home care

Demand for home care is rising steadily increasing from 899 packages of care in April 2023 to 1076 in Mar 2024.

The number of hours of care being delivered has increased by 26% in that period from 12820 hours per week in April 2023 to 16120.50 in Mar 2024.

Under previous contractual arrangements 48% of homecare packages were being awarded on a spot contract basis, which presented significant challenges and risks to the council.

The council tendered for a new open framework for home care (Support To Live Aat Home – STLAH) in August 2022, with a view to increasing the number of providers working with the council under formal contract arrangements, enabling greater oversight of care delivery and opportunities to develop the market.

Since the framework commenced, we've successfully increased the contracted provision, as detailed in the table below:

2022

2023

This has led to a highly competitive homecare market and has placed significant pressures on some providers to remain financially viable.

To address this, and to stabilise the market, the council went back out to tender in September 2023 for a flexible framework of up to 40 providers that could demonstrate quality in the care and support they deliver. The new framework is operational from the 1 February 2024 and is anticipated to meet existing demand; however can be re-opened where there is a need.

The long-term plan for home care in Barnsley is to become part of a wider community offer. There will be a move away from purchasing based on time and task, with care packages being outcome focussed and providers given more autonomy to determine how those outcomes will be delivered through multi-disciplinary approaches and in agreement with service users and their families.

Extra care

Barnsley currently hosts four schemes designed to offer extra care. In April 2021 a single provider was commissioned to deliver on-site 24 hour care and support to residents in two of the schemes. The 2 remaining schemes currently operate a sheltered housing model.

The commissioned service supported 12 residents during 2022, delivering 218 hours of care and support per week. During 2023 19 residents were supported (58% increase on 2022), delivering a combined total of 234 hours of care and support per week (7% increase on 2022).

The new service model brings together care and support with a focus on early intervention and prevention, community involvement and with a view to ensuring that extra care residents can remain in their home until the end of their life without the need for residential care.

During 2024 we'll review the overall impact and outcomes achieved in these schemes to identify the value and opportunities of rolling this out further.

Procurement opportunities

Early intervention

Transitions (learning disability/mental health)

Older people

Other

Brokerage

As a result of feedback from care providers, we've now developed a brokerage team as part of our commissioning approach. The brokerage team are responsible for brokering care packages across a number of service areas including home care, supported living and day care. Brokers do not source residential care but do work closely with our social work teams to provide information relating to location, occupancy and quality to help people make informed choices.

The brokerage function means that providers receive a more co-ordinated approach to the sourcing of packages and reduces the number of people providers are dealing with on a daily basis.

Packages are awarded based on choice, quality and price and feedback from the team is used to inform our commissioning plans and help shape the market.

Quality assurance

We strongly believe that clear quality standards are fundamental to the delivery of safe and reliable services that will help people to achieve their desired outcome.

Our quality standards will be clearly defined in service specifications and all of our contracted providers will be subject to planned an unplanned audits against contract compliance.

Through our established partnerships we'll work alongside providers to address quality issues offering support, advice, guidance and training.

And we will use data and intelligence on both regulated and non-regulated services across the borough to support our market shaping.

Care home quality team

In partnership with Barnsley ICB we have recently developed a care home quality team. The team will work with our care home to deliver improvements and ensure that Barnsley care homes are offering the best quality care to their residents.

Social value and carbon footprint

In line with the council's 2030 vision we want to work with providers who can help us to deliver our ambitions around social value and reducing our carbon footprint.

Our contracts will include a requirement for providers to evidence how their services support the principles of social value and deliver the council's ambition to ensure people live in sustainable communities with reduced carbon emissions.

What businesses and organisations can do

• Champion healthy workplaces and active travel.
• Bring the zero-carbon ambition to life by using sustainable sources to run their services.
• Run services efficiently and responsibly to benefit the environment and community.
• Support volunteering opportunities and community group initiatives.

Read our Social Value Policy.

How to engage with us/co-production

We recognise that we cannot meet the challenges faced by the local authority and our health partners without a continued close working relationship with all of our stakeholders including providers, service users and carers.

In order to develop creative, innovative services which will help deliver our vision, commissioners will continue to use a range of methods to support the on-going development of commissioning intentions and the co-production of services with stakeholders.

Our offer to support providers can be described as follows:

• Workforce planning and development.
• Implementing a refreshed quality framework for contracted care homes and home care providers.
• Continued use of the recognised provider arrangements.
• Regular provider forums that cover prevention and wellbeing services through to specialist learning disability provision are available to local providers regardless of contract status. Alongside information sharing around gaps and tender opportunities, the forums will provide the opportunity for developing best practice within the provision of care and support.
• Continued promotion of individual budgets and direct payments.
• Involving providers in meaningful operational and commercial discussions as part of project work, service shaping and pre procurement.
• Progression of key commissioning plans.

The recommendations below are for all parts the market and they aim to help organisations to understand what they can do to make sure that their services align with the council’s priorities for care and support in the future:

• Ensure your organisation and services provided are accurately listed on local information directories and the recognised provider list (RPL).
• Use tools to gather feedback from people who use your services and develop your organisation and service provision.
• Support us in developing and shaping the market locally, such as regularly attending provider forums.
• Access training and proactively use the council’s contracts and quality teams to help improve your service quality.
• Engage with the work on integrating health and social care services, so the system works for you and your service users.
• Focus on maximising independence, supporting people to help themselves as much as possible.
• Think about how your services could support the increase in the number of service users who take up direct payments for their care and support.

Working with people and communities

In Barnsley we want everyone to have the best possible chance of enjoying life in good physical and mental health. Our Adult Social Care services play a vital role in making sure local people experience high-quality care and support when they need it.

The Care Quality Commission (CQC) strategy makes a commitment to deliver regulation driven by people’s needs and experiences of care. Their single assessment framework supports this commitment.

Using new ‘quality statements’ called ‘we statements’ CQC will focus on specific topic areas. The ‘we statements’ are written from a provider's perspective and provide information on what CQC expect of them. They draw on previous work developed by Think Local Act Personal (TLAP), National Voices and the Coalition for Collaborative Care on Making it Real.

CQC will make judgements using evidence which will include people’s experience.
The ‘we statements’ show what is needed to deliver high-quality, person-centred care. They directly relate to the regulations, and are used in the assessment framework to:

• Sets out clearly what people should expect a good service to look like.
• Places people’s experiences of care at the heart of CQC judgements.
• Makes sure that gathering and responding to feedback is central to CQC expectations of providers and systems.

Our framework for working with people and communities will provide adult social care staff with the principals, tools and resources for working with our Barnsley people and communities. This will allow people’s experience of care to be captured and placed at the heart of what we do in Barnsley Place, health and adult social care.

Meet the commissioners

Joint commissioning structure

• Richard Lynch - Service Director - Commissioning
  • Sharon Graham - Head of Service
    • Ruth Newton-Scott - Senior Commissioning Manager - Older People
    • Alison Rumbol - Senior Commissioning Manager - Learning Disabilities
    • Clare Burton - Senior Commissioning Manager - Mental Health
      • Val Cole - Commissioning Manager
    • Adrian Hobson - Senior Contracts and Compliance Manager
      • Diane Swift-Baldock - Contracts and Compliance Manager
        • Joanne Harper - Contracts Projects and Quality Officer
        • Dawn Mullins - Contracts Projects and Quality Officer
        • Anne Flear - Contracts Projects and Quality Officer
        • Gayle Bennett - Contracts Projects and Quality Officer
        • Debbie Whitehead – Contracts Projects and Quality Officer
    • Emma White - Principal Public Health Officer
      • Alec Tinker - Senior Public Health Officer
      • Catherine Fraser-Ryan – Engagement and well-being lead
        • Zoe Boyes – Public Health Officer
        • Lauren Dalton – Public Health Officer

Care Home Quality Team

• Debbie Anglesea – Service Manager
• Liz Locke – Clinical Quality Lead
  • Jayne Emms – Social work practitioner
  • Ann Midgeley – Nurse
• Jayne Hemmingham – Programme Manager – well-being

Useful links

• Barnsley 2030
• Barnsley Council
• Barnsley Council Contract Register
• Live Well Barnsley
• Joint Strategic Needs Assessment
• NHS South Yorkshire Integrated Care Board
• Recognised provider list (RPL)
• YORtender

Plans/strategies

• Barnsley Council Medium Financial Strategy
• Carers' Strategy
• Council Plan 2021-24
• Health and Wellbeing Strategy 2016-2020
• Mental Health Strategy
• Public Health Strategy 2018-2021
• Transforming Care Partnership Plan
• Market Sustainability Plan