Adult Social Care Strategy

This vision is part of our improvement plan for adult social care across Torbay. There is also an easy read version of this strategy.

Working in partnership

Contents

Introduction

Foreword

Who is this Strategy for?

Context

Overview of Torbay

National social work context

Integrating Care in Torbay – Our Journey So Far

The Challenges We Face

Our Vision for Adult Social Care in Torbay

1. Focused on outcomes and wellbeing
2. Personalised, co-created and flexible
3. Proactive and preventative
4. Integrated and coordinated
5. Local, community and relationship based

Our Values, Behaviours and Approach

Priority 1:  Helping people to live well and independently

Priority 2:  Helping people to regain their independence

Priority 3:  Helping people with care and support needs to live independently, safely and with choice and control

Introduction

This strategy outlines our values, our ambitions and how we’re going to achieve the best outcomes for everyone.

Social Care Futures say that we all want to live in a place we call home with the people and things that we love, doing what matters to us in communities where we look out for one another (from Social Care futures) and that sums up what we’re trying to achieve, working with people who are in the best place to tell us if we are achieving it!

There are so many great things about Torbay, and we’ve achieved a lot already – this strategy outlines how we’re going to move forwards together. 

Joanna Williams, Director of Adult and Community Services

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Foreword

I want to thank everyone that has taken the time to complete the survey or has taken part in the consultation meetings we have held over the Summer.  We have heard how important it is for people who use services to be heard and to work collaboratively together in our communities to improve services. 

This strategy sets out our aspirations in relation to working together for everyone who has social care needs ensuring that people can remain independent, regain independence and for those that have care needs to be supported in the best way for them and their carers and families.  We will continue to build on our integrated care model that puts a strengths-based approach at its heart, focussing on what matters most to people.

Cllr Hayley Tranter, Cabinet Member for Adult and Community Services and Public Health

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Who is this Strategy for?

This Strategy outlines how we can work together to deliver improved adult social care services for residents in Torbay.  The Strategy seeks to achieve the best for people in Torbay, their friends and family. The key principle is that we always work with people who may need care and support in Torbay, and those who care for them, and prioritise their voice above everything else.

We all want good outcomes, that we choose ourselves and to have control over how we live in our community. A vital part of adult social care is ensuring that people have the resources, and environment to keep them well in their own home.

Adult social care provides 'care and support', which covers a range of activities to promote people's wellbeing and support them to live independently, staying well and safe. It can include ‘personal care’ such as support for washing, dressing, and getting out of bed in the morning, as well as wider personalised support to enable people to stay engaged in their communities and live their lives in the way they want. Adult social care supports adults of all ages and covers a diverse range of needs, including autistic people, people with a learning disability or physical disability, people with mental health conditions, people with sensory impairments, people who experience substance misuse, people with dementia, and other people with long-term conditions.

This strategy is designed for those who may need care and support and their carers, paid or unpaid.  It is also for care staff, care providers, the voluntary and community sector and our partners in the NHS.

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Context

Overview of Torbay

Torbay can offer an unrivalled quality of life for individuals and families.  The beautiful Torbay and its stunning natural environment provide a wide range of outdoor activities.  We have excellent schools and a growing arts and cultural sector. But in common with other coastal communities, Torbay has its challenges. Our Joint Strategic Needs Assessment shows us where our major challenges lie there is a six-year gap in life expectancy between different areas of the Bay.

Torbay has the highest levels of deprivation in the South West. We have an ageing population who may experience ill-health, loneliness, and frailty. The number of people aged over 85 is expected to increase by over 50% within the next decade or so. As the population ages it is expected that we will see more people become frail and require support from health and social care services. We have high levels of children living in poverty, child and adult obesity, and suicide. Poorer environmental conditions are inevitably associated with poorer physical and mental wellbeing.

The level of need and inequality within the Bay has widened over the last 10 years and younger people and working age adults have higher levels of poor mental health and higher levels of drug and alcohol problems within the Bay.  There is a higher incidence of younger people (under 18) with mental health problems and self-harm.

The Joint Health and Wellbeing Strategy lays out the plan to address these challenges and improve the health and wellbeing of the population in Torbay between 2022 – 2026. Five focus areas and six cross cutting areas identify priorities for collective system action over the next four years. 

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National social work context

We must be honest about where we are. The Care Quality Commission State of Care Report in 2022 highlighted that the health and social care system is gridlocked and unable to operate effectively. People from deprived areas, people with disabilities and people from ethnic minority groups are less likely to access good care in a timely manner.

People can't always leave hospital when they are ready to, and providers are finding it extremely challenging to recruit.

Recognising the challenges facing the sector, the Government has embarked on a programme of reform.  Its adult social care reform white paper, “People at the Heart of Care”, sets out a 10-year vision to transform care and support in England based around three objectives:

1. People have choice, control, and support to live independent lives.
2. People can access outstanding quality and tailored care and support.
3. People find adult social care fair and accessible

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Integrating Care in Torbay – Our Journey So Far

Torbay has long been at the forefront of pioneering integrated care.  In 2005 the Torbay Care Trust was established to provide integrated community health and social care services.  These services were based around an integrated management structure, pooled budgets, and integrated multi-disciplinary teams.

Integrated care was further developed with the creation of the Integrated Care Organisation in October 2015 - Torbay and South Devon NHS Foundation Trust.  This was strongly supported and encouraged by both the Clinical Commissioning Group and Torbay Council. It has resulted in a more effective patient journey where fewer people in Torbay experience delays in moving between hospital and home and waits for care at home remain short.  This is in stark comparison to many other areas across the country.

The Integrated Care System for Devon which brings together, for the first time, all the county’s local authorities, NHS organisations and the voluntary sector to create the One Devon Partnership.  Together a single vision has been developed to ensure our communities have “Equal chances for everyone in Devon to lead long, happy healthy lives”. 

More recently the Government has established Integrated Care Boards. NHS Devon is one of 42 Integrated Care Boards across the country and took over the statutory functions of Clinical Commissioning Groups (CCGs) on 1 July 2022.  NHS Devon is responsible for the majority of county’s NHS budget, and for developing a plan to improve people’s health, deliver high-quality care and better value for money.  The aim is to improve people’s lives in Devon – wherever they live – to reduce health inequalities and make sure we can deliver these services for the long term. Within the One Devon Partnership there is a representative from each of the five Local Care Partnerships.  The Local Care Partnership (LCP) for Torbay is the South LCP. This is where most of the planning for integrated care and service transformation and change will happen.

Work started with the National Development Team for Inclusion (NDTi) in 2018 which set out a new approach to social care.

• Coproduction brings people and organisations together around a shared vision.
• There must be a culture based on trust and empowerment.
• There is a focus on communities, and each will be different.
• People are treated as equals, their strengths and gifts built on.
• Bureaucracy is the absolute minimum it must be.
• People get good advice and information that helps avoid crises.
• The system is responsive, proportionate and delivers good outcomes.

Building on this work, we have focussed on developing an integrated care model that puts a strengths-based approach at its heart, focussing on what matters most to people. This model provides joined up services, a fully integrated health and social care system, delivering a person-centred approach and building on the wider support around people.  This means working with people, as equal partners, and making the best use of what is already available at home and in the community. We will routinely seek feedback from people of their experience and outcomes which will be used to bring about improvements.

Our voluntary, community and social enterprise (VCSE) partners has delivered a new ‘front door’ to adult social care with an emphasis on making the most of individual and community resources as part of our strengths-based approach. We also have asked VCSE partners to address the issues they themselves have said are the most important, via a Voluntary Sector Alliance.

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What We Do

The Challenges We Face

There is much to be proud of in Torbay and we have long been at the forefront of integrating health and care. However, we know that the demand on the adult care system in Torbay is high and it will only continue to increase due to our ageing population and areas of social deprivation. 27% of Torbay’s population are aged 65 or over, compared to just 18% of population across England. By 2040, this is expected to rise to one in three (34%) of Torbay’s population. As our population ages, we expect the number of frail people, people with physical restricted mobility, slowness, low physical activity, and people with dementia to increase and that they will require support from health and social care services. Frailty estimates for Torbay show that over the next 10 years frailty rates will increase by 25% to over 5000 people. Prevalence data estimates for Torbay show that over the next 10 years, the number of people living with dementia will increase by over 30% to 3300 people.

People with poor physical health are at higher risk of experiencing common mental health problems, and those people with mental health problems are more likely to experience poor physical health. One-in-four adults will experience mental illness during their lifetime. Measures such as depression rates in primary care, and hospital admissions for self-harm and suicides, are higher in Torbay compared to wider England average.

Other issues affecting levels of need are the relatively high numbers of people with a learning disability. A learning disability can be mild, moderate, severe, or profound and affects the way a person understands information and how they communicate. The percentage of GP patients known to have a learning disability is higher across Torbay compared to England, which is also reflected in the high numbers of working age adults accessing adult social care.

As well as facing increased demand, need and acuity we know that our model of care needs further development. Presently we have too many people in long term residential care and not enough people living independently. We also want more people to exercise choice and control over their care and support and yet we know the numbers accessing Direct Payments are below national average. Direct Payments allow people to receive cash payments from the Local Authority instead of care services.  Like other areas we are experiencing unprecedented financial pressures which mean our current system is not sustainable. These challenges are recognised in our Blueprint for Market Transformation (2020-2030) which sets down a radical shift away from the existing provision of care through the growth of extra care, supported living, short term care provision and specialist nursing homes. Extra care housing is used to describe developments that comprise of self-contained homes with design features and support services available to enable self-care and independent living.  Supported living is housing where support and /or care services are provided to help people live as independently as possible. Within Torbay there is vibrant and diverse adult social care market, and the quality of our regulated provision is above national averages. But like everywhere following the pandemic it is increasingly challenged and will need support from commissioners to change to meet the requirements of this Strategy.

As well as having a healthy care market, we recognise that to deliver safe, effective, high-quality care, they we need a workforce of sufficient scale and quality. Again, in line with the national picture, we know our workforce is incredibly strained.   It estimates that the staff turnover rate in Torbay was 33.8%, which was like the region average of 36.0% and higher than England, at 30.0%. Not all turnover results in workers leaving the sector, around half (55%) 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.

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Our Vision for Adult Social Care in Torbay

We have co-produced our vision with our community, voluntary and care sectors working in partnership with Torbay Council and Torbay and South Devon NHS Foundation Trust staff as we work to deliver improved adult social care services for residents in Torbay.

Our shared vision is:

Thriving communities where people can prosper.

We want our residents to have a place to call home, in a community they can be part of, while being empowered to achieve what matters most to them through the best care and support available.

Our mission statement is:

We will work with our local community to support residents in Torbay to maximise their own wellbeing and independence, advising and guiding them around the best health and social care systems for them. Those who offer and provide support services will feel empowered to enable people to engage fully in their own decision making on choices of care. By working with our community this way, we will create a new way of supporting each other to achieve wellbeing for everyone - those receiving support and personal assistance and those giving it.

Our system of care and support will be:

1. Focused on outcomes and wellbeing
   Care and support is focused on promoting our wellbeing in all its facets – physical, mental, emotional and spiritual – and the outcomes we decide are important to us.
   
   It also promotes equity and inclusion by ensuring different groups in the population experience similar outcomes.
2. Personalised, co-created and flexible
   We have a say and shape care and support both individually and at community/ local level.
   
   Care and support adapts to our needs as they change, and recognises our diversity and individual preferences, beliefs and circumstances. When we lack capacity there are advocates to represent our prior wishes and best interests. When needed people will be supported by appropriate interpreting services and advocacy.
3. Proactive and preventative
   We can access support to enhance our health and wellbeing and reduce inequalities across communities. Care and support is easily available at an early stage to help slow or prevent escalation into crisis, or before we have acute care needs.
4. Integrated and coordinated
   The care and support we receive is better joined up around our needs and those of our carers.
   
   Care and support links to and/or includes support around health, housing and employment.  We will build upon the partnership working with Childrens services to ensure seamless transitions from Childrens to Adults services.
5. Local, community and relationship based
   We can access care and support near to where we live, or where our close family and friends are.
   
   Care is based upon relationships rather than being transactional, recognising our interdependence and mutuality. We feel at home and are part of our local community.

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Our Values, Behaviours and Approach

We will co-create personalised and flexible care which is easily accessible and high quality.

Our strengths-based approaches focus on individuals’ strengths (including personal strengths and social and community networks) and not on their deficits. Strengths-based practice is holistic and multidisciplinary and works with the individual to promote their wellbeing. It is outcomes led and not services led. It focusses on “What is Strong”, not “What is Wrong”. 

This model will centre around creating the safe community infrastructure to have real conversations, based in the community, about what people need - such as help with housing, debt and wellbeing; continuing our integrated multidisciplinary working, focussing on personalising our approach to care and support and continuing to invest in community assets and the voluntary and community sector.

We are committed to working and delivering in partnership with the NHS, providers and communities. This means co-producing and co-delivering the approach to everything we do.

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Our Priorities

To achieve these outcomes, we have co-produced the following priorities and the activities which we will carry out to meet those priorities.

Priority 1:  Helping people to live well and independently.

We will:

• Have strengths-based conversations.
• Provide accessible information, advice and guidance.
• Use our community front door and community sectors.
• Provide more support for carers.

Priority 2:  Helping people to regain their independence

We will:

• Provide a rapid/crisis response
• Increase community reablement
• Develop a short-term care centre

Priority 3:  Helping people with care and support needs to live independently, safely and with choice and control

We will:

• Encourage an increase in the use of Direct Payments
• Enable the provision of extra care and supported living housing options
• Have good and outstanding care homes
• Provide specialist dementia care

Underpinning these priorities, we will:

• Develop and grow our workforce
• Engage and consult with service users, their families and carers and our partners

Delivery, Leadership and Oversight

We have a long-standing partnership with Adult Social Care and Torbay and South Devon NHS Foundation Trust and we will deliver our plans together, alongside other key partners outlined below.

The ambitions set out in this Strategy will be delivered alongside related strategies and plans, including the Coproduction Framework in Adult Social Care, the Adult Social Care Transformation and Sustainability Plan, Torbay and Devon Safeguarding Adults Partnerships Strategic Business Plan and our joint Carers Strategy.  We will work in collaboration with our partners including users and carers, Healthwatch, partnership forums, care and support providers, the Community and Voluntary Sector, Devon Partnership NHS Trust, and other key statutory partners.  Partners routinely measure the impact of their work to tackle risk and drive improvements in adult social care.

As we take forward the strategy, successful delivery will be dependent on further engagement and co-production with people with lived experiences and the wider public. We will work with them as equal partners both in the planning and delivery of services so that we learn from their experiences to build a more accessible, responsive, resilient and personalised system.

Torbay has a long and strong history of integrating health and care. To deliver seamless care, Torbay Council has chosen, via a Section 75 agreement, to deliver much of adult social care with Torbay and South Devon NHS Foundation Trust. Within these arrangements the Council remains accountable for adult social care, retaining the lead for strategic commissioning and employing the Director of Adult Social Services (DASS).

The Council will lead the delivery and oversight of this Strategy, but in close collaboration with Torbay and South Devon NHS Foundation Trust. Both organisations will retain leadership and oversight of the implementation and delivery. The Council’s Cabinet and Overview and Scrutiny Board and the Trust’s Board are supported in their leadership roles by the Adult Social Care Continuous Improvement Board (ASCCIB). It provides an independently chaired forum for the partners to oversee their joint work on adult social care, providing support and challenge and escalating any risks and concerns through each organisation’s governance arrangements.  The ASCCIB will provide key oversight of the Strategy going forward.

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