We are committed to developing, stimulating and supporting a vibrant and diverse care market which can provide safe, effective, sustainable, high quality and value for money care and support to the people of North Yorkshire.

Our market position statement supports this by: 

  • providing an overview of our current care market and demographic profile
  • describing our strategic priorities and vision for transformation
  • providing a link between locality profiles and plans and our commissioning intentions
  • describing our approach to and facilitating engagement with providers and stakeholders to build and shape provision in North Yorkshire.

The market position statement builds on the statement published in 2018.  It includes key information for current and future providers to assist them with service development that both meets the needs of and demand from people in need of care and support in North Yorkshire now and in the future, and ensures alignment with our strategic priorities and vision. The market position statement should act as a starting point for discussions between us and those who provide or wish to provide care services.

The market position statement encompasses our position, intentions and vision in relation to care for anyone with an eligible social care need as assessed by the Care Act. It includes care for older people, adults with physical disabilities, mental health needs or learning disabilities across five key service areas

We intend for the market position statement to remain a live document, regularly updated to reflect engagement and co-production with providers and people who use services. This will enable us to continually:

  • design strategies that meet local needs
  • engage and co-produce with providers and local communities
  • focus on outcomes and wellbeing
  • understand the market
  • facilitate the sustainability and development of the market
  • integrate our approach with local partners
  • secure supply in the market and assuring its quality through contracting
  • ensure choice

We highly value our strong and well-established working relationships with the people we support, care market colleagues, voluntary and community sector and health and mental health services and remain committed to working in partnership to develop and take forward our vision for transformation of the health and care system. We also work closely with the Independent Care Group who represent North Yorkshire providers.

Foreword

The Adult Social Care market has faced unprecedented challenges over the last two years, the Covid-19 pandemic has put immense pressure on all parts of the care sector both nationally and locally. This has also be a very difficult time for the people and communities we support.

Across North Yorkshire, we have been very fortunate to be able to draw on and further strengthen the well-established working relationships with the people we support, care market colleagues, voluntary and community sector and health and mental health services which remains committed to take forward our vision for transformation of the health and care system.  

This relationship has been praised in view of the response to the pandemic by the Local Government Association Outbreak Management Peer Challenge team, which took place in September 2021. 

“A proactive relationship-based approach is evidence in our proactive engagement with care homes, care settings and care users. The positive impact of this is evident in the strength of the relationships forged during the pandemic with these partners.”

As we consider our priorities for the next three years, we still believe in our existing vision of people living longer, healthier, independent lives. This vision is now one of the five ambitions for 2025 set out in the North Yorkshire County Council Plan 2021-25. However, we also know that this is not happening at the same pace for everyone. It is important that we make this vision a reality for the people we support. 

We can see examples of inequalities, with different groups and communities experiencing more disadvantage and fewer opportunities than others. We know that some people are waiting too long for services. They want us to listen to their experiences and learn from them to make processes simpler, and more joined up with other services they might use or need.

We also know that Covid-19 has changed some things forever, including the way we think about our homes and our communities. We have learned new things about what is important to us, about where we live, and what we need to live the life we want. Likewise, our communities are living with Covid-19 and it is vital that we adapt to new circumstances.

The challenges across social care are set to continue as we start to receive information about the upcoming social care reform, however we must work proactively together to do all we can to ensure we continue to deliver safe, high quality services to the people of North Yorkshire. 

Our workforce is our biggest asset, we would like to thank frontline teams who, despite facing a challenging period in dealing with the pandemic, have continued to deliver care and support to our local communities. It is essential that we work collectively to continue to grow the care sector with a skilled, passionate and knowledgeable workforce. 

Richard Webb
Corporate Director,
Health and Adult Services North Yorkshire County Council

Our vision

The Council Plan 2021–2025 clearly sets out the ambitions in North Yorkshire that every adult has a longer, healthier happier life with outcomes that ensure:-

  • People have control and choice in relation to their health, independence and social care support
  • People are safe, with individuals, organisations and communities all playing a part in preventing, identifying and reporting neglect or abuse
  • People can access good public health services and social care across our different communities

In order to achieve these outcomes, priorities include:

  • Using a strength-based approach – embedding the approach to work with people to help them draw on their strengths and assets, including what others around them, in their relationships and their communities, are, or could be doing to support them.
  • Integration – working with the National Health Service to develop integrated models of commissioning and service delivery in each area of North Yorkshire. Ensuring people have cost efficient, effective and joined up health and social care provision.
  • Working with a range of organisations from the health, independent and voluntary sectors to develop a sustainable, diverse and innovative care market that meets the varied needs of the people of North Yorkshire and ensures quality and dignity for all.

Our Health and Adult Services Plan 22-25 Longer, healthier, independent lives sets out three priorities:

  1. Opportunities for everyone, everywhere
  2. My time and experiences are valued
  3. My home, my community, my choice

These priorities will form the basis for our plan for the next three years - a chance to build on what we have already achieved and to learn from our shared experiences.

The 2021 Annual Report of the Director of Public Health provides an assessment of the general health of the county. Overall, health in North Yorkshire is good, with most indicators above the England average. 

However, there is substantial inequality in life expectancy in North Yorkshire. Women and men live 4.8 and 6.9 years longer respectively in the least deprived areas compared with those in the most deprived areas.

The annual report has also set priorities for the year ahead to:

  • Continue to reduce health inequalities
  • Continue with measures to protect the health of the whole population
  • Improve mental health and wellbeing across the whole population
  • Ensure babies, children and young people get the best start in life
  • Continue to work with National Health Service partners to maximise joint effectiveness and impact on health outcomes
  • Ensure the working age population have opportunities to live well
  • Ensure the older age population can age well
  • Develop a centre for public health excellence to promote research, training and behavioural science

Our vision and plans for transformation are set out in the North Yorkshire Commissioning and Service Development Plan 2021-25 in the context of the national, regional and local landscape. 

In developing our vision we have considered what outstanding adult social care and public health services might look like which is underpinned by both policy and the experience of the people who work for us, with us and those we provide and commission our services on behalf.  We have strived to ensure:

  • A focus on the person and their outcomes
  • The person remaining as independent as possible and living in their own home for as long as possible
  • Focus on prevention and alternative provision for complex needs and switching away from residential homes and nursing beds
  • Frontline colleagues excelling at strengths-based practice, being empowered to be creative
  • Organisation interfaces working seamlessly together and not being visible to people we support

The Adult Social Care transformation plan will be co-produced with providers and people who use services, and will focus around five headline areas, namely:

  • Home-based support
  • Community-based support
  • Residential and nursing care
  • Supported living
  • Complex care

The vision of these transformation plans are underpinned by our ambitions around prevention, increased technology and digital solutions, improved and greater access to supported housing, support for unpaid carers and to build further our relationship with local communities to create a platform for working together to make real change. 

We are keen to work with experts by experience, care providers and local communities in the ongoing development of services to ensure progressive person centred community based models of support which supports and encourages social enterprise and social capital.

An accessible and thriving care market is crucial to ensure the delivery of the vision we have set out, we are keen to try new commissioning arrangements and encourage alliances between care providers, the voluntary and community sector and local communities to create capacity, drive sustainability and be in the best position to develop services at a local level to meet the diverse demands of communities across North Yorkshire. 

Our care market needs to be ready for the ongoing and projected increase in demand for adult social care services, working with a vibrant and skilled workforce to ensure people living in North Yorkshire can live longer, healthier, independent lives.

To become more sustainable, the workforce across the care sector needs to feel supported and have permission to focus on the outcomes people need, make the right decisions with compassion and spend public money wisely.

Many people in our workforce are North Yorkshire residents, with families and loved ones. A large number also have caring responsibilities, and over half already work shift patterns. We expect care providers to share our aim to support our collective workforce by:

  • Offering flexible and better working options with more family friendly shift patterns
  • Continuing to develop the skills and confidence of the workforce
  • promoting careers in health and social care and encourage more people to choose to work in the sector
  • Increasing the number of colleagues feeling supported to carry out their role with a good work-life balance.
  • Retaining and building our workforce and reduce turnover across the sector

North Yorkshire is a large rural authority and the unique opportunities and challenges this brings to service delivery and to people’s ability to access universal services are well understood, as is people's ability to develop and maintain social networks, particularly for those from  minority group.

Transformation of services and the continuous development and shaping of the local care market will be key to providing high quality services within our communities in the future, including developing new and innovative solutions with and for people across the county. 

As part of the Health and Adult Services Directorate, the Service Development Team are responsible for commissioning and developing a range of services across the county, specifically focussed within the geographical districts of Harrogate, Craven, Scarborough District (including Whitby,) Ryedale, Hambleton, Richmondshire and Selby.  This allows us to ensure services are delivered in an efficient and effective manner while at the same time giving us the ability to focus on the individual needs of each local area.

North Yorkshire is the largest geographical county in England covering 8,608 km2 (including City of York and Teesside), stretching from Scarborough on the North Sea coast to Bentham in the west and from the edge of Teesside to south of the M62. Large parts of the county sit within two beautiful National Parks and among Areas of Outstanding Natural Beauty.

A map showing North Yorkshire County Council and District Local Authorities. Contact us for this information in a different format.

The overall population of the county is 604,900. Due to the size of the county, the population is diverse and dispersed across a variety of urban, rural and super rural areas. The largest settlements are Harrogate (with around 75,070 residents) and Scarborough (with around 52,100 residents). Ninety eight percent of the county is either sparsely (13 per cent) or super-sparsely (85 per cent) populated with just over a third of the population living in these areas. 

Demand for adult social care services across North Yorkshire continues to increase and over the next 20 years the population in England is expected to grow by almost ten per cent with the number of people aged 75 and over expected to grow by almost 60 per cent - an additional 2.7million people.

Currently, in North Yorkshire, people aged 65 and over year olds year olds make up 24.7 per cent of the North Yorkshire population, and this is expected to increase to 32.2 per cent by 2035.

North Yorkshire has an older population than the country as a whole. Craven and Scarborough have the highest population of over 65 year olds at 27.3 and 27.5 per cent respectively. Richmondshire has the lowest percentage of over 65 year olds at 21.4 per cent, however Richmondshire is expected to see the greatest increase in the 65 and over age group (9.9 per cent) while the increase across North Yorkshire and York is expected to be around 6.7 per cent. 

By 2039, four districts will have Old Age Dependency Ratios (ratio of aged 65 and over to working age population) among the highest ten per cent of local authorities in England. Craven will have the 15th highest ratio out of 326 local authorities.

North Yorkshire is a net importer of older working age and recently retired adults. Around 1,200 additional people aged 55-69 per year move in from other parts of the UK, increasing the potential demand for care in later life.

  Craven Hambleton Harrogate Richmondshire Ryedale Scarborough Selby North Yorkshire England
Percentage of the population aged 65 and over in 2019 27.3 26.5 23.6 21.4 27.0 27.5 20.4 24.7 18.4
Percentage of the population aged 65 and over in 2035 35.0 34.8 31.8 31.3 33.3 35.0 25.6 32.2 23.0
Percentage increase 7.7 8.3 8.2 9.9 6.3 7.5 5.1 7.5 4.6

The number of family (or unpaid) carers recorded in the North Yorkshire in the 2021 Census was 4780 which equates to 1.3 per cent of the population, compared to a national average of 1.7 per cent. 

In 2021/22, we received 69.6 per 100,000 of population referrals from carers. In addition, in 2021/22, our commissioned Carers’ Information and Advice Services, delivered in each locality of the county, received 2440 new referrals, with an average of 1,053 carers supported per month throughout the period. 

For further population data, you can visit the Data North Yorkshire website where you will find the latest Joint Strategic Needs Assessments for each of the localities in North Yorkshire. You can also access the Census 2021 data for North Yorkshire.

North Yorkshire is a large rural authority where the challenges to adult social care service delivery and access to services alongside the ability to develop and maintain social networks are well understood.

There are, however, also opportunities and strengths in communities to support the development of innovative solutions to support people’s care and support needs.

Transformation of services and the continuous development and shaping of the local care market will be key to providing high quality services within our communities in the future, including developing new and innovative solutions with and for people across the county.

We offer a wide range of local social care services, either by directly providing services, offering information, advice and guidance about local services so people can arrange care and support themselves or through commissioned services with the care market; independent sector and voluntary, community and social enterprise providers. We provide care and support to people with an eligible need under the Care Act, including older people, people with learning disabilities, mental health conditions, physical disabilities, sensory impairment, those with substance misuse problems and other vulnerable groups. We also offer care and support to people’s carers.

We have continued to encourage people to think about their own health and wellbeing and have supported community groups around the county to promote community resilience through our Stronger Communities programme and Living Well Service.

We currently commission the majority of adult social care services via approved provider lists. Currently there are three approved provider lists as follows:

  • Domiciliary Care and Other Regulated Services
  • Residential and Nursing Care
  • Non-Regulated Services

These approved provider lists have been in place since 2015 and will come to an end on 31 October 2022. There are no permitted extensions to these contracts. We also recognised that there was a need to review the contractual terms and service outcomes of our adult social care services in North Yorkshire to both respond to care market pressures and challenges, as well as improve outcomes for people living in North Yorkshire.

Over the last 12 months, we have undertaken a programme of engagement to inform the development of the new approved provider lists for Adult Social Care in North Yorkshire. This has resulted in the development of new contractual terms, a new standards and outcomes framework and four new service specifications as follows:

  • Home Based Support
  • Residential and Nursing Care
  • Supporting Living
  • Community Based Support

The new approved provider lists will run until 31 October 2027. We recognise that the care market and the care sector as a whole shall see significant change over the lifetime of the current approved provider list due to the impact of workforce pressures, the introduction of new technology, social care reform announcements from central government and the increased expectations of people receiving care.

Within the bounds of the approved provider list, the delivery of service will need to be flexible over time and we will work with care providers to move service delivery towards more personalised and integrated care models. This may include existing models, but also emerging methods of care planning, delivery and payment linked to individual or community scale outcomes.

For commissioning and administrative purposes, health and adult services is divided into geographical areas of Harrogate, Craven, Scarborough, Whitby, Ryedale, Hambleton, Richmondshire and Selby. 

From 1 July 2022, Integrated Care Boards became responsible for the local commissioning of health services. Integrated Care Boards are a new type of organisation, governed by partners and focused on collaboration as a means of driving improved outcomes for local people, created from the new Health and Care Act 2022. 

Integrated Care Boards will have a broad scope and pick up the functions of clinical commissioning groups. They will lead on some functions that previously sat in National Health Service England, Health Education England and elsewhere. Integrated care systems are about giving people the support they need, joined up across local councils, the National Health Service, and other partners including care providers, the voluntary, community, social enterprise sector and charities. It involves partnerships of organisations coming together to plan and deliver seamless health and care services to improve the lives of people in their area.

We continue to build on previous work with Clinical Commissioning Groups, and work with Humber and North Yorkshire Integrated Care Board and West Yorkshire Integrated Care Board to develop more integrated working arrangements between health and adult services and the National Health Service in order to prevent and reduce unnecessary hospital and long term residential care admissions and improve hospital discharge in line with the home first approach.

More information about our local Integrated Care Boards and health commissioning arrangement cans be found on the Humber and North Yorkshire Health and Care Partnership website and the West Yorkshire Health and Care Partnership website.

The health and wellbeing of North Yorkshire

  • A male living in Scarborough district has a life dependency of 78 years, which is four years less than a male living in Hambleton district
  • Males and females in Scarborough district have the lowest life expectancy at birth
  • 69 per cent of adults living in Scarborough are classified as overweight or obese, which is higher than the England average
  • Suicide rates in Scarborough are significantly higher than the England average at 16 people per 100,000
  • Scarborough district has the highest rate of physical disability. The 2035 prediction is that the greatest need will be in Harrogate followed by Scarborough districts.
  • All districts in North Yorkshire are similar to the England average when it comes to smoking rates, with the exception of Hambleton which is lower (8.4 per cent) and Harrogate is higher at 14.4 per cent
  • All districts of North Yorkshire have population densities far lower than the England average
  • 23.1 per cent of the population of North Yorkshire are aged 65 or over. This is expected to increase to 29.8 per cent by 2035
  • By 2035 the greatest number of people aged 65 and over with dementia are expected to be in Harrogate and Scarborough. Current diagnosis rates fall below the national average across much of North Yorkshire, suggesting there may be unmet demand
  • Craven district has the highest percentage of residential care homes which are 'good' or 'outstanding' while Richmondshire has the lowest number of providers. Richmondshire and Ryedale districts have the highest proportion of 'good' or 'outstanding' nursing homes
  • Selby, Harrogate, Scarborough and Ryedale districts are above 90 per cent occupancy despite the Covid pandemic. Nursing occupancy rates are at 98 per cent, demonstrating that demand may outstrip supply
  • 28.6 per cent of deaths occurred in care homes. The highest proportion was in Harrogate (34.4 per cent), while Hambleton district had the lowest proportion (24.1 per cent). The proportion of deaths at home was highest in Hambleton (34.7 per cent) and the lowest was in Harrogate district (23.7 per cent)
  • Harrogate and Scarborough districts are the highest populated in the county. It is estimated that they will have the highest levels of personal care by 2035 for those aged 18 to 64
  • Average length of stay in a care home in North Yorkshire is 2.3 years with Richmondshire having the lowest length of stay at 1.9 years
  • Selby district has the highest number of unsourced home care packages

The care market in North Yorkshire is large in size which is relative to the geographical nature of the county, however, the demand for social care is on an increasing trajectory. 

We report quarterly to the North Yorkshire Strategic Market Development Board on the care market position across the county. This is so the board can uphold its role in overseeing our Care Act duties in relation to market shaping, and maintain oversight of North Yorkshire’s care market. 

Quarterly reports focus on demand, capacity, quality, cost and sustainability. The following is a summary position of the North Yorkshire care market over the last two years, including more detailed information broken down by service area.

For the period 1 April 2020 to 31 March 2021, we provided services to 14,112 people. Between 1 April 2021 and 31 March 2022, we provided services to 14,650 people, which was an increase of 3.8 per cent from the previous year. A total of 10,480 of these people were aged over 65 years. Referrals per 100,000 of population increased from 260.25 in 2020/21 to 295.25 in 2021/22. 

At the end of the last financial year, 31 March 2022, we were providing adult social care services to 7,171 people. Of those people, 4,516 (63 per cent) were aged over 65 years. A total of 1,538 (21 per cent) people had learning disability as their primary support reason. Some 65 people (0.9 per cent) supported between 18 to 64 had sensory support listed as their primary support reason. 

Within the 18-64 age group, there are 1,295 (49 per cent) people who have a learning disability. A total of 449 people (17 per cent) have mental health support listed as their primary support reason. 

The following table shows the number of people receiving services by service type:

  2020/21 On 31/03/21 2021/22 Percentage change On 31/03/22 Percentage change
Residential services 3,228 (25 per cent) 1,654 (25 per cent) 3,326 (25 per cent)

plus 3 per cent

1,732 (26 per cent) plus 5 per cent
 
Nursing care services 1,583 (12 per cent) 739 (11 per cent) 1,523 (11 per cent)

minus 4 per cent

700 (11 per cent) minus 5 per cent
Domiciliary care services including supported living 5,624 (43 per cent) 2,464 (38 per cent) 5,504 (41 per cent) minus 2 per cent 2,421 (37 per cent) minus 2 per cent
Non-regulated services 1,239 (9 per cent) 946 (15 per cent) 1,401 (10 per cent) plus 13 per cent 1,048 (eight per cent) plus 11 per cent
Direct payments 1,481 (11 per cent) 706 (11 per cent) 1,594 (12 per cent) plus 8 per cent 681 (five per cent) minus 3 per cent
Total 13,155 6509 13,348 plus 1.5 per cent 6,582 plus 1.1 per cent

Hospital Discharge demand has increased by 128 per cent and we are working with system partners to develop new discharge pathways and ensure the care market is able to respond to the increase in demand in a timely way. Home First pathways still make up the majority of Hospital Discharge activity which is in line with our vision. 

In 2020/21, pathways 0//1 made up 60 per cent of activity, and in 2021/22 this increased to 64 per cent. Reablement outcomes have also changed over the last two years, with those people requiring no further support following reablement support increasing from 71.98 per cent in 2020/21 to 75.23 per cent in 2021/22.

For locality based information on population, population health, local care market position, geographical barriers to service, unmet demand and projected demand please visit our adult social care district profiles.

As demand has continued to increase, in particular for Home First pathways, capacity for home based support services across North Yorkshire has become increasingly challenging, further exacerbated by the workforce and recruitment challenges faced across social care.  

North Yorkshire has some deeply rural and sparse parts of is population and rural areas are particularly difficult to commission domiciliary care due to the distances required to travel and shortage of workforce. 

Across the county at the end of June 2022, there were 60 unsourced packages of care making up 654 hours of care. This is much less than the winter months where 103 packages of care were unsourced.  This situation puts significant pressure on other parts of the care market and provides less opportunity to meet people’s outcomes. Our reablement service has picked up a large proportion of unsourced care taking the service away from their objectives.  Similarly short term residential care placements and an increased reliance upon unpaid carers has been necessary to ensure a person’s needs can continue to be met. 

Care home occupancy has also increased over the last two years. In 2020/21 the annual average occupancy was 90.77 per cent. This has increased to 94.83 per cent for 2021/22. According to the NHS Capacity Tracker, as at 28 June 2022 there were the following beds available in North Yorkshire:

Vacancy type Maximum capacity Number of admittable vacancies     Percentage of admittable vacancies
General residential 2,296 408 17.77 per cent
Dementia residential 1,292 240 18.58 per cent
General nursing 967 160 16.55 per cent
Dementia nursing 712 93 13.06 per cent
Learning disability residential 326 29 8.90 per cent
Mental health residential 155 28 18.06 per cent
Transitional 42 23 54.76 per cent
Mental health nursing 52 19 36.54 per cent

Admittable vacancies within the North Yorkshire area are in line with those available at this time last year, however showed a significant drop of up to 16.7 per cent during winter months. 

The above availability within care homes, however, does not always reflect the local position in terms of identifying a suitable placement for a person, particularly where people have more complex needs. There are particular challenges around provision of specialist dementia care, and care for working age adults with complex needs. 

Overall the quality of care is good in North Yorkshire across all social care services, both those delivered in-house and those delivered by independent sector and or Voluntary, Community and Social Enterprise providers. 

We are proud of the quality of care across the services in the county, and has invested in the Quality Improvement Team to provide practical support to providers and registered managers delivering care in our county. 

75.86 per cent of care homes have a Care Quality Commission rating of good or outstanding and Care Quality Commission ratings vary across the county, with Richmondshire having 85.71 per cent of care homes with a rating of good or outstanding, while Harrogate has 71.01 per cent.

The following table shows the Care Quality Commission ratings of care homes across North Yorkshire by Care Quality Commission registration (as at 6 July 2022):

Overall Care Quality Commission rating Residential homes Nursing or dual registered homes
Outstanding 5.31 per cent 3.33 per cent
Good 92.04 per cent 66.67 per cent
Inadequate 0.88 per cent 0.00 per cent
Not rated 1.77 per cent 6.67 per cent
Requires improvement 0.00 per cent 23.33 per cent

There are currently 12 residential and nursing homes across North Yorkshire with a current phased or full suspension. Staff recruitment, documentation and recording are common issues raised. 

80.65 per cent of domiciliary care agencies have a Care Quality Commission rating of good or outstanding. Care Quality Commission ratings vary widely. Craven has 100 per cent of domiciliary care agencies with a rating of good or outstanding, Harrogate has the lowest proportion at 73.17 per cent. 

The following table shows the Care Quality Commission ratings of domiciliary care providers across North Yorkshire by Care Quality Commission registration (as at 6 July 2022):

Overall Care Quality Commission rating Domiciliary care Extra care housing
Outstanding 5.71 per cent 0.00 per cent
Good 83.57 per cent 85.71 per cent
Inadequate 0.71 per cent 0.00 per cent
Not rated 10 per cent 14.29 per cent
Requires improvement 0.00 per cent 0.00 per cent

An Actual Cost of Care exercise for 65 plus residential and nursing care has been completed and agreed with the Independent Care Group.  Work towards the Actual Cost of Care commenced on 4 April 2022 and will take three years to implement fully.  The 2022/2023 rates for Actual Cost of Care are:

Care setting type 2022/2023 rate Direct care hours - Care assistants Direct care hours – nursing
Residential  £742 24 None
Residential/ dementia £784 27 None
Nursing £819 25 10
Nursing/ Dementia £826 29 8

The 18 plus domiciliary care rates paid in the last financial year are detailed below. Fee rates are the main rationale for providers seeking financial support via the Council Sustainability Policy. 

  Personal care (generic) Personal care (enhanced)
Urban £21.41 £22.84
Rural £22.67 £23.84
Super rural £25.30 £25.43

We are currently completing a Fair Cost of Care exercise for homecare. The results are awaited, and will be shared with the care market once available. It is anticipated that once complete this will be implemented and operate in the same way as the Actual Cost of Care for Residential and Nursing Care, however this cannot be guaranteed at this stage. 

Workforce pressures are significant across social care provision. In care homes, there is a particularly heavy reliance upon agency staff to maintain safe services. The shortage of registered nurses has seen 212 nursing care beds lost with homes de-registering in the last two years due to lack of registered nursing personnel. A number of homes are reporting a future intention to de-register.  

Workforce and retention issues are leading to vacancies in care homes which cannot be staffed. Six care homes closed during 2021/22. 

Home care providers across North Yorkshire are seeing significant challenges with staffing. Retention has dropped for some providers by ten to 15 per cent and recruitment is more costly and less successful with lack of applicants applying and candidates not always turning up to interviews. Staff shortages are resulting in a reliance upon agency staff, which is also struggling to meet the demand.

Providers are reporting that many staff are choosing to leave the sector, due to no longer having a desire to work in social care, many are reporting the impact of the pandemic on a feeling of burn out and others are leaving due to higher pay in other sectors. This has been a significant factor in the 300 plus packages of care handed back to the local authority in the last 12 months. 

We have in place a Provider Sustainability Policy and Procedure which aims to:

  • Ensure that sustainability funding is properly awarded, managed and controlled
  • Be clear and transparent to providers when applying for funding
  • Promote sustainability in the providers we support in the care market
  • Be person centred, reflecting the variety of services offered to the person and improving choice and greater control over their own care.
  • Be sustainable for Health and Adult Services in the long term in terms of supporting services in line with our strategic framework

Since its launch in September 2021, we have received 28 applications for support through this process. The policy is currently being reviewed to ensure it meets the needs of both providers and ourselves, and providers views will be sought as part of this review. 

Residential and Nursing Care

We currently commission 148 Care Homes (including 13 North Yorkshire County Council in house services) which provide support for people over 65 years old, with 5,774 beds (2,764 Residential, 432 nursing, and 2,578 dual registered). 

The following table shows number of beds by Care Quality Commission registration:

Residential Nursing Dual registered
2,764 432 2,578

Of the 148 care homes:

  • 106 support people with dementia
  • 41 support people with mental health issues
  • 38 support people with learning disabilities

Note: These figures are double counted where a care home has multiple specialisms.

The care home market in North Yorkshire is diverse with a mix of small independent providers and some larger corporate organisations.  These homes employ approximately 5,883 staff (excluding agency) made up of 366 nurses, 3,807 care staff and 1,710 non care staff. The current agency utilisation is 77 nurses, 361 care staff and 98 non-care staff.

The following table indicates the size of care homes in North Yorkshire by staff numbers:

Staff range Number of care homes
Less than 20 24
20 to 50 69
50 to 100 49
100 plus 4

The following table shows the Care Quality Commission ratings of care homes across North Yorkshire by Care Quality Commission registration (as at 6 July 2022):

Overall Care Quality Commission rating Residential homes Nursing or dual registered homes
Outstanding 5.31 per cent 3.33 per cent
Good 92.04 per cent 66.67 per cent
Inadequate 0.88 per cent 0.00 per cent
Not rated 1.77 per cent 6.67 per cent
Requires improvement 0.00 per cent 23.33 per cent

75.86 per cent of care homes have a Care Quality Commission rating of good or outstanding and Care Quality Commission ratings vary across the county with Richmondshire having 85.71 per cent of care homes with a rating of good or outstanding whilst Harrogate has 71.01 per cent.

There are currently 12 residential and nursing homes across North Yorkshire with a current phased or full suspension. Staff recruitment, documentation and recording are common issues raised. 

Across the county there is a shortage of placements for people with very complex requirements including dementia care. There is also a legacy of provider failure with 173 nursing beds and 82 residential beds closed in the last two years. A total of 212 nursing care beds have de-registered in the last two years becoming residential only beds due to lack of registered nursing personnel. A number of homes are reporting future intentions to de-register.  

Home based support

We currently commission 141 domiciliary care providers (plus 12 North Yorkshire County Council services) to support people over the age of 18. We also has 12 in-house domiciliary care services, delivering reablement support as well as care within extra care settings. We have one personal care at home service in the Selby area.

The following table shows the number of domiciliary care providers by locality:

Area Domiciliary care providers registered with Care Quality Commission With whom we currently commission (including not yet rated with Care Quality Commission)
Hambleton         26 24
Richmondshire   10  9
Selby 15 12
Harrogate 37 41
Craven 13 12
Scarborough 38 40
Ryedale 16 17

The domiciliary care provider market across the county is diverse in terms of business size and models. According to National Health Service Capacity Tracker (29 June 2022), Independent Sector providers employ around 5,162 staff. Some providers employ as few as three staff and the largest provider employs over 800 staff. The following table shows the size of domiciliary care providers by staff numbers:

Staff range Number of providers
Less than 20 55
20 to 50 68
50 to 100 11
100 plus 7

The following table shows the Care Quality Commission ratings of domiciliary care providers across North Yorkshire by Care Quality Commission registration (as at 6 July 2022):

Overall Care Quality Commission rating Domiciliary care Extra care housing
Outstanding 5.71 per cent 0.00 per cent
Good 83.57 per cent 85.71 per cent
Inadequate 0.71 per cent 0.00 per cent
Not rated 10 per cent 14.29 per cent
Requires improvement 0.00 per cent 0.00 per cent

When quality is considered by locality, Craven has the highest number of providers with 100 per cent at good or outstanding. Harrogate is the poorest with 73.17 per cent at good or outstanding.

As at February 2022, our data showed that there were 2,129 people in receipt of a personal care service commissioned by ourselves. This equated to 28,654 personal care hours per week, delivered by 133 service providers. This includes all our, Continuing Health Care and Section 117 funded personal care hours and will cover traditional homecare delivered within a person’s own home and supported living services. As anticipated the highest number of hours are within the Scarborough and Whitby, Vale of York and Harrogate and Rural Alliance areas, which correlates to locality pressure areas:

Locality Total hours
Scarborough and Whitby 7,428
Vale of York 7,327
Harrogate and Rural Alliance 5,636
Hambleton and Richmondshire 5,116
Craven 2,488
Mental health 404
Countywide 256
Grand total 28,654

North Yorkshire has some deeply rural and sparse parts of is population and rural areas are particularly difficult to commission domiciliary care due to the distances required to travel and shortage of workforce. The current area of most concern is Scarborough.

This situation puts significant pressure on other parts of the care market and provides less opportunity to meet people’s outcomes. Our delivered reablement service has picked up a large proportion of unsourced care taking the service away from their objectives. Similarly, short-term residential care of increased reliance upon unpaid carers has been necessary to ensure a person’s needs can continue to be met. 

Supported living

We define supported living as a ‘housing with care and support’ model. There are different definitions nationally as to what constitutes as supported living.

In North Yorkshire (for the purposes of this document) supported living is defined as a home of your own that you are supported to live in. It must contain both of the following elements:

  • Housing-related support including living skills and help to maintain a tenancy and;
  • A care and support Team who are available for a substantial amount of time to help people to live independently and meet eligible care and support needs.

It is North Yorkshire’s ambition to increase and improve the provision of supported living services, as part of a range of housing options for people with care and/or support needs. There are currently over 200 properties providing Supported Living services (over 800 units of accommodation), with much of this being shared houses. The housing is provided by a mix of housing associations, charities, council housing and private individuals. There are also a range of organisations who provide care and/or support services within the county.

There is strong demand for supported living services in most larger towns within North Yorkshire. This demand is across all levels of support that different services might provide, from relatively moderate to intensive services. There are currently over 100 people currently known to ourselves and local National Health Service groups who have been identified as potentially benefitting from a supported living service, with a clear move in demand towards for more self-contained accommodation.

In addition, it may be that some existing supported living services may become unviable over the coming years due to long term voids and being unsuitable for the future. This may be for a number of reasons, including location, physical suitability of the building, changing support needs of tenants, and lower demand for certain models of supported living. This will result in additional demand for new services which do meet the future need.

The following table shows the current number of supported living properties and units currently available in North Yorkshire, along with our current demand data as at 1 June 2022:

Locality Number of properties Number of units     Individuals with urgent need (Within 3 months) Individuals with intermediate need (3-12 months) Individuals with future need (1-5 years)
Craven   10 28 9 5 16
Hambleton and Richmondshire   37 114   14 10 3
Harrogate 60 252 12 15 15
Ryedale 36 111 93 3 0
Scarborough 58 265 27 4 14
Selby 13 43 6 7 8
Total 215 816 77 44 56

Our plan is to meet the unmet need for supported living by working strategically with housing and planning teams across the county to develop a coordinated approach to delivering additional housing. This will include a partnership approach with care and support, and housing providers, to ensure new provision meets the growing need.

Community based support

We currently commissions community based support through our Non Regulated Services Approved Provider List, which categorises non-regulated care different service types offering daytime activities and daycare.  Currently (as at 6 July 2022) 1,074 clients were receiving non-regulated care services. The following table shows the current number of providers of each type of service in North Yorkshire:

  Number of provider/services
Collective care daytime activities
 
79
Collective care employment training 30
Non-collective care daytime activities   329

Note well: Some providers have multiple service types for the same service

Currently, approximately 80 per cent of services falling under the category of community based support are providing support to people with a learning disability and/or autism. Approximately ten per cent are older people and ten per cent are people with a mental health condition.  

We also have 11 in-house day services providing daycare, predominantly within building-based services, for people with a learning disability and/or autism and other complex needs, and for older people within elderly person’s homes. The pandemic has changed demand for this type of service and adult social care is working to review the current demand and service offer for day services. This will inform future commissioning plans.

Extra care

Extra care housing is the basis of our approach to keeping people healthy and able to live at home in supportive local communities, so reducing the demand for more intensive services.

There are currently 28 operational extra care schemes across the county providing 1,538 units of accommodation with further schemes planned or in the pipeline including, but not limited to, Whitby, Harrogate, Malton and Catterick.

Extra care housing provides high quality accommodation enabling people to live independently, in their own home, with access to care and support 24 hours a day, seven days a week. There is also access to other facilities such as restaurants, hairdressers, shops and library facilities. Extra care enables people to remain living in their own communities and maintain access to their support networks.

Extra care housing is a vital part of our programme of prevention; by addressing one of our key challenges, an ageing population. However, its impact spreads far wider than this. It brings employment opportunities, resilience and regeneration to our communities.

View a list of extra care housing schemes in North Yorkshire or see their locations on a map

Technology enabled care

With the use of assistive devices and technologies we aim to maintain or improve an individual’s safety and independence to facilitate participation, enhance overall well-being, and prevent or reduce the impact of impairments and secondary health conditions. Where assistive technology can be utilised across health and social care, including: reducing care provision; admission; need for admission into a care home or looked after care; and improving health and wellbeing. 

Social care is becoming more reliant on finding innovative ways to support the people we care for. As a result of this, Technology Enabled Care  is becoming increasing important to enable us improve people’s safety and promote independence as much possible. Our service commissioned through NRS Healthcare, is available to people who have been identified as having an eligible need under the Care Act 2014, children with learning and physical disabilities as well as a private paying option.

Our current commissioned service is delivered by NRS Healthcare and provides a service across the whole of North Yorkshire. We currently provide technology enabled care services to over 2,600 people, including people living in the community and our extra care housing schemes.

NRS Healthcare provides a wide range of solutions, specifically designed to meet individuals identified outcomes. We will continue to utilise and expand the variety of technology enabled care solutions available to the people in North Yorkshire.

Current spend

We had a total gross spend on adult social care services/provision in 2020/2021 of £175,231,299.02. In 2021/2022, this increased to £188,517,324.87. 

This was partly funded through the contributions from service users, Better Care Fund and Government grants.  

The table below summarised the total net spend on direct care provision within adult social care in 2020/2021 and 2021/2022:

Provision Spend 2020-21 Spend 2021-22
Residential and nursing care £109,009,482.40 £117,925,398.54
Home based support  £25,936,714.64 £26,313,713.99
Supported living £25,955,268.34 £28,772,690.94 
Community based support £5,432,802.58 £6,129,979.31
Prevention services    
Gross care provision spend £175,231,299.02 £188,517,324.87
Client contribution income -£34,865,903.67 -£43,186,601.58
Continuing health care income -£16,997,472.86 -£20,059,711.25
Net care provision spend  £123,367,922.49 £125,271,012.04 

More financial information can be found in our local account at Local Account.

Each year, we take account of the care market conditions in North Yorkshire and reviews fee levels taking into account changes in living wage and general inflation. We have a duty to proactively balance the support to the care market to ensure sustainability whilst ensuring funding allocations are distributed wisely. 

We also recognise the impact of Covid-19 on care providers’ ability to retain financial sustainability. A range of national and local support mechanisms have been in place since early in the pandemic to reduce the financial impact on the care market and, where possible, prevent provider failure. This includes support from central government, including: 

  • Infection prevention control funding;
  • A national personal protective equipment portal; and, 
  • The block purchasing of discharge beds.
  • At a more local level, the county council has implemented:
  • Compensatory payments;
  • Supplier relief and hardship processes;
  • Payment on planned activity; and, 
  • Payments in advance for the annual inflation settlement

An Actual Cost of Care exercise for residential and nursing care has been undertaken and negotiated with the Independent Care Group to reach an agreement, this has now been implemented.  

The recently published government commitments laid out in “Build Back Better – Our Plan for the National Health Service and Social Care” aims to introduce caps on care costs, changes to the thresholds for means-tested contributions, and a bigger role for councils in organising care for people who self-fund with an expectation that people who self-fund their care will pay care fees at local authority fee rates.

As part of this we are also completing a fair cost of care exercise for home care and will align the outcome into a market sustainability plan, and update this Market Position Statement to reflect this.  

We will continue to work collaboratively with the care sector to ensure we retain a financially sustainable care market which has the capability to transform and ensure continuous learning and quality improvement to meet the needs of the people we support.  

People are required to pay towards the cost of their care. The amount that they pay is calculated by completing a means tested financial assessment. This is carried out by applying statutory guidance issued by the Department of Health and more specifically the Care Act 2014.
Details of how services are charged for are available on our paying for social care services in the community page or our paying for care in a residential or nursing home page.

A personal budget is an amount of money allocated to a person who is eligible for social care services following an assessment of needs. While some people chose to take their personal budget as a direct payment and manage the money and support themselves, health and adult services has also explored other ways in which clients can spend their personal budgets without taking on the full responsibility of a direct payment.

In North Yorkshire, there is a diverse adult social care workforce split between roles in local authority, independent sector and Voluntary Community and Social Enterprise providers and jobs working with direct payment recipients.   

The table below shows the workforce across residential and nursing care and domiciliary care services across North Yorkshire at 29 June 2022:

Type of care Workforce description Totals
Domiciliary care Number of care workers 5,162
Residential and nursing care Number of nurses 394
Number of care workers 4,820
Number of non care workers 1,807
Agency workers 629

The number of our staff currently employed by Health and Adult Services for the last two years was:

  • 2021/2022- 1,947 employees
  • 2020/2021- 2,016 employees

The number/proportion employed in frontline care roles as opposed to support or office roles is as follows:

  • 2021/2022- 17.4 per cent support/office roles versus 82.6 per cent frontline roles
  • 2020/2021- 15.2 per cent support/office roles versus 84.8 per cent frontline roles 

The turnover for Health and Adult Services staff has increased over the last two years:

  • 2021/2022- 14.9 per cent (276 leavers)
  • 2020/2021- 9.4 per cent (184 leavers)

Skills for Care estimated that the staff turnover rate for North Yorkshire was 28.9 per cent for 2020/2021, which was similar to the region average of 28.7 per cent and similar to England, at 29.5 per cent.  Not all turnover results in workers leaving the sector, over half (61 per cent) of starters were recruited from within the adult social care sector, therefore although employers need to recruit to these posts, the sector retains their skills and experience.  

We recognise, however, that providers across North Yorkshire are seeing significant challenges with staffing. Retention has dropped for some providers by ten to 15 per cent and recruitment is more costly and less successful with lack of applicants applying and candidates not always turning up to interviews. Staff shortages are resulting in a reliance upon agency staff, which is also struggling to meet the demand.  Providers are reporting that many staff are closing to leave the sector, due to no longer having a desire to work in social care, many are reporting the impact of the pandemic on a feeling of burn out and others are leaving due to higher pay in other sectors.

We continue to work with the care market to support with local Make Care Matter recruitment campaigns and any regional and national opportunities to grow and retain the care workforce.  

As part of our work with the care sector to transform services, we are keen to adopt the principles of the Ethical Care Charter, the overriding objective of which is to establish a minimum baseline for the safety, quality and dignity of care by ensuring employment conditions which:

  • do not routinely short change people and
  • ensure the recruitment and retention of a more stable workforce through more sustainable pay, conditions and training levels. 

We are ambitious about the future of adult social care and would like to co-produce a transformation plan with providers and people who use services, focussed around five headline areas, namely:

  • Home-based support
  • Community-based support 
  • Residential and nursing care
  • Supported living
  • Complex care

The vision of these transformation plans are underpinned by our ambitions around prevention, increased technology and digital solutions, improved and greater access to supported housing, support for unpaid carers and to build further our relationship with local communities to create a platform for working together to make real change. We are keen to work with experts by experience, care providers and local communities in the ongoing development of services to ensure progressive person centred community based models of support which supports and encourages social enterprise and social capital.

Our Commissioning and Service Development Strategic Plan 2021 to 2025; commissioning and service development strategic plan 2021-25 sets out a high level summary of our ambitions for the care market in North Yorkshire, which we will tested and further shaped to co-produce our vision between now and summer 2023.  

We recognise the diversity of North Yorkshire as a large rural geographical area, and that each locality of the county has its own challenges and opportunities. We have, therefore, developed locality plans which set out our current identified priorities for each locality and our commissioning objectives for 2021/2022, alongside the underpinning data. These are included within our Commissioning and Service Development Strategic Plan 2021 to 2025.  Commissioning at a place-based or locality level is in line with intentions for Integrated Care Boards to develop community partnerships.

What we will do

Hambleton

Our priorities are:

  • Dementia care
  • Reducing inequalities
  • Improving emotional resilience and wellbeing
  • Collaboration
  • Home first approach
  • Creating outstanding services
  • Empowering resilience communities

Scarborough

Our priorities are:

  • Sustainability in the care home market
  • Specialist dementia support
  • Home care
  • Supported living or accommodation
  • Extra care facilities
  • Empowering people to deliver complex care
  • Carer support
  • Prevention
  • Support for those living with autism

Richmondshire

Our priorities are:

  • Dementia care
  • Reducing inequalities
  • Improving emotional resilience and wellbeing
  • Collaboration
  • Home first approach
  • Creating outstanding services
  • Empowering resilience communities

Craven

Our priorities are:

  • Supported living accommodation
  • Home care
  • Home first approach
  • Meaningful daytime opportunities for people living with learning disabilities and dementia
  • Special dementia care and support
  • Rurality, social isolation, access to services

Harrogate

Our priorities are:

  • Cost of care
  • Domiciliary care
  • Dementia services
  • Supported living or accommodation
  • Home first approach
  • Integration and partnerships
  • Day services
  • Pathways and engagement

Ryedale

Our priorities are:

  • Home care
  • Supported accommodation
  • Residential and nursing care
  • Community assets
  • Speciality support
  • Creating a strong and sustainable workforce
  • Assisted technology and innovation
  • Supporting carers

Selby

Our priorities are:

  • Home care
  • Supported accommodation
  • Residential and nursing care
  • Community assets
  • Speciality support
  • Creating a strong and sustainable workforce
  • Assisted technology and innovation
  • Supporting carers

Commissioning intentions – residential and nursing

Our vision is to work collaboratively to create good quality, strong and sustainable residential and nursing care home provision across North Yorkshire. We want to develop provision that:

  • is responsive to the locality and community needs, both short and long term
  • which enables the health and social care system to function at an optimum level
  • is innovative in addressing the issues of lack of nursing staff and providers seeking de registration of provision
  • maximises independence rather than fostering dependency and reliance
  • supports individuals to stay well to prevent unnecessary hospital admission and where necessary to facilitate timely discharge minimising the length of time that people spend in hospital meeting both long term and short term care needs
  • Supports individuals living with dementia and their carers to prevent hospital admission and to remain at home

Across North Yorkshire we have an ambition to reduce reliance on bed based provision but to make this transition we need to place investment opportunities in the home care sector.  However, it is acknowledged that until this investment is embedded and a robust home care infrastructure is in place, there needs to also be some recognition of the stabilisation of the current care home market to manage the increased demand, particularly coming from hospital discharge.  

Workforce and retention issues are significant in care homes leading to vacancies, which cannot be staffed, and there is a heavy reliance upon agency staff to maintain safe services. The nursing workforce is a particular challenge across the health and care sector making the viability of registered nursing homes difficult to sustain with a number of homes reporting a future intention to de-register. A new innovative model of delivering nursing home provision is required.     

Across the county, there is a shortage of placements for people with very complex requirements including dementia care and there is a need for innovative solutions to support those living with dementia to remain at home and prevent unnecessary hospital admissions.   

Commissioning intentions – Home based support

We wish to develop a new, collaborative approach that enables people to stay at home, live independently, maintain a good quality of life with appropriate choice and maximise opportunities to integrate within the community. To do this, we will:

  • Evaluate the micro enterprises pilot considering recommendations for future service rollout
  • Evaluate the Reeth innovative homecare project, to understand the current position and future roll out capability
  • Maintain and manage the current domiciliary care framework agreements in Selby and Harrogate
  • Implement the new outcomes based service specification for home based support and associated outcomes and performance framework and locality based key performance indicators
  • Implement homecare innovations and new models of care, considering Tech first approaches, rapid response, multi-disciplinary support and community based pilots.

Commissioning intentions – supported living

Our vision for supported living is for good quality and good value housing to be available for people with support needs; helping them to live in a home of their own, within their local community, and being supported to live their lives how they want.

We are working further to define how the need for supported living services will be met in the coming years, it is likely that this will include:

  • Formalisation and publication of our minimum accommodation standards and preferred options for securing more housing
  • Delivery of new supported living services in most large towns across the county, the majority of which are likely to be a ‘self-contained’ housing style
  • Work will take place through the Supported Living Approved Provider List to transform care and support services over time, ensuring they are delivering a strong ethos of promoting choice, independence and skill building.
  • Improving pathways to other housing options to make sure people are accessing the right housing for them
  • Focussing on improving the forward planning of young people who are transitioning to adult services and could be best supported by a supported living service

Commissioning intentions – community based support

The long-term vision is to ensure that people with an assessed care need are able to fully integrate into the life of their neighbourhoods and communities; in turn fostering genuine resilience, independence and self-reliance. Also to ensure environments are well equipped and supportive for people with more complex needs, whilst still encouraging access and integration into the wider community wherever possible. 
 
To realise this vision the intention is to:

  • Respond flexibly to the ebb and flow of people’s needs, using different partners and local community based assets to unlock solutions for whatever the need is at that moment in time
  • Help people to build and maintain new friendships and relationships and become fully integrated into the fabric of their local neighbourhoods and communities (making sure that such connections are facilitated as much or as little as people want)
  • Help people to develop new skills and have access to new experiences, including leisure, education and employment opportunities
  • Deliver services in such a way that fosters positive and collaborative relationships with other statutory and voluntary services.
  • Develop a strengths and assets based approach by working with and through a community anchor model.
  • Ensure the needs of carers are recognised

Commissioning intentions – complex care

Due to increased demand, intensity and complexity for people accessing health and social care, North Yorkshire faces a number of challenges including; appropriate care and accommodation for people with complex needs (including those with dementia, autism and other neuro-divergent conditions, acquired brain injury, complex mental health conditions), a shared definition of understanding of complex needs and the need to develop innovative services to meet this need.

Our vision for complex care in North Yorkshire is to enable people with complex needs to live a longer, healthier and independent life by:

  • Striving for excellence in complex needs
  • Ensuring equality of access
  • Providing a safe care environment
  • Improving self-advocate experience, engagement and co-production
  • Developing integrated systems and pathways, and
  • Educating and training professionals, self-advocates and carers.

To achieve this vision, we will need to ensure we have services in place which can respond and support people in crisis.  Our ambition is that services will provide:

  • Local, high quality, person-centred emergency care for people with complex needs at short notice, until assessment and onward transition is completed
  • An immediate place of safety and stability with the right levels of staff and training available to support people
  • A place that can provide time and space for a person for de-escalation following a distressing period, prior to ongoing assessment for future provision
  • An opportunity to meet a person’s needs and outcomes in their local area. 

In order to achieve the above, and to improve our response to people with complex care needs, we will also further develop:

  • a co-produced shared definition of complex care that ensures consistent understanding across stakeholders
  • additional specialist facilities in collaboration with partners
  • our internal and care market workforce through training
  • engagement and co-produce with the market, people, carers, and staff

Commissioning intentions – extra care

Our care and support strategy Where I Live shows our vision to meet people’s needs now and into the future. It sets out proposals for transforming services to ensure people can remain safe and independent in their own homes. In addition to improving the amount and quality of accommodation with care and support across the county by 2020 and meet financial savings.

A key element of the strategy is to build on the success of the extra care programme so far by:

  • Expanding the number of extra care housing schemes provided across the county and exploring different models of extra care accommodation to meets the needs of smaller towns across North Yorkshire.
  • Ensuring schemes meet the requirements of future generations. Better placed to meet the needs of people living with dementia, the changing aspirations of the wider population and play a pivotal role in the community to ensure North Yorkshire towns and villages are active, thriving and stronger places to live.

In 2015, we appointed six organisations to our Extra Care Housing Framework. Work is ongoing to commission and procure new extra care housing schemes through the framework.

Work is also taking place with clinical commissioning groups and extra care housing providers in a number of areas across the county to consider the use of units with schemes to deliver intermediate care, rehabilitation and respite services where appropriate. 

We will continue to:

  • Work with providers on our extra care housing framework to develop and deliver new extra care schemes across the county.

  • Explore different models of accommodation to meets the needs of smaller town and rural locations across North Yorkshire.

  • Encourage and support proposals for new extra care housing schemes outside of the framework where such a scheme would be consistent with our needs, aspirations and requirements for extra care housing and would not require any form of financial contribution from ourselves.

  • Continue to work with the market, partners and stakeholders to consider how extra care housing schemes can contribute to the challenges faced by us and other public sector partners. These challenges include integrated service delivery with the National Health Service and the increasing number of people living with dementia.

Commissioning intentions – prevention

We currently commission a range of prevention services that meet the following anticipated benefits 

  • people will be safe and sustainably independent in their own communities;
  • people will experience physical and mental wellbeing;
  • people will experience economic wellbeing;
  • prevention will be the norm across health and social care; and
  • carers will be healthy and experience physical and mental wellbeing.

Commissioned services complement the in-house prevention services 

  • Living Well – In place since 2015 and operating countywide, Living Well works with individuals to improve health, wellbeing and independence, reducing use of formal support services by facilitating self-help. People are connected to assets in their local community and encouraged to use local community activities and groups. Delivers social prescribing services across Harrogate and Selby Town Primary Care Networks
  • Income Maximisation Service – promotes financial wellbeing and provides  targeted support to individuals to maximise their income and enable them to remain as independent as possible
  • Stronger Communities – In place since 2014 and operating countywide, Stronger Communities supports social action, through investing in and strengthening voluntary and community organisations and developing local services. The team develops the community infrastructure, which, when combined with Living Well, takes a holistic approach to individual and place based asset development. Stronger Communities manage budgets to provide infrastructure support for voluntary sector (Survive to Thrive) and Inspire, Achieve, Innovate Grant and investment programmes

Services currently commissioned 

  • Wellbeing and Prevention: The aim of the Wellbeing and Prevention Service is to help people to stay well and independent in their local communities and reduce the demand for long-term statutory services, care and support. Budget of approximately £450,000 per annum funds seven lots across the county delivered by 11 community based organisations until 31 March 2023. From 1 April 2023 this is moving to a grants-based approach
  • Carers Support Services: The aim of the service is to promote, support and improve the mental, physical, emotional and economic wellbeing of carers, so that they can continue in their caring role, look after their own mental health and wellbeing and have a life of their own in terms of opportunities for work, training, education, leisure and social interaction. Budget of approximately £722,000 per annum funds four lots, delivered by two community based organisations. Contract runs from 1 July 2023 for maximum of eight years. 
  • Carers Sitting/Short Breaks Service: the aim is to support and sustain carers in their caring role and promote their health and wellbeing by providing a break from caring. Budget of £291,000 per annum funds eight community based organisations. Contract runs to 30 September 2023. Intention to start procurement process. 
  • Community Mental Health:  the main aim is to help prevent people from developing mental health issues and to support people with mental health issues to recover and stay well. Budget of approximately £246,000 per annum funds six community based organisations. Contracts run to 30 September 2023 with option to extend for further two years. 

In addition to these targeted prevention services the council invests in many low level community prevention and support services: including;  

  • Strong and Steady – targeted and universal physical activities
  • Pathways to Health – walking and well-being
  • Age Friendly Communities
  • Lifestyle Services – smoking cessation, weight management, sexual health, drug and alcohol services, sexual health

Our vision for prevention in North Yorkshire is 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 support that is 'lives not services', asset based, and forms 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 North Yorkshire’s public health agenda focussing on the wider determinants of a person’s health and wellbeing which may impact on their need for support
  • support seamless pathways and links to other services
  • promote the use of technology to meet individual needs

To do this we 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
  • work with providers who can clearly demonstrate a commitment to delivering high quality support and who place people at the centre of what they do
  • co-design services with partners, staff and people receiving support to ensure they are fit for purpose
  • identify gaps in service provision through the monitoring of data available and ensure these form part of future commissioning intentions 
  • Work with providers who can clearly demonstrate a commitment to work collaboratively with other providers in their community to deliver a place-based response to need  

Commissioning intentions – personalisation

We continually work hard to support people to access direct payments to manage their own care and support arrangements. For 2020/2021, Adults Social Care Outcomes Framework ranks North Yorkshire 121 nationally for the proportion of people assessed to need care and support, who use direct payments.

This is 19.1 per cent of people receiving long-term services from health and adult services in the community.

Over the last year interest in direct payments has increased and the 692 people in receipt of a direct payments are made up of:

Primary need Number of people
Learning disability 306
Older people 155
Physical disabilities 222
Mental health 9

We also encourage carers to access direct payments in the form of a grant to improve health and wellbeing. In 2021 to 2022, we applied 712 direct payment grants to support carers maintain their caring role.

More than 40 per cent of direct payments use personal assistants but we face increasing challenges to find and secure Personal Assistants successfully.

We are developing a catalogue of case studies to help promote the use of direct payments in flexible, meaningful ways that may involve non-traditional types of support.

We employ an experienced in-house Direct Payments Support Service to ensure people have access to the information and support they need to manage and administer direct payments.  We are working closely with National Health Service colleagues to extend the service to people with health needs to access direct payments via Personal Health Budgets.

We want to grow and develop opportunities for people to use direct payments to improve personalisation, choice and control. We want to support service users to move towards greater independency by creating more opportunities for people to remain and live in their communities.

Our intentions are:

  • To increase the proportion of people who receive direct payments.
  • To create better opportunities to source and secure Personal Assistants who have the skills to support people maintain their quality of life and dignity.
  • Understand the personal assistant market and contribute to community economic growth and sustainability.
  • Develop our digital offer to enable direct payment users enhanced access to information as and when they need it.
  • Build on our partnerships with National Health Service colleagues to develop a smooth pathway for people with health needs to choose and manage their own care.
  • To reduce the bureaucratic requirements of a direct payment service user so they can focus on living their lives.
  • Work better with mental health to understand how the benefits of direct payments can have positive impacts on mental well-being.
  • To encourage and build confidence to use direct payments innovatively and in flexible ways

Commissioning intentions – assistive technology/technology enabled care

As well as providing Technology Enabled Care solutions through our standard referral process, NRS Healthcare work alongside North Yorkshire County Council to explore other innovative solutions that link into the Council’s Strategic Plans and help us to implement pilot projects to try out new technology. An Innovation Panel has been set up with representatives from different services within North Yorkshire to review pilot projects and explore other technology solutions.
 
For our future plans and vision for the use of Technology Enabled Care is;

  • To utilise more solutions based on research and good practice, linking in with other organisations to increase and improve knowledge around the benefits of using Technology Enabled Care to support people both with a Social and Healthcare need. Introduce a Technology Enabled Care first approach to care and support planning.
  • Reduce the reliance on traditional services such as domiciliary care services 
  • Provide us with a wide range of Technology Enabled Care solution to support a variety of needs, ensuring that a value for money approach is achieved.
  • Ensure interoperability of systems and devices, so that Technology Enabled Care solution can be used in all types of accommodation setting.
  • Understand the implications of the adult social care reform white paper, and  the use of technology within those guidelines.
  • As a result of the local government reorganisation, work in partnership with the local district and borough council services to develop our new Technology Enabled Care service from 2024.

In order to achieve the above, we will:

  • Work with our commissioned service to continue to explore innovative Technology Enabled Care solution to meet a range of needs, for different client group across North Yorkshire.
  • Develop Service Specification for new Technology Enabled Care service in response to local government reorganisation. 
  • Implement guidelines round the use of technology as indicated by the Adult Social Care reform white paper.
  • Research and best practice on the use of innovative Technology Enabled Care solutions
  • Work with internal and external colleagues to increase the uptake of Technology Enabled Care solutions with a Technology Enabled Care first approach.
Contract Summary Renewal Value (£)
Advocacy An independent advocacy service for adults residing in North Yorkshire, regarding issues around health and social care and self-advocacy support

31 March 2025 Independent Advocacy Service

31 February 2024 Self-Advocacy Support

£4,193,651.00

£351,800.00

Carers information and advice Information and advice services for carers across our localities 1 July 2023 £536,431.82
Dementia support Providing support, advice for anyone affected by dementia across the county 31 March 2024 £1,365,723.17
Mental health support Providing support, advice for anyone affected by a mental health condition across North Yorkshire 30 September 2023 £217,473.01
Sitting service Providing carers break services across our localities 31 March 2023 £291,106.18
Wellbeing and prevention Early support to promote well being and independence 30 September 2022 £321,757.48

We aim to advertise all tenders over £25,000 via Yor Tender.  As such we encourage all providers to register with Yor Tender for access to details of tendering activity including soft market testing, consultation and engagement and procurements. 

Details on how to register can be found on the page Procurement Information for North Yorkshire County Council - Datasets - Data North Yorkshire.

In exceptional circumstances and in line with procurement regulations, commissioners reserve the right to directly award contracts in order to meet the needs of people.   

There are a number of national drivers that are shaping the current and future provision of adult social care: 

  • the Care Act and other legislation
  • continued financial pressures on local authorities to meet their statutory duties (finance)
  • the creation of integrated care systems promoting integration and collaboration across health and social care (national agenda)

The Strategic Market Development Board was established in 2020 to oversee our Care Act duties of market shaping and oversight of North Yorkshire’s care market. It has recently embarked on an ambitious programme to transform the way we commission and deliver those services which includes a review of the current Approved Provider Lists and developing new models for procuring residential and nursing care, domiciliary and non-regulated services.  

The board has defined its ambition in a strategic plan for care market service development.

To achieve our plan, we will:

Collaborate and integrate

  • Build and maintain links and information sharing networks with the market
  • Supporting partners and influencing the market
  • Involving partners (recognising them as partners and not consumers)
  • Acknowledging excellent in practice
  • Research and engagement

Transparently review commissioned services

  • Ensuring that all reviews of current contracts are outcome based and not service based
  • Carefully looking at what we buy and why we buy it
  • Reviews should compare demand (stock and flow), use of care (amount of care per person) and cost of care (unit cost of care). We ask ourselves 'is it doing what we we want it to do?'

Supporting evidence based market development to inform future commissioning and investment

  • Reviewing historically commissioned services
  • Recognising research and best practice
  • Effective and responsive recording of what we are buying and its effectiveness at meeting outcomes

Recognising barriers and effectively removing them

  • Innovatively thinking about procurement law
  • Testing the market by adopting locality based pilots
  • Data collection
  • Reinvestment opportunities
  • Spend by outcomes
  • Clarity of spend
  • Service and quality improvements

Achievement of the plan will require a commitment from all parts of the care market to work in partnership to deliver this plan over the next three years.

As identified in the Association of Directors of Adult Social Services 9 Principles for Reform, we believe that traditional services (such as residential care, domiciliary care and day centres) will continue to have a role to play in the future. However, they need to be part of a much broader local offer including smaller, more bespoke providers, micro-enterprises and wider community assets such as community-owned care, mutual aid and shared lives that have all played a part in responding to the current pandemic.

These help bolster community resilience and their potential to help secure a more preventative approach to wellbeing that supports people to live safely and well at home must be harnessed.

Most recently, the Government White Paper, The Future of Health and Care ‘Integration and Innovation: working together to improve health and social care for all’ (February 2021) proposed a number of specific and targeted social care changes. It promised that further proposals will be brought forward this year on the reform of Adult Social Care, Public Health (National Institute for Health Protection) and Mental Health (Update Mental Health Act to 21st Century).  

People at Heart of Care and Fair costs of care, Adult Social Care Reform White Paper December 2021 sets out a ten-year vision for transformation of social care in England. This vision revolves around three objectives; people have choice, control, and support to live independent lives; people can access outstanding quality and tailored care and support; people find adult social care fair and accessible.

We recognise the need for continuous learning and quality improvement across the whole health and care sector and to support this, we have developed a new quality pathway. This pathway will provide simple and clear end to end processes that drives quality in the market, provides early identification of support requirements of the care market and offer a suite of tools and resources to our providers.  

We want to ensure the council's expectations and quality standards are recognised and delivered across our community to ensure everybody receives consistent good quality care and support. 

The quality pathway aims to:

  • Identify and rate risks to support early intervention enabling support where it is needed.
  • Gather data and intelligence that informs decision making 
  • Provide transparent and clear decision making that can be evidenced and provide a fair and robust process 
  • Ensure outcomes and standards of care are assured through various approaches 
  • Assure ourselves we are meeting needs and continually driving to improve the outcomes and experience of people and their families within our community. 
  • Align our quality standards with the Care Quality Commission new strategy and continue to work in partnership with Care Quality Commission colleagues
  • Support market sustainability and reduce provider failure by directing resources to where it is most needed. 
  • Enable providers to quality assure themselves via self-assessment; encouraging the identification of risk at the earliest opportunity as well as identify best practice

We are keen to deliver on our ambition to promote a pathway to outstanding, improving outcomes and lived experiences to those accessing our direct services and commissioned services.  A range of best practice tools and guidance are available for care providers to further develop services. 

Climate change is having an increasingly prominent impact on our everyday lives and adversely affecting those with pre-existing health conditions and vulnerable people. Aligned with the nationwide ambition to reach net-zero emissions by 2050, we have set our aspirational target for 2034.

To achieve this, we are working with providers, organisations, teams and individuals to implement pilots, improve the energy efficiency of services, buildings, for example heating systems, and developments as well as promoting green and blue spaces and social values. We are learning from other examples of good sustainable practice to ensure long-term positive change.

We will promote health and wellbeing, independence and positive sustainable outcomes for both people and places. This is through addressing inequalities, attainment gaps, employment, links to the wider economy, housing, place-based approaches in the community, inclusive cultures, developing the North Yorkshire prevention offer and supporting children in the Childhood Futures programme. The planning and delivery of this work facilitates the recognition and enhancement of social value in the community, ranging from access to specialist services to environmental conservation. 

People who use our services and their families are experts in their own lives. They have unique experiences and views about their service needs and the barriers they experience. It is only by listening to people that we can truly understand what services or support people need, and what improvements are needed to make them accessible, and of a high quality so people can live as independently as possible. 

We aim to work collaboratively and as equal partners with people who use our services and their families, providers, and the wider North Yorkshire community.  

We will:

  • Make sure our service planning processes build in engagement and co-production at the earliest stages of development and review
  • Make good use of what people tell us, through the full range of ways in which they give feedback – gathering and reflecting on this as the first step in designing our engagement activities
  • Develop our workforce skills so that all our colleagues feel more confident about their role in engaging with communities 
  • Commit to working in ways that are open, respectful, equal and reciprocal   
  • Develop ways to routinely capture feedback from everyday conversations with people
  • Think carefully about people’s time and make sure that our engagement activities are useful 

We will follow these key principles: 

  • Our engagement is meaningful - it is robust, we take account of it when we make decisions, it makes a difference, and we provide feedback
  • Our engagement is inclusive - we know who is in our communities and who is impacted by our work; we make efforts to reach and include a wide range of people; the way we engage works for people with different needs 
  • Our engagement is timely – we plan and carry it out in good time to influence decisions, with enough notice for people to take part; we plan time to think about engagement into our workload 
  • Our engagement builds relationships of trust – we work with people in a way that builds trust and ongoing relationships, we treat people with respect and we value their time
  • Our engagement is equal and reciprocal - we work with people in a way that recognises and addresses imbalances of power, acknowledging the vulnerability that people who access support may feel about sharing their views 
  • Our engagement is asset-based - we recognise people’s strengths and assets, and we value their expertise

Co-production should underpin all elements of providers’ services. Providers should support and encourage people and their families to share their views and participate as equal partners involved in shaping services. To align with the council’s priorities for care and support, we recommend that services apply the commitments and key principles outlined above to the ways that they develop and deliver services.  

You can contact the Health and Adult Services Service Development Team by emailing HASservicedevelopment@northyorks.gov.uk