Market Position Statement and Strategic Market Development Plan

Our market-shaping priorities have been developed to align with our ambitions and deliver our improvement priorities for health and social care. They have been informed by data, including our joint strategic needs analysis, and broad engagement with people with lived experience, providers and partners.

A core theme that runs throughout is that of ‘home first.’ It centres on the principle that the best place for people to recover and be cared for is in their own homes, rather than a hospital or care home. Home first offers many benefits both to the person and the wider health and care system. It helps individuals retain their independence, enhances quality of life, and improves overall wellbeing. Home first can also promote quicker recovery, while freeing up hospital beds and reducing the need for long-term care services. This is at the heart of our improvement plans, not only for adult social care but for the wider health and care system.

Our 10 strategic market development priorities are:

1. Community-based prevention: working with the voluntary and community sector to create conditions for community assets to thrive, and connect people with resources that improve wellbeing and prevent or reduce the need for planned care and support.
2. Better choice and flexibility of respite care and breaks for carers, enabling them to look after their own wellbeing and lead healthy and fulfilling lives, while continuing in their caring role.
3. Maximise technology, equipment and adaptations to support independence and reduce the need for care and support services. We will fully integrate technology into how care and support are planned and provided, making technology-enabled care a core part of service specifications and social care practice.
4. Better choice, personalisation and inclusion by supporting the growth of community micro-providers and personal assistants, and increasing take-up of direct payments and individual services funds.
5. My day, my way! We want a diverse choice of inclusive day opportunities that empower people to take part in activities they enjoy, develop new skills and gain employment while making friends and being part of their community.
6. A closer relationship between housing and care: supported housing in all its forms has a key role to play in the future of care. We want to bring care and housing providers together to create high-quality places to live, co-produce innovative service models and develop new career pathways for their combined workforce.
7. A sustainable home care market. We will work with a smaller number of trusted home care providers to co-design and pilot new ways of working, developing more localised approaches that move away from time and task, towards services that are built around people’s lives, focus on outcomes, and create social value.
8. An exemplar, integrated intermediate care model that harnesses the capacity, skills and expertise of the care and support sector, working alongside our in-house services to avoid stays in hospitals and care homes, enable timely discharge, and support people to recover and regain independence.
9. Better choice of care and support for people with specialist and complex needs. We need providers with the right skills, capacity, and environments to meet the needs of people with advanced dementia and people with profound learning disabilities, autism, mental health, and physical disabilities. We want to develop and improve local provision (new and existing) so people have a good choice of accommodation with care and support that improves their independence and enables them to live their best life. People should be supported to remain in a place they call home, be it through times of crisis, or as their health and care needs change over time.
10. Joined-up support for people with complex life circumstances – More people with complex life circumstances are coming to Health and Adult Social Care for help. We want to improve how we work together with partners to provide housing, social care, addiction support, mental health support and healthcare. We also plan to develop and improve our approach to trauma-informed care for North Yorkshire. Guidance on providing a working definition of trauma-informed practice for practioners working in the health and care sector can be found on the government's website.

Delivery of our priorities is reliant on the following core enablers being in place. We must get these right if we are to deliver against our priorities:

Collaboration and co-production

Through co-production and collaboration with people with life experience, partners and care providers, we will develop innovative, localised services that enable people to lead the lives they want to live.

People with lived experience

People are experts in their own lives and their voices must be at the heart of health and adult services. Only by listening to and working with people and communities can we design and deliver effective, high-quality and inclusive services in North Yorkshire.

It is important that we do not just engage when we have planned projects. Ongoing conversations are vital. They build relationships of trust and enable us to listen to what our communities want to tell us, not just put forward the questions we want to ask. We will be open to people’s ideas and look for opportunities for us to work together. Working with local networks and lived- and living-experience voice groups, we will support communities to talk about the things that matter to them and be actively involved in the planning and design of services. We want to empower and support our communities and aspire to enable communities to take the lead where appropriate.

Working with care providers and their staff

We are fortunate to have developed strong working relationships with care providers and will continue to build on this. We recognise the role of providers as key strategic partners in the health and care system and value their knowledge and expertise in helping us to co-produce solutions, not only as providers of services but also as advocates for the people they support.

We commission the Independent Care Group to be the voice of the provider market. The Independent Care Group represents local providers and is a key member of the market development board. It is actively involved in the development of market transformation and sustainability plans and regularly hosts engagement events for providers.

We will create further opportunities for engagement and co-production through existing mechanisms such as our regular forum with care providers called ‘Care Connected’. Care Connected brings together all provider types and is a joint venture between ourselves, York City Council and Humber and North Yorkshire Integrated Care Board.

The service development team is creating new avenues of discussion with bi-monthly provider surgeries and provider forums. Specific one-off engagement events will also be arranged to discuss ideas and opportunities for developing or improving services.

We have a Market Development Board that brings commissioners and providers together on a regular basis to provide strategic direction in relation to market development activities. The role and remit of this group are currently under review.

Equality, equity, diversity and inclusion

Putting these principles at the heart of everything we do helps to ensure that services are responsive to the needs of all individuals, leading to better outcomes and a more equitable care system.

We will use data, and engage with community groups and individuals to create actionable insight into the things that matter most to people. We will also ensure our commissioning, procurement and contracting processes support and enable a diverse and inclusive care market that can meet the needs and preferences of our communities.

Valued, diverse and skilled workforce

We need to work together to improve the perception and experience of a career in care. We will support and encourage providers to embrace diversity and inclusivity in their workplace and take steps to ensure care workers are valued through their pay and working conditions. We will work collectively to address recruitment and retention challenges, develop knowledge and skills and support career progression.

Value for money

Our market conditions mean that the cost of care is relatively high in North Yorkshire.

Whilst we have a duty to promote the efficient and effective operation of the adult care market, we also have a responsibility to ensure public money delivers the best and most cost-effective outcomes. Ensuring commissioned services deliver value for money is therefore a key priority for us. This will be achieved through a combination of managing activity and demand, service innovation and market shaping activity.

North Yorkshire is England’s largest county, covering an area of over 8,000 square kilometres. The total population is 623,500, 25% of whom (158,300) are over 65 (2022 mid year population estimates (ONS)). This figure is expected to increase to almost a third by 2035, based on projected trends and the inward migration of older people.

North Yorkshire has some urban areas and is also highly rural, with up to 85% of the county being classified as ‘super sparse’. This results in a population density of just 78 people per square kilometre, compared with an England average of 438.

The county is also home to Catterick Garrison, which is the largest British Army garrison in the world, with a population of over 13,000.

Overall, North Yorkshire is a good place to live and work:

• 80.6% of the working-age population are economically active, compared with 76.8% for the Yorkshire and Humber region and 78.8% nationally
• large parts of North Yorkshire have life expectancy rates above the England average
• 2021 Census data paints a positive picture for wellbeing and education indicators and for some economic indicators
• North Yorkshire is one of the least deprived local authority areas in England, ranked 127th most deprived out of 151 upper-tier local authorities (index of multiple deprivation (IMD 2019))

However, there are pockets of deprivation and inequality across the county. 11 neighbourhoods in North Yorkshire are among the 10% most deprived areas in England, predominantly in the east of the county.

The gap in life expectancy varies across the county between our most and least deprived wards; for males, there are 15.5 years difference in life expectancy between the ward with the highest life expectancy (Hipswell 88.2 years) and the ward with the lowest life expectancy (Whitby West Cliff 72.7 years). For females, the difference is 12.6 years between Claro (90.8 years) and Knaresborough Eastfield (78.2 years). We want to close these gaps, thereby reducing health inequalities. Nationally and locally, existing health inequalities were made worse by the pandemic. Understanding and addressing these inequalities continues to be a focus for our work and our partners.

High levels of rurality bring other inequalities, for example, access to services, fuel poverty, affordable housing, and digital exclusion. Census data shows that North Yorkshire performs below average for economic indicators relating to transport and broadband.

North Yorkshire has relatively low levels of ethnic diversity. 6.7% (Census 2021) of North Yorkshire’s population define their ethnicity as other than White British. Where ethnicity information is provided 2.9% of people referred to adult social care and 2.5% of people using services identify as other than White British. While the percentage of people from an ethnic minority background referred to social care does not reflect the overall population, the difference is less stark when looking at working-age adults (18 to 65 - 5.52% / 6.73%), and even closer for the 18 to 30 age group (6.51% / 6.73%). Further work is underway to explore this in more detail and understand how we can improve access to services for people from diverse backgrounds.

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 read the Annual Director of Public Health Report, or access the Census 2021 data for North Yorkshire on the Office for National Statistics website.

Providers can also access population data and projections at:

Projecting Older People Population Information System on the POPPI website
Projecting Adult Needs and Service Information System on the PANSI website

We are responsible for providing and commissioning social care services across coastal and market towns, villages, hamlets, and vast swathes of rural hinterland. Because of this, we have one of the largest adult care markets in the country with approximately 200 registered care homes; 150 commissioned home care agencies, and over 5000 voluntary and community sector organisations.

As is the case nationally, the social care sector in North Yorkshire is facing significant pressures. Cost of living; a highly competitive labour market; NHS pressures; an aging population and increasing complexity and acuity of need; are all impacting adversely on the sustainability of the market. These challenges are further exacerbated by the size and rurality of the county. Lower population density makes economies of scale difficult, resulting in reduced choice and a ‘rural premium’ for service delivery.

As one of the highest numbers of self-funders in the country North Yorkshire is an attractive place for independent sector care providers to invest, with a particular focus on attracting and retaining private clients. However, this also reduces the capacity for local authority-funded services, drives up costs and makes it difficult for us to shape and influence the market.

We have a relentless focus on prevention and wellbeing to enable people to lead full and active lives within their own homes and communities. This helps us to prevent, reduce and delay the need for long-term care.

As a council, we have invested heavily in our in-house prevention services to complement a wider programme of prevention and wellbeing led by local communities. More information can be found in the Prevention Services section.

‘Home First’ is always the priority - whether someone needs help with day-to-day tasks or is ready to leave the hospital following an illness or operation. Wherever possible, our ambition is for people to remain in or return to their own home environment with the help of informal support networks, technology or equipment or short-term help to enable them to keep their independence.

Demand for services in 2023 to 2024 - facts and figures

• 15,680 people used social care support, 70% (11,020) were aged 65+
• 31% (1,440) of people aged 18-64 who used support (4,660) had a learning disability recorded as their primary support reason
• 9,880 people used long-term support, 35% (3,450) of those people received long-term residential or nursing support during the year
• 87% of people using long-term residential or nursing support were aged 65+, this reduced to 61% for people using long-term community-based support
• 3,330 people used short-term support, 56% (1,880) of those people used short-term residential or nursing support during the year
• 94% of people using short-term residential or nursing support were aged 65+, this reduced to 90% for people using short-term community-based support
• North Yorkshire has 246 Residential Self-funders and 183 Community Care Self-funders per 100,000 people, making us the 16th highest for Residential and 18th highest for Community Care in England (CQC provider information return, September 2024)

Adult social care survey 2022 to 2023

• overall satisfaction of people who use services with their care and support – 67.7% compared with 61.2% (England) and 62.7% (Yorkshire and Humber) – North Yorkshire was ranked 18/151 local authorities, where a low number indicates better relative performance
• proportion of people who have control over their daily lives – 80.1% compared with 77.2% (England) and 77.6% (Yorkshire and Humber) – North Yorkshire was ranked 37/151
• social care related quality of life 19.2 compared with 19.0 (England) and 19.2 (Yorkshire and Humber) – North Yorkshire was ranked 16/151
• proportion of people who use services who have as much social contact as they would like – 50.0% compared with 44.4% (England) and 46.3% (Yorkshire and Humber) – North Yorkshire was ranked 16/151

Council expenditure on social care

The adult social care net spend for 2022 to 2023 was over £200 million. Of that, almost £166 million was spent on care and support, including commissioned services. It is estimated that the Local Authority purchases around 50% of care in North Yorkshire, with the remaining 50% being purchased by the NHS and self-funders.

Table 1: Our expenditure on social care 2022 to 2023

For more information about how we have performed in adult social care, including how we spend our budget, you can read our health and adult services local account page.

We use YORtender to advertise tendering opportunities and manage the procurement process electronically. Further information about our approach to procurement can be found on our website.

Approved provider lists

We use approved provider lists (APL) to commission adult social care services. The current approved provider lists run from 1 November 2022 until 31 October 2027, with an option to extend for a further period of up to 24 months.

We have four approved provider lists:

• home-based support including home care, practical support and live-in care
• community-based support
• residential and nursing
• support living

Our approved provider lists are open to independent, not-for-profit and voluntary and community sector organisations.

Providers who wish to work with us must submit an application for approval before being considered for any packages of care or placement. The approved provider lists remain open for their duration. This means providers can apply to join at any time. Further information regarding the provider lists and the application packs are available through YORtender. Information can be found on the YORtender website.

When providers apply to join our approved provider list, they can submit rates that are sustainable for the duration of the contract. When setting fees, providers need to be aware that joining the approved provider list does not guarantee business with us. All new packages of care are sourced by our in-house brokerage team using a ‘best value, best match criteria.’ This means contracts are awarded to the provider that can meet the required outcomes at the lowest cost.

Our approved provider lists and frameworks enable us to spot purchases from the market at pre-agreed rates. They also provide a solid basis upon which we can work with trusted providers to co-produce innovative and flexible commissioning and delivery models. This may include outcome-based commissioning, block contracts or blended models that share risk and enable greater choice and personalisation. When opportunities arise to deliver services differently or co-produce new delivery models, approved provider list providers are invited to submit expressions of interest.

Frameworks

In addition to our approved provider lists, we have an extra care framework that allows the delivery of standard model extra care. This includes a mix of developers and housing providers who have committed to building and providing high-quality extra care services. Our current framework ends in September 2025, and we are now actively exploring options for the future delivery of extra care housing to meet the needs of an aging population in North Yorkshire.

Block contracts

We also commission block contracts outside our approved provider lists. These tend to be for preventative or statutory services and are often commissioned jointly with the NHS. When awarding these services, we will follow our procurement and contract procedure rules and will usually require some form of procurement process to identify the relevant award procedure.

Contract management

The contract management team within health and adult services is responsible for the oversight of contracts ensuring they are delivering value for money; meeting performance expectations and delivering services against the contract specifications. This is monitored through annual reviews and other data and intelligence gathered. The team is also the main point of contact regarding fees or any other contractual issues.

Cost of care and financial sustainability

We review fees every year. We consider annual inflationary factors, wider market forces, feedback from providers, cost of care exercises and other relevant benchmarking data. This helps to ensure the fees paid by ourselves remain fair and sustainable for providers, the council, the NHS and people who pay for care and support. Any inflationary award is made at our discretion.

In addition, we have a provider sustainability policy that sets out our risk-based approach to supporting providers where there are sustainability concerns.

We are also implementing ‘care cubed’ - a cost modelling tool that calculates a fair price for care for placements in care homes and supported living. This will help us to ensure we have a care market that provides a fair and sustainable cost of care and provides an evidence-based baseline of care costs. It will offer clarity and transparency to the cost of care for both commissioners and care providers.

NHS partners

We work closely with our NHS partners. This includes three integrated care boards (ICBs); four acute and community NHS trusts, one community NHS trust; two mental health NHS trusts and over 70 GP practices.

Most of the county is covered by Humber and North Yorkshire Integrated Care Board. West Yorkshire Integrated Care Board covers our Craven locality. In addition, people living in the Bentham and Ingleton areas are registered with GPs who are part of the Lancashire and South Cumbria ICB.

The North Yorkshire Health and Care Partnership (NYHCP) include health and care organisations from across North Yorkshire who work together to improve the health of our population, so that all residents of North Yorkshire have a fair chance of living a fulfilling life, free from preventable ill health, ‘adding years to life and life to years’. The North Yorkshire Health and Care Partnership has outlined the following priorities:

• a comprehensive and integrated health and social care model
• a high-quality care sector, with sufficient capacity to meet demand
• a strong workforce
• prevention and public health: adding life to years and years to life.

Joint commissioning with the NHS

We have a long-established joint commissioning arrangement with the integrated care boards. This includes joint commissioning for CHC joint-funded packages, Section 117 aftercare and a number of key strategic contracts for statutory and preventative services.

Where we and an integrated care board agree to joint funding for a package of care through continuing health care or Section 117 aftercare, we are the lead commissioner. This means we arrange and pay for the care and charge the NHS separately for their contribution. Integrated care boards are responsible for paying funded nursing care (FNC).

As a health and care system, we are working together to develop more integrated working arrangements. We have established an adults joint planning and commissioning group that brings together senior leaders from the council and the integrated care boards. The group provides strategic direction in relation to joint or integrated planning, commissioning, and delivery to maximise value for money and deliver the best possible outcomes for adults in North Yorkshire.

A series of strategic market development delivery groups are being developed to sit under the joint planning and commissioning group. These delivery groups bring together a broad range of health and care stakeholders from social care, integrated care boards, NHS Trusts and provider representatives, to co-ordinate and deliver our strategic market development plan.

Voluntary and community sector

North Yorkshire benefits from an active, innovative, and diverse voluntary, community and social enterprise sector (VCSE). We recognise and hugely value the sector’s role in our integrated health and care system, bringing local knowledge, insight and creativity to develop local solutions that help people, and their carers have a better quality of life. The sector plays a critical role in our prevention strategy, offering a broad range of asset-based support to prevent, reduce and delay the need for planned social care support.

We are embarking on the co-production of a joint voluntary, community and social enterprise commissioning strategy with the integrated care board, voluntary, community and social enterprise partners and other key stakeholders. Through the strategy, we aim to achieve excellent health and social care outcomes through more joined-up commissioning. By working together and focusing on co-production, inclusivity, and sustainability, we want to create a strong and sustainable voluntary, community and social enterprise sector that significantly improves the health and well-being of North Yorkshire residents.

There will be many opportunities for voluntary, community and social enterprise organisations to be involved in strategic conversations, including through the age-friendly network, which is a joint integrated care board/North Yorkshire Council funded project, through the North Yorkshire Council stronger communities programme, and via a grant-funded voluntary sector infrastructure provider. Additional engagement will take place through the recently established North Yorkshire voluntary, community and social enterprise assembly, commissioned by the integrated care board voluntary, community and social enterprise collaborative.

Community anchor organizations

Community anchors can be described as central hubs within the community that provide essential services, foster local connections, and drive community-led initiatives. These organisations play a fundamental role in the development of services and support involving the voluntary, community and social enterprise sector. They serve as essential pillars in advancing preventive initiatives, acting as 'system' partners working under an 'alliance' arrangement.

Funding for 2024-2025 marks the second year of a three-year agreement from us, aimed at developing capacity and ensuring financial sustainability.

The future shape and scope of these organisations will play a fundamental role in supporting the core aims of the public health funded stronger communities programme which include:

• prevention and reducing health inequalities
• community resilience
• social regeneration

The overarching approach of the programme is to build stronger strategic and operational relationships with a network of community anchor organisations (who are already delivering a range of services funded in a variety of ways). The ambition is to work together to achieve shared ambitions, developing their role as trusted place-based ‘system partners’ who routinely work with partners to improve community well-being and resilience.

In North Yorkshire, there is a diverse social care workforce split between roles in local authority, the independent sector, and voluntary community and social enterprise providers, alongside roles supporting direct payment recipients.

We are gathering workforce data from providers through capacity tracker. This provides insight into the workforce profile, allowing us to target our workforce development initiatives.

Capacity tracker data from 30 April 2024 suggested that almost 14,000 people work in regulated care services (care homes and home care) that are registered in North Yorkshire (see table 2). Since 2022, the number of home care workers remain at a similar level, whereas the number of workers in care homes has increased. The use of agency workers has also increased.

The number of home care workers however is likely to be much higher than shown in the table as it only includes services that are registered in North Yorkshire. We have several agencies that are registered outside the County.

Skills for Care estimated that the staff turnover rate for North Yorkshire (all sectors of regulated care) was 25.5% from 2023 to 2024, slightly higher than the average for England which is 24.2%. This is slightly higher in the independent sector at 26.8%. Not all turnover results in workers leaving the sector, over half were recruited from within the adult social care sector, meaning the sector retains their skills and experience.  

Providers across North Yorkshire are facing challenges with staffing, and agency use has increased. Capacity Tracker data shows that overtime and sickness rates are high. However, the vacancy trend has reduced from 8.6% in 2022 to 2023 to 6.5% in 2023 to 2024, while this is slightly lower for independent providers at 6.3%. Recruitment continues to be a challenge with a reported lack of applicants. Staff shortages result in a reliance upon agency staff, which is also struggling to meet the demand. An increasing number of providers are recruiting from overseas to fill vacancies. This is predicted to change when factoring in reforms to the sponsorship regime and work visas.  

Providers report that staff leave the sector due to higher pay in other sectors, such as hospitality and retail, and no longer have a desire to work in social care.  

The average age of a worker is 44 years old (Skills for Care).  There is a lack of younger people entering the social care workforce: 

• 8% of the workforce is aged under 25
• 65% are aged 25 to 54
• 27% are aged 55 and above

While international recruitment has successfully addressed immediate workforce shortages, if we do not improve recruitment and retention over the next three to five years, we will reach a crisis point as visas expire and a large proportion of the workforce will be retiring.

International workforce

Responsible sponsorship of care workers can offer many benefits, not only to recruitment and retention but also by bringing in fresh perspectives, improving cultural diversity and driving up quality. It also helps to sustain and develop the care market, evidenced by the significant reduction in the number of unsourced packages of care in North Yorkshire and a reduction in hourly rates.

Skills for Care estimated that by December 2023, the independent sector had recruited 32,000 international recruits in England, 2,000 of which were employed in the Yorkshire and Humber region. Our data suggests approximately 140 regulated care providers in North Yorkshire have sponsored care workers. Further work is being done to identify the total number of international workers delivering care in North Yorkshire.

However, there is now an oversupply of staff in some areas, particularly in the home care market. Some care providers are unable to provide the required number of hours required to sustain visa requirements. High levels of sponsorship licence suspension and revocation have highlighted the urgent need to achieve good, compliant sponsored employment, as well as ensuring established, well-paid, full-time (where desired) work is provided for all in the care sector. Work is ongoing to support the sector in its use of international recruitment and to ensure these staff are aware of their employment rights.

Yorkshire and the Humber have secured £1.505m for 2024-2025 to deliver a recruitment matching service for displaced workers. Our Make Care Matter service provides this service to sponsored migrants whose employers have had their licence revoked.

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
• ensure the recruitment and retention of a more stable workforce through more sustainable pay, conditions, and training levels

You can find out more about the charter on the Unison website.

Supporting the care sector

Our HR business partner for the independent sector workforce supports providers with recruitment, retention and workforce training and development. This post works closely with our system partners, supporting various workforce workstreams, such as the Humber and North Yorkshire Health and Care Partnership Breakthrough programme. Working jointly with the partnership, the council recruited a registered manager legacy mentor to offer coaching and mentoring support to Registered Managers across the region.

For more information, please contact us.

Training and development

The portfolio of courses our training and learning service currently offers to providers includes those that collectively make up the Care Certificate. This is the mandatory induction pathway for staff to be compliant and assured of working in adult social care. We also offer leadership and management training, and a wide range of courses that we can deliver as part of health and adult services training requirements. In addition, we offer bespoke courses tailored to individual provider requirements. Quotes can be provided to services that require training courses that are not on the current offer. For further information, please contact us.

Recruitment and retention

We are keen to support providers to recruit a more inclusive workforce, with opportunities for people with different backgrounds, and support for those who would not usually work in social care.

We proactively support providers with recruitment through our Make Care Matter Recruitment Hub. The hub offers free-of-charge support to care providers with their recruitment. We also run regular recruitment campaigns and events and help providers access regional and national opportunities to help address recruitment and retention challenges.

Make Care Matter provides support to all job seekers who wish to pursue a career in the care sector providing advice regarding applications, interviews and starting their career in care. The service has expanded support to displaced sponsored migrants whose employers have had their sponsorship licence revoked and where they need to secure alternative sponsored workers within 60 days.

Visit the Make Care Matter Recruitment Hub here

Extended professional recruitment services can be accessed by care providers for all their recruitment needs on a paid-for basis.

Overall, the quality of care is good across social care services in North Yorkshire with local performance ranking higher than both regional and national averages. As of March 2024, 84% of care home provision and 91% of community-based care providers were rated as ‘good’ or better by the Care Quality Commission (Care Quality Commission API) (see table 3).

Ourselves and Humber and North Yorkshire Health and Care Partnership (HNYHCP), work together to deliver an integrated approach to quality assurance and quality improvement. The integrated quality team (QT) proactively supports providers with quality concerns to improve quality and reduce the impact of provider failure. The team’s work is well-received, and the providers they have supported are receiving improved ratings in their most recent CQC inspections.

The City of Bradford Council has produced a helpful dashboard that summarises CQC ratings for providers in the Yorkshire and Humber Region. View the dashboard on the City of Bradford Council's website.

Provider failure

Between June 2023 and May 2024, seven home care services and one care home closed, impacting 189 people. Two home care closures were linked to the consolidation of offices, two were based on financial viability and two were linked to the revocation of sponsorship licences. In the preceding year, most provider failures were in residential care settings and were linked to quality concerns.

On 1 April 2023, eight councils including the former North Yorkshire County Council formed to become one unitary council – North Yorkshire Council. Adult social care continues to operate on a countywide level, as it did prior to Local Government Reorganisation. Given the size of the county, it is helpful to understand the care market within each of our five localities. While the challenges faced in each locality are often similar, there are variances, and providers looking to plan and develop services will need to factor in the physical geographical differences.

View a map of our locality boundaries here

View locality profiles here

Hambleton and Richmondshire

Hambleton and Richmondshire are predominantly rural localities with populations centred in the market towns of Northallerton, Stokesley, Bedale, Richmond, and Leyburn. The rural nature of these areas affects service commissioning and delivery, particularly given their ageing populations. We are working to understand future demand for residential, nursing, and challenging behaviour placements for dementia - sourcing these placements has become increasingly difficult and complex in this locality.

Northallerton has a higher population of people with learning disabilities than other towns, likely due to available services and better transport links. We are also exploring future support needs for those with learning disabilities and dementia, working with community-based providers to share best practices and collaborate on commissioning.

Home-based support in Hambleton and Richmondshire is diverse, with low numbers of unsourced care packages over the past year. However, sourcing care in super-rural areas remains challenging.

Harrogate

The Harrogate locality includes the urban areas of Harrogate Town, Knaresborough, and Ripon, alongside numerous smaller villages. Uniquely its health and care services are overseen by the Harrogate and Rural Alliance. This collaborative approach with NHS colleagues aims to integrate health and social care services across the locality, streamlining service delivery.

The Harrogate locality is well-supported with numerous home care providers. Day service opportunities are abundant in Harrogate Town, Knaresborough, and Ripon, addressing mild to moderate needs for learning disabilities, autism, older people mental health, and dementia.

Care home fees in Harrogate are higher than in other parts of North Yorkshire – this is driven by a large self-funder market, high land and property costs and low unemployment. Workforce recruitment and retention is a challenge for all care sectors.

Harrogate has a higher prevalence of supported living properties, a large residential college and diverse day services, attracting younger adults with autism, learning disabilities, and mental health needs from across the county. However, there are clear gaps in complex care provision, both specialised accommodation and day services.

Craven

Craven is a predominantly rural and super rural area, with populations centred in the market towns of Skipton, Bentham, Settle, and Grassington. Additionally, the expanded villages of Sutton-in-Craven, Cross Hills, and Glusburn are now regarded as a single entity. This area falls within the boundaries of West Yorkshire ICB and the Bradford and Craven District Health Partnership.

Craven has three Extra Care schemes located in Skipton, Settle, and Bentham, all of which are well-utilised. One of these schemes features a permanent respite suite, which is unique to the county.

There is a notable lack of supported living accommodation in the Craven locality for working-age adults with autism and learning disabilities. Additionally, residential options for working-age adults with learning or physical disabilities are severely limited. Furthermore, there is a distinct shortage of community-based day services throughout the locality for all needs.

Scarborough and Whitby

The Scarborough and Whitby locality includes the main coastal towns of Scarborough, Whitby, and Filey, along with an expansive rural and super-rural hinterland.

The locality has some of the most deprived areas in the county (in both Scarborough and Whitby town centres). Despite this, Scarborough, Filey and Whitby remain a favoured destination for retirement, attracting a growing older population, while simultaneously witnessing a decline in its younger working-age demographic. This has created a significant workforce shortage across the care sector (further exacerbated by buoyant retail and tourism sectors offering competitive rates of pay).

Challenges within deprived areas are multifaceted, including high rates of illness and hospital admissions, substance misuse, unemployment, and an increasing number of individuals living with life-limiting conditions or disabilities. These require a nuanced approach to care provision, involving tailored interventions to meet the diverse needs of specific individuals and communities.

Throughout the locality, there are clear gaps in provision around nursing care, complex dementia care and purpose-built specialist accommodation for both older and younger people across all care types. Many existing buildings (particularly in Scarborough) are not suitable to be re-purposed as care facilities. In Whitby and surrounding coastal villages, there are gaps in home-based support, due to the challenging nature of the terrain and travel time.

Community-based support is a more buoyant aspect of the care landscape with a mixture of urban and rural day service provision for people with mild to moderate learning disabilities – although more support for older people, particularly those living with dementia, is a requirement. Services such as Shared Lives are particularly active in the locality.

Vale of York

The Vale of York Locality is divided into three distinct areas, Selby, Ryedale and South Hambleton. It covers a vast expanse of North Yorkshire stretching from Thirsk in the north to the borders of Wakefield, Doncaster and Goole to the south.

Selby has three market towns, Selby Town, Tadcaster and Sherburn in Elmet, in addition to over 60 villages, which vary in size and facilities. Ryedale is sparsely populated, with populations concentrated in the market towns of Helmsley, Kirkbymoorside, Pickering and Malton. South Hambleton is also predominantly rural, with two market towns – Easingwold and Thirsk.

As with many rural parts of the county, sourcing home care is a challenge – gaps in provision are particularly acute along the eastern flank of Ryedale, bordering the Scarborough / Whitby locality. There is also a need for more purpose-built supported living accommodation across the entire locality. Expanding the availability of supported living facilities, including small-scale developments with on-site care, could help address this gap.

Social isolation and loneliness are significant concerns, especially among older adults and individuals living in rural areas. There is a need for more community-based programmes and services that promote social engagement, companionship, and inclusion to combat feelings of isolation and improve overall well-being (particularly in Ryedale and South Hambleton).

Family carers in these areas often fill gaps in provision. However, they lack access to support services and respite care options, leading to carer burnout and increased stress levels. There is a need for initiatives that provide practical support, information, and resources to carers enabling them to better cope with their caregiving responsibilities.

Alternatives to residential care services, such as Shared Lives, are extremely limited across the locality.

Prevention is about helping people stay healthy, happy and independent for as long as possible, therefore adding healthy years to life. Our focus on prevention and public health aims to

• improve quality of life by creating and promoting health and wellbeing
• reduce health inequalities
• save our public services from the spiralling costs of treating avoidable illness and ongoing needs
• improve the efficiency and wellbeing of the workforce

This means reducing the chances of problems from arising in the first place and, when they do, supporting people to manage them as effectively as possible. Prevention is important across all life stages; adding years to life and life to years.

Across North Yorkshire, we offer a range of prevention services that focus on specific interventions to avoid the onset of diseases, reduce/ delay health problems before they occur and support people living more independently.

Our in-house prevention services complement our wider programme of prevention. Our Living Well service supports individuals in making changes to their lives which prevents them from needing formal care and support. Living Well coordinators work with individuals who may be on the cusp of needing formal social care, by visiting them in their homes and working with them on a one-to-one basis. Living Well helps individuals to identify solutions to address their health and wellbeing goals, connecting individuals to assets, activities, and groups in their local community. On average 60% of people referred to Living Well are diverted away from requiring adult social care services. This is an innovative service and is planning a wider scope of preventative support for people living with dementia, autism, and unpaid carers. Living Well teams are also present in hospital discharge hubs as a preventative model to support people to integrate themselves back into their local community.

Our communities service works with local residents, community groups and other partners from the public and private sectors across North Yorkshire, identifying opportunities to co-produce a range of local support and services aimed at reducing inequalities, and improving the wellbeing and social connectedness of people of all ages. The service develops the community infrastructure, which, combined with Living Well, takes a holistic approach to individual and place-based asset development.

Our public health team works on a broader level of prevention that focuses on protecting and improving health at the population level. The health improvement domain of public health focuses on enhancing the overall wellbeing of individuals and communities through creating healthy environments, health promotion and prevention interventions. Within North Yorkshire the public health commissions sexual health services, NHS health checks, drug and alcohol services, 0-19 healthy child programme and an in-house provision for smoking cession, mental health and suicide prevention training. More details are available on our healthy living page.

As well as investing heavily in in-house prevention services, we also invest in preventative services delivered by the VCSE across North Yorkshire. This includes:

• wellbeing and prevention: The aim of the wellbeing and prevention service is to help people stay well and independent in their local communities and reduce the demand for long-term statutory services, care and support. A budget of approximately £450,000 per annum funds grants to 25 organisations delivered on a community footprint from April 2023 to March 2026.
• carers support services and carers sitting/short breaks service
• 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. A budget of approximately £246,000 per annum funds six community-based organisations. Contract runs to 30 September 2025
• dementia support and advice service: Delivered by Dementia Forward, the service offers signposting and support for people living with or suspected to be living with dementia, their carers and families. Dementia Forward is a key partner in the North Yorkshire Health and Care system and has been instrumental in the delivery of our Bring Me Sunshine – Living Well with Dementia in North Yorkshire” strategy. The contract, which was commissioned in 2019, will run for a maximum of 10 years with an annual budget of approximately £381,000. More information on living with dementia 
• home from hospital service to help people return home, rebuild confidence and prevent hospital re-admission. Visit the Carers' resource website for more information
• strong and steady – targeted and universal physical activities
• pathways to health – walking and well-being

Prevention services – messages to the market

The public health commissioned service contracts are dependent on the public health grant from the national government. The local authority must meet the expectations from the grant to spend on mandated services. Commissioning opportunities will be advertised on YorTender once available for more details please contact us.

VCS infrastructure contract

Ourselves and the ICB grant fund a voluntary sector infrastructure provider to support and build capacity in grassroots VCSE organisations. It facilitates networking and collaboration among VCSE groups and the wider health and care system, and advocates for the VCSE, influencing policy and decision-making. This service is in the process of being re-procured, with the market engagement phase having recently commenced. For more information about the VCSE infrastructure contract, please contact us.

A carer is anyone who cares, unpaid, for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support. Carers are holding families together, enabling those they care for to get the most out of life, making an enormous contribution to society and saving the economy billions of pounds. We know that caring can have a significant impact on health and wellbeing, finances, family life and employment.

Some key facts from Carers UK show that:

• between 2010-2020, people aged 46-65 were the largest age group to become unpaid carers. 41% of people who became unpaid carers were in this age group (Petrillo and Bennett, 2022)
• 60% of carers report a long-term health condition or disability compared to 50% of non-carers (Carers UK analysis of GP Patient Survey 2021)
• unpaid carers in England and Wales contribute £445 million to the economy every day – that’s £162 billion per year (Petrillo and Bennett, 2023)
• caring comes with additional costs that can have a significant impact on carers’ finances and many carers suffer financial hardship. 44% of working-age adults who are caring for 35 hours or more a week are in poverty. (Joseph Rowntree Foundation, UK Poverty 2022)

The 2021 Census reports that there are 53,723 unpaid carers living in North Yorkshire, of these, 60% of females provide unpaid care. This equates to 8.6% of the usual resident population aged five years and over, which is slightly lower than the England figure of 8.9%. Over 15,000 of these provide 50 or more hours of unpaid care a week. The proportion of people providing 50 hours or more of unpaid care a week increases with the age of carers.

We have commissioned a carers’ support service and a carers break service to support the wellbeing of carers, enabling them to continue in their caring role for as long as they want. Demand for these crucial services continues to increase due to:

• an ageing population
• the increasing number and complexity of people caring for relatives with dementia
• parents caring for disabled and autistic children, for longer

There are also challenges in recruiting volunteers to ensure that carers’ services can meet demand, particularly for the carers’ break service.

A refreshed carers strategy will be available by the end of 2024. This is an update of the all-age strategy launched in 2017 Caring for Carers which had a proposed end date of 2022. More information can be found on North Yorkshire Partnerships website.

For more information on support available for adult care visit our carers page.

Carers support service

Carers support service is an all-age service that supports young carers, parent carers and adult carers. It is jointly commissioned with children’s services, with a budget of approximately £722,000 per annum. The service is delivered by two VCSE providers:

• Carers Plus (covers Hambleton, Richmondshire, Scarborough, Whitby, Ryedale)
• Carers Resource (covers Harrogate, Craven and Selby)

The carers support service enables carers to look after their own mental health and wellbeing, by supporting them to access opportunities for work, training, education, leisure, and social interaction. The service does this by providing carers with emotional support, information, advice and guidance, and peer support. Between January and December 2023, the carers’ support service provided information and support to over 1,800 carers across North Yorkshire.

Carers break service

The carers break service is delivered by three lead VCSE providers working in partnership with 11 community-based organisations. The contract runs from 1 October 2023 for a maximum of seven years, with a budget of approximately £320k per annum.

The three lead providers are:

• Carers Resource – covering Harrogate, Craven and Selby
• Ryedale Carers Support – covering Ryedale, Scarborough, and Whitby
• Hambleton Community Action – covering Hambleton and Richmondshire

The service arranges for volunteers to spend time with the cared-for person either in their own home or by helping them take part in activities within their community. This provides the carer with time away from their caring role. Between 1 October 2023 and 31 January 2024, a total of 281 carers have received a break from their caring role.

Family carers often lack access to support services and respite care options, leading to caregiver burnout and increased stress levels. There is a need for initiatives that provide practical support, information, and resources to carers enabling them to better cope with their caregiving responsibilities.

Respite care and short breaks

Respite care, also known as short breaks or replacement care, is any care arrangement designed to give rest or relief to unpaid carers. It aims to support carers to have a break from their caring responsibilities.

As well as the carer break service described above, people in North Yorkshire can also access community day services, or if the carer needs a longer break, the cared-for person can have a short stay in a care home.

However, the capacity for short stays in care homes has decreased over recent years. Many homes are reluctant to book respite in advance as hospital discharge or permanent placements take priority. This means there are limited opportunities for carers to take a longer break. We also know that people can be reluctant to stay in a care home, and carers do not always want to leave their loved ones in a care home. We are therefore looking to increase the choice and availability of respite care. We are particularly keen to increase the use of direct payments, Shared Lives, extra care and live-in care to give people a much-needed break from their caring responsibilities.

Support for carers: Messages to the market

We are very keen to broaden the range of services to enable carers to take a break and would be pleased to hear from providers looking to co-design this type of service. We are keen to expand opportunities to support cared-for people in the community, be it in their own homes, housing with care, or in the homes of others - for example through Shared Lives.

There are no immediate plans to reprocure the carers support and carers break contracts, given they run from 2023 for a maximum of eight years.

Accelerated reform fund

We have secured funding from the Accelerating Reform Fund working as part of a Humber and North Yorkshire Consortium to support innovations that focus on shared lives and support for unpaid carers, particularly on ways to better identify unpaid carers and support carers to have breaks. We are currently considering a range of options and will engage with providers about any opportunities.

While existing carers’ services do respond to a wide range of needs of adults, there are potential opportunities to deliver support to carers in more specialised situations, such as carers of people with chronic mental health conditions, drug or alcohol misuse, dementia, and parent carers of disabled children.

Accelerating reform fund for adult social care guidance can be found on the government website.

Technology enabled care

Technology enabled care (TEC), also known as assistive technology, refers to assistive devices and technologies that enable people to live healthier, independent lives. Technology enabled care in North Yorkshire has moved on from the provision of traditional social alarms and environmental sensors (Telecare). We now use a bespoke range of solutions to match people's outcomes, helping to maintain or improve a person’s functional capabilities. With technology enabled care, we aim to maintain or improve an individual’s safety and independence to facilitate participation, enhance overall wellbeing, and prevent or reduce the impact of impairments and secondary health conditions.

Technology enabled care supports our wider programme of prevention, by using proactive and reactive technologies in and around a person’s home to help to prevent, reduce, and delay the need for, or complement traditional social care support. It can also prevent hospital admissions and support early discharge.

Our current commissioned service is provided by NRS Healthcare who deliver an end-to-end service including assessments, provision, an alarm receiving centre and responders across the whole county. This service is available to people who:

• have been identified as having an eligible need under the Care Act 2014
• have recently been discharged from hospital
• require a period of reablement

As of April 2024, we fund assistive technology solutions for over 1500 adults living in the community.

Community equipment

The North Yorkshire and York Integrated Community Equipment Service is commissioned by the Integrated Care Board, in collaboration with ourselves and City of York Council.

The provision of high-quality care equipment and aids services is vital to the independence of people of all ages with health conditions, disabilities, or mobility issues. Care equipment services improve the independence, dignity, and self-esteem of not only the people using the equipment but their families and carers too. This integrated service is a key component of both health and social care services, supporting our ‘home first’ ambitions, reducing the amount of care that people need, and preventing hospital and care home admissions.

The current commissioned service is provided by Medequip. They are responsible for sourcing and delivering equipment to people’s homes; maintenance and repairs, and when the items are no longer needed collection and recycling. In 2023-24 the service loaned more than 90,000 items to people living across North Yorkshire and York.

Technology enabled care and equipment: Messages to the market

Technology enabled care

Maximising the use of Technology Enabled Care is key to achieving our ‘home first’ ambitions. We will continue to drive forward and expand the use of technology enabled care across the county, particularly in rural locations, where traditional services are harder to commission. We need to create a culture whereby health and social care professionals think ‘technology enabled care first.’

The current contract has recently been awarded to our incumbent provider, NRS, and will be in place until September 2026. In 2025, we will be undertaking testing and engagement with the market to inform the 2026 re-procurement. Through the re-procurement, we will explore how we can move into a world of technology enabled care to increase people’s independence in their own homes, ranging from simple sensor-based solutions to more innovative connected care products.

Community equipment

The contract for the existing community equipment service comes to an end in March 2026. We are working with key partners to co-produce a refreshed service model. Further information will be shared with the market in due course.

Direct payments

Direct payments offer people greater choice and flexibility over how their care and support needs are met, empowering people to live more independently, and actively participate in their communities.

Direct payments are used to meet a wide range of care and support needs and can be tailored to a person’s individual needs and preferences. People can use direct payments for support with daily living activities such as personal care, domestic tasks and engaging in social activities. Direct payments can also be used to enable unpaid carers to take breaks from their caring role.

Currently, more than 45% of recipients use their direct payment to employ personal assistants. The remaining recipients use their payments to buy home care or day services. Some use their payments to buy annual passes (for example, Flamingo Land, National Trust etc.), so they can access regular activities, and some may use their payment to take short breaks.

In March 2024 over 800 people were arranging their care and support through a direct payment. Most people who receive a direct payment in North Yorkshire have a learning or physical disability. Older people and people with mental health conditions are less likely to take up a direct payment.

In order to increase uptake of direct payments there is a need to help people overcome barriers. We do this by providing managed accounts as standard; offering and signposting to support with recruitment and retention of personal assistants and payroll providers.

Individual service funds

We are dedicated to fostering a person-centred approach to care and support services. As part of this commitment, we are starting to promote individual service funds (ISFs).

Individual service funds are an innovative mechanism that empowers individuals to have more control and flexibility over their care arrangements, enabling them to tailor services to better meet their unique needs and preferences. Essentially, a provider manages and holds a personal budget on behalf of the individual. The provider then works with the person to plan and coordinate care and support to help them achieve their identified needs. The provider may deliver some of the support themselves or will arrange and/or purchase via other organisations.

Within North Yorkshire, we have a handful of long-standing individual service funds. However, our goal is to reinvigorate the use of individual service funds, ensuring more individuals and providers can benefit from the opportunity to work together to co-design a more innovative and personalised approach to care.

Personalised support – Messages to the market

Direct payments

Improving take-up of direct payments is one of our biggest improvement priorities in adult social care. Our key focus is increasing the use of personal assistants. However, recruitment can be a key challenge. We have started working with a PA register but would be interested to talk to community-based organisations that could help in matching local people to local personal assistants. 

We would also welcome conversations with people or community-based organisations who are thinking about setting up their own micro-business to offer personal assistant services.

We recognise the challenges people face in understanding and meeting their responsibilities as an employer. While there are many employers’ liability insurance, payroll, and managed account providers available on the market, there is a shortage of providers that offer end-to-end digital solutions. We would be interested to talk to providers that can offer this service.

If you are interested in exploring opportunities relating to direct payments, please contact us.

Individual service funds

Individual service funds present significant opportunities for care providers in North Yorkshire. By engaging with individual service funds, providers can enhance the level of flexible and personalised care they offer, strengthen their relationships with people they support and drive creativity and innovation.

Our intention is to run some focused individual service fund pilots to evidence how they might efficiently support a move away from ‘time and task services’ to better enable people to live life as they wish. During 2024-25 and beyond, we will be seeking expressions of interest from a small number of value-driven and trusted providers to develop the pilots. Specific localities have not yet been identified, but they are likely to focus on community based support and supported living in the first instance.

If you would like to talk to us about how individual service funds may benefit the people you support, please contact us.

There is a wide range of community-based support provisions across the county offering a variety of activities for people with care and support needs. These services include:

• employment skills service, providing short-term employment-focused support
• day opportunities aimed at promoting independence and skills development
• day care, catering to individuals with the most complex needs

Predominantly accessed by individuals with learning disabilities, community-based support services also accommodate smaller numbers of older people, people experiencing mental ill health and those with physical and/or sensory disabilities.

There are several dedicated land-based and building-based services, primarily in areas of higher population. Many of these offer a diverse range of work-based activities including horticulture, landscape gardening, arts and crafts, catering, drama etc. Promoting links with the wider community is a key feature of this provision. There are also some incredible facilities, including several full-scale garden centres, cafés and working farms that are open to the public, with a strong social enterprise element embedded within their offer.

Several providers offer bespoke support enabling individuals to pursue their goals and interests in their local community. However, traditionally people have attended these services on a long-term basis – encouraging move-on to full-time employment and/or volunteering in the wider community remains a challenge.

We also provide seven in-house day services: one in each locality of North Yorkshire. These services predominantly support working-age adults with a learning disability and/or autism, as well as people with complex physical and sensory needs. Our in-house services are predominantly building-based, but also support people to access the local community. 

Table 5 shows the number and types of community-based support services that we contract with by locality. It highlights the significant gap in provision in Craven.

Table 6 shows that the number of people using ‘contracted’ community-based services has remained relatively static, with a small reduction seen in people aged 65+. This reduction, against the backdrop of an ageing county population, may be due to the wide variety of ‘universal’ community offers available (for example, organised by local community groups).

People in the 18 to 64 age group are predominantly those with learning disabilities. We know that younger people with learning disabilities are now less likely to wish to spend their days predominantly at one site-based day service and are seeking a more varied life in their local area.

We want community-based support to be exactly that - about supporting people to live well and independently within their communities. Different forms of community-based support should be about opportunities for improving health and wellbeing in its broadest sense and we are forging strong connections with leisure services to improve the range and choice of activities that promote physical, cognitive, and emotional well-being. 

Due to the rural nature of North Yorkshire, transport can be a significant challenge for individuals seeking to access community-based support services. Limited public transportation options and the long distances between service providers and users can create barriers to timely and consistent access. To address this, innovative solutions such as community transport schemes, travel training, volunteer driver programmes, and digital service delivery options are being explored to ensure that all individuals can benefit from these vital services, regardless of their location.

Currently, services are primarily commissioned on an hourly basis. This model provides a straightforward way to measure and fund the delivery of support but may not always reflect the true value and outcomes of the services provided. To enhance the effectiveness and efficiency of commissioning, alternative models are being explored. These may include outcome-based commissioning, where funding is tied to the achievement of specific results, and block contracts, which can offer greater financial stability for providers and more consistent service availability for users. We are also keen to increase the use of Direct Payments and Individual Service Funds so people can make their own arrangements with their chosen providers, giving them greater control and flexibility to tailor services around the needs and preferences of the person.

Community-based Support: Messages to the market

We are keen to move away from long-term, full-time attendance at dedicated day services towards a more personalised approach to supporting people to take part in meaningful activities in their local community. We are keen to work with providers that work with people to

• maximise independence
• foster confidence and skills development
• promote health and well-being
• sustain social connections
• serve as a stepping-stone into broader community involvement and employment opportunities

We are particularly interested in talking to providers that:

• offer flexible, creative community-based support for young adults with learning disabilities or autism, including people with autism who do not have a learning disability. As indicated above, we are particularly interested in services which serve as a stepping-stone into broader community involvement and employment opportunities
• are interested in establishing day services of all types in the Craven area - particularly the cohort identified above
• are interested in developing community-based programmes and services that promote social engagement, companionship, and inclusion to combat feelings of isolation and improve overall wellbeing
• are interested in working with individuals as an equal partner, allowing them to design and develop their own support – and helping to broker and/or deliver that support through Individual Service Funds and/or Direct Payments
• are interested in developing services that will allow carers for people with Dementia to take a break – across all areas of the county
• provision of travel training to enhance independence and mobility
• exploration of potential support for individuals with dementia and/or their carers

Home-based support covers a range of activities, which may be put in place to support a person in their own home. This includes:

• personal care such as physical assistance with eating or drinking, toileting, washing, medication management
• practical support such as meal preparation, shopping support, essential domestic tasks and support to access the local community
• sitting services are where the sitter may provide companionship, personal care, or practical support
• live-in care is when the care worker lives in the person’s home on a 24-hour basis to provide support which may include personal care or practical support. Care is available to the person day and night and may be provided by a single care worker who lives in permanently, or by two or more care workers working on a rota basis.

Home-based support: supply

We commission more than 150 providers on our home based support approved provider list, to deliver almost 29,000 personal care hours per week. Care is delivered by a range of large national organisations, local franchises, and small and medium enterprises within people's own homes.

There are 163 registered domiciliary care providers registered with CQC in North Yorkshire. Several providers are registered locations outside the county.

90% of home care providers in North Yorkshire are rated good or outstanding by CQC. This is higher than the national (86%) and regional (84%) averages. There are no providers with an Inadequate Rating. 15% of North Yorkshire providers have not yet been inspected (visit the CQC website here: 7 June 2024).

During the pandemic and up until early 2023, the number of unsourced packages of care averaged around 70 per week. Since then, we have procured our new Approved Provider List and have been very successful in attracting new providers to enter the home care market in North Yorkshire. This has resulted in the number of people waiting for care (unsourced packages) reducing from an average of 70 per week in 2022, to four packages per week in 2024 (see table 7)

Although the number of unsourced packages remains low, it is still more difficult to source in rural and super-rural areas. Providers report that services are often unprofitable because of fuel costs, workforce shortages, inability to secure office bases, and low volume of hours/referrals. This can lead to providers refusing or handing back packages and removing rural areas from their service footprint. Larger and more complex packages can also be difficult to source, particularly in more rural areas of the county. Table 7 shows the average weekly number of unsourced packages of care in 2022 to 2023 compared to 2023 to 2024.

Although new providers are entering the market at a lower cost and driving down the cost of home care, there are still sustainability risks to the market. The vast majority of services are spot purchased from our approved provider list on a ‘best value, best match’ basis and providers have no guarantee of referrals. This means some of our more established providers that recruit locally are being priced out of the market by newer entrants to the market that are heavily reliant on a sponsored workforce. There is also limited ability for providers to build additional capacity into their service models.

An increasing number of providers rely heavily on a sponsored workforce as part of their organisation recruitment strategy. Further information about the risks and opportunities that sponsorship presents can be found in the social care workforce recruitment and retention section.

Between June 2023 and May 2024, seven home care services closed. Two were linked to consolidation of offices, two were based on financial viability and two were linked to the revocation of sponsorship licences.

Home-based support: demand

Demand for home care is increasing. There is an upward trend in the number of people receiving home-based support packages, with a 4% increase since 2021. This is expected to increase in line with North Yorkshire’s aging population and as a direct result of our focus on ‘home first.’

During 2023 to 2024, we supported 5510 people with a range of home-based support. Table 8 and table 9 show the number of people and number of hours of home-based support that were commissioned in 2023 to 2024.

Home-based support: Messages to the market

Strengthening our home first offer to support people to live a good life in their own homes is a priority for the council. Home-based support services are critical for this.

Our aim is to maximise the use of informal support and short-term help for people who have been admitted to hospital, or who are starting to need more help with day-to-day tasks. We also want to work with trusted home care providers and VCSE organisations, bringing them together with people with lived experience to co-produce innovative models of care and support and pilot new ways of delivering more localised, community-led flexible and outcome-based care.

We are reviewing our systems and processes to make sure that they are as efficient as possible. Over the coming months, we will be launching an e-brokerage service that will make it easier for providers to bid for packages of care. We will also be introducing an online provider portal that will speed up invoicing and payment processes.

Overall, there is a good supply of home-based support providers operating in North Yorkshire. However, in some areas of the county, there has been an influx of new providers which has saturated the market. In some of our more rural and super-rural areas, there are still gaps in provision, and it can be very difficult to source care. This is particularly the case in rural and super rural areas with current sourcing issues in the Whitby area too.

We would be very pleased to speak to providers who are considering applying to join our approved provider list so we can discuss where there are gaps in the market and therefore potential investment opportunities.

Housing with care and support, also known as ‘supported housing,’ is an umbrella term for the following services:

• extra care
• short term accommodation with support
• supported living
• shared lives

With the creation of North Yorkshire Council in April 2023, we became a housing authority and are exploring the many opportunities this creates for innovative delivery of housing and support options. Health and adult services are working closely with housing colleagues to develop a range of accessible and affordable housing options all across North Yorkshire which can support people to remain independent and within their own communities.

A full review and redesign of both short and long-term supported housing is underway with a view to creating a single, integrated housing pathway across supported and general needs provision. This will allow people to access the right level of support in accommodation which enables and enhances independence.

Both the care and housing aspects of this provision will be redesigned in the coming years under a broad change programme that will see the development of new bespoke accommodation alongside the development of new care models focussing on independence through the maximisation of technology and positive risk-taking for individuals.

We will work closely with our registered social landlord (RP) partners to develop the accommodation we need, maximising funding such as Homes England grant streams and making innovative use of housing benefit to maximise the quality of both accommodation and support that people experience.

We will also work together on a future workforce plan for the housing with care sector, bridging the gaps between colleagues’ skill sets and registered functions with an aim of creating roles that combine strengths and minimise gaps in our workforce.

Extra care

The North Yorkshire extra care programme is recognised as a beacon of best practice in the delivery of accommodation with support. We have ambitions to continue expanding the provision of extra care across the county whilst embracing new and diverse models of accommodation and support.

Our extra care housing schemes provide safe and secure self-contained accommodation for older adults who need varying levels of care and support, enabling them to live independently in their own homes. Extra care provides access to care and supports 24 hours a day, seven days a week, alongside other on-site facilities such as restaurants, hairdressers, and shops.

There are 28 operational extra care schemes across North Yorkshire providing 1540 units of accommodation with further schemes planned across the county. North Yorkshire’s extra care service has grown to provide accommodation for 6000 older people in the 20 years since it was launched. The successful delivery of extra care in North Yorkshire has secured savings and capacity for the council.

Demand for service is high with waiting lists for all our schemes. Each scheme maintains a balance between low, medium, and high care needs, which are determined at allocation meetings held between North Yorkshire Council and the housing and care providers. As of April 2024, this list stands at over 300 expressions of interest.

Short-term accommodation with support

Short-term accommodation with support is defined as accommodation provided alongside support, supervision, or care, to help people live as independently as possible in the community. Support is typically provided for 12 to 24 months. We commission the following contracts:

• mental health supported housing provides housing-related and other support to enable people living with mental health issues to maximise and sustain their independence in the community. The maximum length of support is 12 months, with an optional further six months of floating support
• RACSS (offenders housing related support) provides housing-related support to enable high and medium-level risk offenders, supervised by the National Probation Service, to maximise and sustain their independence in the community and significantly reduce the risk of re-offending. The maximum length of support is 24 months
• REACH (reducing exclusion for adults with complex housing needs) is a holistic, multi-agency project in Scarborough that is based upon the principles of the housing first model to provide dedicated units of housing with intensive and community support to people who are currently homeless, or likely to be homeless, due to health needs, poor mental health, substance use, physical health, criminal activity, or anti-social behaviours. REACH is in place for as long as we have funding, support usually ends when the client no longer has a need
• the substance misuse service supports people accessing adult substance misuse services, who are homeless or at risk of becoming homeless. This service provides individual support to those residing in the properties allocated, in addition to the assistance which they will be receiving from specialist adult substance misuse services to promote long-term recovery. The maximum length of support provided is 24 months

Supported living

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 meet care act eligible care and support needs and help people to live as independently as possible

In North Yorkshire, there are over 200 supported living properties, including shared housing and self-contained housing. Properties are often specially adapted for those living there and are protected for people who have care and support needs. Supported living should be available and flexible to respond to a wide range of care and support needs, irrespective of any particular diagnosis, but responsive to how individuals can be best supported to live in a home of their own.

As of April 2024, there are currently over 800 people living in over 200 properties. There are over 40 housing providers, including registered providers of social housing and other not-for-profit landlords. (see table 10)

63% of North Yorkshire’s supported living provision is in Scarborough and Harrogate. In Harrogate, supported living properties are more prevalent partly due to the residential college and the diverse range of day services available. Consequently, the area attracts younger adults with autism, learning disabilities, and mental health support needs.

Demand for supported living is increasing due to:

• an increase in population
• reduction in the use of residential care
• the likelihood of people living with older carers (often parents) becoming unsustainable

As shown in table 11: supported living demand by area, 35% of people waiting for supported living wish to live in the Harrogate area, however the buoyant property market in Harrogate, like many areas across the county, makes it challenging for supported housing providers to deliver new schemes in the area.

We have recently commissioned a housing needs analysis for people with learning disabilities and autistic people, this will be published soon and will help to inform future strategies.

Shared lives

Shared lives is a scheme where a person who needs long-term support is matched with a host family and lives in their home as part of their family. The host family is known as shared lives carers. Some people move in with their shared lives carer, while others are regular daytime visitors or stay for short breaks.

Person shaped support (PSS) has recently been awarded the contract to manage the shared lives scheme on behalf of the council. Their role, which started in January 2024, is to grow and administer the shared lives scheme in North Yorkshire, ensuring the carer family and the person in need are well supported.

The refreshed service delivers an outcomes-focused specification that incentivises service growth. The intention is to recruit more shared lives carers across North Yorkshire and to support a more diverse range of people through the scheme, including younger people, people in the criminal justice system, people with dementia, and support for hospital discharge (acute and mental health).

Housing with care and support: Messages to the market

Short-term accommodation with support

All of the contracts above are due to end in September 2025. We have started work to review and reprocure the above services to decide what we should procure in the future.

Extra care

Our current extra care framework was developed to allow the delivery of extra care developments for people over 55, at scale and pace. This has resulted in extra care housing schemes being developed in nearly all major market towns across North Yorkshire.

We are co-producing a new framework model for extra care and wider supported housing options which will allow us to deliver new elements such as smaller-scale schemes to support our rural communities and schemes to support people with a wider range of support needs such as younger people with learning disability and mental health difficulties. As a new framework is devised for 2025, we will work with housing providers to develop new models of high-quality, safe, attractive, and sustainable extra care schemes that deliver a wide range of care and support to meet changing and emerging needs, across North Yorkshire.

If you are interested in talking to us about developing or delivering extra care, please contact us at extracareenquiries@northyorks.gov.uk.

Supported living

As summarised above, we are currently undertaking housing need analysis research, which will shape our future supported housing strategy. We estimate that the supply of supported living across North Yorkshire will need to increase by more than 50% to meet demand between now and 2040. We are developing a long-term strategy to ensure people wishing to live in quality regulated supported housing have a choice of where they live, who they live with, and how they live; in line with the reach standards and the real tenancy test. We will offer an integrated housing pathway that enables people to ensure their housing with care needs can continue to best meet their changing needs throughout their adult life.

We encourage providers to talk to us about how existing services can be modernised, adapted, or replaced to ensure that the quality and quantity of supported housing across North Yorkshire meets the needs of our population. We are eager to have similar conversations regarding new purpose-built accommodation with registered social landlords.

For all queries relating to supported housing please contact HAS.supportedhousing@northyorks.gov.uk

Shared lives

Our contract with person shaped support to provide our shared lives service runs until at least January 2027. There are no plans to commission any other shared lives service until then. However, we are always looking for new shared lives carers. Anyone interested in becoming a shared lives carer can contact person shaped support at northyorkshiresharedlives@pss.org.uk

Home-based intermediate care

Together with Health partners, we agree that same-day home-based intermediate care will be the default option to meet the needs of people in North Yorkshire being discharged from hospital, prevent unnecessary readmission and prevent initial admission where a period of intermediate care can be delivered safely in a person’s own home.

Bed-based options should only be considered where a person cannot be safely supported at home at the point of discharge and should be viewed as a stepping stone on the recovery journey. Is an ambition that as many people as possible will be discharged with a reablement service along with other informal and community support.

We intend to continue being the main provider of reablement services across North Yorkshire. However, we look to the market to support the delivery of home-based intermediate care. Examples of services we have commissioned to date include:

• a countywide bridging services for winter 2023 to 2024
• a pilot live-in care service and
• home from hospital service to help people return home, rebuild confidence and prevent hospital re-admission

Home-based intermediate care – messages to the market

When opportunities arise for the market to co-design and deliver services as part of our home-based intermediate care offer, we will be undertaking expressions of interest with trusted providers already operating and approved on our approved providers list. Success will be reliant on providers working as equal partners in delivering intermediate care with a clear focus on improving independence and reabling people to minimise reliance on long-term support.

Bed-based intermediate care

Bed-based intermediate care provides acute and community-based services that provide assessment and support to people in care homes, community hospitals and extra care housing. The focus of the service is on promoting independence and recovery. Support is provided by multi-disciplinary teams including nurses, social care, and therapists. Therapists provide ongoing intensive support to achieve specific goals during the short stay, to facilitate a smoother transition home.

We currently commission short-stay beds in care homes through both block and spot purchases via our approved provider lists.

In 2023:

• 327 people accessed a block-purchased intermediate care setting upon discharge from hospital
• 784 people accessed a spot purchased bed upon discharge from hospital
• 328 people accessed a spot purchase short stay from the community

Throughout 2023 to 2024, we block purchased 73 intermediate care beds across the county, in both the independent market and in our in-house services. These are supported by a fluid number of beds in community hospitals. As of April 2024, these beds are split as follows:

• 50 residential beds
• five dementia residential beds
• seven nursing beds
• 11 nursing dementia beds

Hospitals are under pressure to facilitate safe and timely discharges. This has increased the demand for intermediate care beds. The beds are also accessible for short term hospital avoidance placements. We want to work with providers to move towards more readily accepting admissions on evenings and weekends to support flow through hospitals.

Analysis of discharge data shows that the number of people requiring bed-based intermediate care in North Yorkshire is increasing. In 2021, the percentage of people leaving hospital with ongoing care needs who required bed-based intermediate care in North Yorkshire was 25%. In 2023, this increased to 31%.

In 2023, we saw a steady increase in demand for residential dementia short stays. 32% of short stays in 2023 were residential dementia placements.

Bed-based intermediate care: messages to the market

Jointly with the ICB, we have commissioned a range of bed-based intermediate care services for 2024 to 2025 based on locality-based demand analysis. Provision is made up of in-house care homes, independent sector care homes, units within extra care housing and community hospitals. Demand and capacity remain under ongoing review, and additional provisions may be commissioned in the independent sector. Should opportunities arise to deliver additional bed-based intermediate care in this financial year, approved provider list providers will be invited to submit expressions of interest.

Beyond this financial year, we are working with the ICB to develop our model of bed-based intermediate care and to move away from multiple short-term contracts to a longer-term offer delivered by stable and trusted providers working proactively with newly developed intermediate care hubs and specialising in the delivery of recovery and rehabilitation that meets needs in a flexible and responsive way. As part of this strategy, we need to ensure that services have the right physical environment to deliver reablement and rehabilitation, and that provision is accessible for people requiring double-handed care, those with dementia or delirium, and those requiring rehabilitative therapy.

We are strengthening our in-house delivery of bed-based intermediate care, and our longer-term ambition is for us to be the primary provider of specialist bed-based intermediate care. However, an interim medium-term solution will be required and we envisage that this may be commissioned via the independent sector.

We currently commission 124 care homes within North Yorkshire, (plus seven “in house” older people’s care homes) which provide residential or nursing services including dementia for people over 65 years old.

Of these 124 care homes:

• 50 are dual registered residential and nursing, of which 49 offer dementia care
• 10 are residential only
• 58 are residential dementia
• six are nursing only, of which five offer nursing dementia.

Approximately half of the beds available in North Yorkshire are commissioned by ourselves.

We use national capacity tracker to monitor bed availability in the county. On average, homes are operating at around 90% occupancy. This level of occupancy means people who need a care home placement often have choice, and people rarely need to wait to find the right placement. The only exception is where people have very specialist or complex needs or wish to move into a care home within a very specific area. This is evidenced by the very low numbers of unsourced care home placements (see table 11). Table 12 gives a snap-shot of available care home vacancies taken from capacity tracker. Available vacancies are those that are available for admissions at a given point in time.

Cost of care: 65+ care homes

The weekly cost of permanent residential and nursing care placements continues to be a major pressure. Weekly residential care home rates for older people are particularly high in Harrogate where new purpose-built developments have been introduced, there is a high prevalence of privately funded placements and high employment levels lead to higher wages.

In 2022, we completed an ‘actual cost of care’ (ACOC) exercise for residential and nursing care for people aged 65+. We committed to fully implementing actual cost of care by 2024 to 2025. This means that all eligible placements are paid at least the North Yorkshire Council actual cost of care rate. Our actual cost of care rates are listed in table 14. During 2024 to 2025, we will be working with the care market to review and refresh the methodology for the actual cost of care. Any changes will be reflected in the 2025 to 2026 inflation considerations.

During 2023 to 2024, only one care home exited the market and this was a planned closure. There was no change to the number of available nursing beds. This is a very different picture to April 2020 and April 2022 when North Yorkshire lost over 200 nursing beds. This was predominantly down to challenges with recruitment and retention of nurses. The situation has now stabilised with many providers filling nursing vacancies through agency staff or overseas recruitment.

Supply and demand for care homes

Out of the 124 care homes within North Yorkshire, half are of medium size (10 to 60 beds); 25% small (less than 10 beds) and 25% large (60 plus beds) (see table 18: number of people with a client category of learning disability, sensory, physical disability and mental health. Harrogate has the highest proportion of homes followed by Vale of York, Scarborough Hambleton and Richmond and Craven.

In terms of service quality, only 1.76% of care home provision within the county is not rated by CQC, however, the majority of provision is rated as “good” with 3% classed as “outstanding” and 0.6% deemed as “inadequate”.

Table 15 shows the number of permanent care home placements for older people (65+) by service type. The overall number has remained relatively steady over the last three years, with between 2400 and 2600 people in a placement arranged by us at any one time (including both permanent and short stay). This includes people who are placed in and out of the county.

Since 2021, there has been a notable increase in demand for dementia care with a 29% increase in residential dementia, and a 14% increase in dementia nursing placements. While numbers are low, there has also been an increase in the number of people with early onset dementia being placed in a care home. Care Providers and health and social care practitioners all report an increase in the acuity and complexity of the need of people in care homes. This can lead to an increased reliance on 1 to 1s which can be very restrictive and is not always in the best interests of the person. It can also lead to people having to relocate to more specialist, often higher cost provision.

Data from the projecting older people population information system (Poppi) shows that by 2040 there are expected to be an additional 2999 people living in a care home in North Yorkshire. The biggest increase is expected to be in Harrogate with an additional 940 people expected to be living in a care home in 2040 (see table 16). Harrogate also has the largest proportion of people living in a care home with 11.6 per 1000 people compared to Selby’s 5.9.

Residential and nursing care: messages to the market

Our ‘home first’ ethos means that more people will be supported to remain living independently, in their own homes and community for as long as possible. When the difficult decision is taken to move someone into a care home, their dementia and frailty will be more advanced and their needs more complex. It is important for people to know this can be their home for the rest of their lives. We do not want to have to relocate people because their provider is unable to meet their needs. This means demand for lower-level ‘general residential’ care is expected to reduce.

A more consistent approach is required to ensure issues currently encountered with market capacity and the gap between residential and nursing dementia care which is growing is addressed. Residential care providers are unable to support those with advanced dementia needs which in turn is putting pressure on nursing home placements, widening the gap in the provision of placements in the nursing care market and identifying the need for developing more co-ordinated support to address individual needs.

All care homes, not just those that specialise in dementia or end-of-life care, will need a well-trained workforce capable of providing high levels of personalised care in a safe and supportive environment. However, we recognise that care homes may need support to achieve this. We are working closely with our NHS partners and care sector representatives to offer dementia training to care home staff and developing a system-wide wrap-around support offer to ensure care homes have access to professional support, advice and guidance to prevent situations from escalating. We also want to embed the use of trauma-informed practice across all care settings.

If you are a provider looking to develop residential or nursing care services in North Yorkshire, please contact the service development team at the earliest opportunity so we can talk to you about gaps in the market, and help you develop a service and pricing model that meets local needs.

We would be particularly keen to speak to providers that are interested in:

• developing affordable care home services that are capable of supporting people with advanced dementia and frailty – with appropriate physical environments and competent highly skilled staff
• developing affordable services for people who are local authority funded in Harrogate and surrounding areas
• developing an alternative commissioning model to address the widening gap of residential/nursing care support and provision

If you are interested in developing a new or existing care home service in North Yorkshire, please contact HASservicedevelopment@northyorks.gov.uk

Specialist and complex services provide highly specialised and personalised support for people who are living with profound learning disabilities, Autism, functional mental health conditions or physical disabilities. This includes accommodation with care, such as care homes or supported living, and specialist services that support people in their own homes and community.

It is common for people to have co-existing health and sensory conditions. People may also have communication difficulties and experience distressed behaviours. People with specialist care needs can experience challenges in maintaining good health and wellbeing. Therefore, we want to work with providers who can deliver proactive, personalised models of care, embedding effective risk management and positive risk-taking in the least restrictive way.

The workforce within these services must be:

• multi-disciplinary, highly skilled and trained in planning and delivering personalised support
• equipped to handle the emotional and psychological demands of working with individuals who have specialist needs
• well supported to avoid burnout and high staff turnover rates

The current lack of data for people with more specialised needs means we are limited in our ability to share in-depth data on current and future placements or packages of care. The data contained within this document relates to people aged 18 to 64 who are living with profound learning disabilities, autism, functional mental health conditions or physical disabilities, but may not necessarily be identified as receiving a specialist service. Over time this dataset will be refined and expanded to offer more detail.

Home and community-based support

People with specialist care needs should be able to access meaningful daytime activities. We understand and recognise the important role that community-based services have in supporting people with specialist needs, however, more can be done to develop life skills in a way that is meaningful for the person. As a result, we will be undertaking a review of specialist day services provision in North Yorkshire and will be seeking the views of people on this important subject.

We will also be focusing on working with specialist home-based support providers as part of the specialist care commissioning model to clarify the training and skills needed to support people and ensure that their specialist care needs are met, where they are living in their own home.

Direct payments

Further work is required to understand the number of people accessing specialist services via the use of Direct Payment. We know there are over 650 working-age adults in North Yorkshire accessing services via Direct Payment. We plan to reach out to these people as part of our plans for the development of a specialist care commissioning model.

Accommodation with care

Wherever possible we aim to support people with specialist care needs to live in their own homes, rather than care homes. This is what younger people are telling us they want, and this is driving demand for supported living. The council and the Integrated Care Board have recently commissioned a housing needs analysis for people with learning disabilities and autistic people. This will be published soon and will help inform our market development plans. For more information, please refer to the housing with care and support section.

There will still be a need for a smaller number of care homes who can continue to support individuals when other types of accommodation with care are not appropriate. We have limited in-county residential and nursing capacity to support people with the most specialist care needs.

We currently have 124 care homes on our approved provider list, of these we have:

• 57 care homes supporting people with a learning disability
• 26 care homes supporting people with a physical disability
• 15 care homes supporting people with a nursing need

The current provision is a combination of purpose-built and converted buildings. The long-term viability of these buildings is an area of future development to ensure they can continue to offer long-term safe environments for people with specialised care needs. We need to ask ourselves, and the care market, can these buildings be long-term homes for people to age well in?

In October 2024, we found that out of 231 placements for 18 to 64-year-olds, 45% were with out-of-county providers. 79% of out-of-county placements were supporting people with learning disabilities or autism, 15% were supporting people with mental health needs, 5% were supporting people with physical disabilities and 1% were related to residential colleges. We need to better understand the reasons why a significant number of young people are moving out of our area, and whether this is due to a lack of provision in North Yorkshire, or personal choice.

Emergency respite/crisis intervention

Crisis intervention is a short-term, immediate response aimed at supporting people through and reducing periods of distress. The intervention should ensure an individual remains safe, and that the staff team are offering practical and emotional assistance to support the person through their crisis.

We are keen to explore options around services that can provide short-term ‘relief’ for an individual who is experiencing a period of distress. This is sometimes referred to as a crisis service or a safe space and involves varying levels of support. This can be in the form of building or community-based services, dependent on the support required.

This situation requires further work with the specialist care market to firstly prevent care and support from breaking down. We believe that the first option, where possible, should be to support the person in the place they call home. This could be additional support for care providers to ensure the person remains safe and the staff team have access to additional support. These proposals need further development including the views of people with lived experience, their families and care providers.

We currently provide five in-house short break services across the county, also known as respite services, so that their carers can have a break. These services predominantly support working-age adults with a learning disability and/or autism, as well as people with more specialist physical and sensory needs. Due to gaps in specialist care provision, these services often provide emergency respite or crisis support in the event of a person’s care and support package breaking down.

A specialist care community-based service has been developed by ourselves in the Harrogate area to support people with specialist care needs. This is a new bespoke day service facility and offers an exciting new opportunity to re-invent the day service offer for specialist support in Harrogate. The service will be able to offer:

• a personalised individual approach to care and support planning
• includes access to a sensory room
• adaptive equipment
• dedicated outdoor space
• opportunity to access the community
• bespoke activities for each person

We want to reach out to the care market and discuss developing similar services in other areas that compliment and bolster the work being done by our in-house care provision.

Specialist care for children and young people who are preparing for adulthood

We want to work with providers who deliver services that compliment and support a young person’s transition to adulthood. Support from the provider should be person-centered and enable the person to maintain and build on the outcomes they have already achieved in their preparation for adulthood.

Where the young person has an Education Health and Care Plan and/or Personalised Learning Plan, this should be used to support the identification of ongoing person-centered outcomes to support the person’s transition to adulthood.

More young people who are preparing for adulthood want to be more independent and move from the family home. A key area of service development is the transition from children’s services to adult services, supporting young people to remain independent within their local communities. This will include a key focus on areas such as supported living and day opportunities provision.

We want to develop a provider market that is responsive to the needs of young people preparing for adulthood and can offer services which promote independence, and enhance a young person’s ability to be an active part of their community and all that it has to offer.

Commissioning approach for specialist care

At present, we require all providers to join our approved provider list. However, specialist care providers tell us our fixed APL pricing model does not support the delivery of the highly individualised, flexible support that is required for people with intensive, and often fluctuating care and support needs.

We are therefore working in partnership with our Integrated Care Boards to review our commissioning model for specialist and complex care. Our aim is to increase the choice and availability of affordable, high quality and personalised services within the county. This will ensure more people with learning disabilities, autism, and physical disabilities are supported to live as independently as possible, in the place they call home, with strong connections to their community.

We want to work closely with providers of specialist services to ensure they can deliver high-quality, innovative services which reflect best practice. We want to stimulate the specialist care market by exploring alternative contracting and pricing models.

We will work closely with specialist care providers, people with lived experience and their families to develop a co-produced specialist care commissioning model that will look to address the issues raised within the market and provide person-centred, flexible support for those people living with co-occurring or multiple chronic conditions, who may experience distress and may need specialist support. We need to work with people and their families, so we understand what’s important to them, to identify their priorities to help shape a person-centered care market that supports people’s long-term aims, and goals and focusses on their independence.

Specialist and complex care: Messages to the market

The first step of engagement with stakeholders was undertaken in October and November 2024. This resulted in the creation of a specialist care steering group who are committed to co-producing a specialist care commissioning model that is sustainable, long-term and offers high-quality services.

The focus for the first quarter of 2025 will be around engagement with people with lived experience and their families and carers to truly hear the voice of the people we are looking to support and to invite some of these individuals to be involved in this work. The next step for the specialist care steering group is to identify several small working groups to take forward specific pieces of work.

We want people with specialist care needs to be supported to grow and develop as individuals. They should be empowered to make their own choices to lead fulfilling lives. Our aim is to ensure that specialist services enable people to live the lives they want.

The council, together with our health partners are keen to work with the market to develop high-quality and personalised services that:

• prevent admission into in-patient mental health settings
• deliver good outcomes for people who are being discharged from in-patient mental health settings
• enable people who are experiencing, or at risk of a mental health crisis, to recover and remain in the place they call home
• people with learning disabilities, autism, and physical disabilities are supported in environments that meet their needs, by highly trained carers who understand their strengths, challenges, and interests
• proactively reduce the use of restrictive interventions
• support people to be more independent People are more independent and have the chance to obtain improved skills and experience.

Young people preparing for adulthood

Over the coming months we will be co-producing a new model of commissioning for specialist care. This will include extensive stakeholder engagement and will provide actionable insights into how we need to develop the market to support a smooth transition between adult and children’s services while maintaining a strong focus on independence.

We commission two specialist substance use services – North Yorkshire Horizons and North Yorkshire RISE. We hold contracts with Humankind for both services. Humankind sub-contracts the clinical service within North Yorkshire Horizons from Spectrum CIC, and the aftercare and recovery offer from changing lives. We also commission a range of GP and pharmacy-based services including drug treatment shared care, opiate substitute therapy supervised consumption, and needle, syringe and harm reduction services. The council also supports North Yorkshire Connected Spaces lived and living experience forum, via a contract with Red Rose Recovery.

North Yorkshire Horizons is an integrated specialist substance use service for adults aged 18 years and over. The service supports people who experience alcohol dependence and/or use other drugs. The service does not support people who experience medicine dependence. The service supports people across the North Yorkshire Council footprint by delivering a wide range of community-based harm reduction, treatment and recovery interventions and support, as well as access to inpatient detox and rehabilitation, as well as mutual aid – for example, NA, AA etc. The service currently supports over 2500 people per year. The service has been operating in North Yorkshire for 10 years in October 2024 and is recognised by CQC as outstanding.

North Yorkshire RISE is an integrated specialist substance use service for young people aged 10 to 18 years, and up to 25 years if the individual has special educational needs. The service has been in operating in North Yorkshire since 2021. The service currently supports around 120 people per year.

North Yorkshire Connected Spaces is a lived experience recovery organisation that supports adults with personal experience of harms associated with substance use to have a voice in the design, development, and delivery of services. The organisation runs forums as well as other community initiatives such as litter picks. Red Rose Recovery deliver the North Yorkshire Connected Spaces offer which is funded until the end March 2025 by North Yorkshire Council.

Substance use: messages to the market

We have just completed a public consultation on a draft North Yorkshire substance use strategy. The final strategy is currently being prepared and will be adopted and launched in the Autumn 2024.

We are currently leading a substance use service transformation programme with partners. This is summarised in a key decision published paper: decision - extension of existing contracts for the provision of specialist adult drug and alcohol service for North Yorkshire and the young people’s substance misuse service.

The decision details can be found here.

Service development (commissioning) team

As part of health and adult services, the service development team are responsible for commissioning and developing a range of services at both county-wide and locality levels. The team has designated locality leads, as well as portfolio leads. The service development team is responsible for commissioning residential and nursing care; home-based support; community-based support and intermediate care. To contact the service development team, please email HASservicedevelopment@northyorks.gov.uk

Housing, technology and sustainability team

The housing, technology and sustainability team is responsible for housing with care and support, including extra care, supported living, and short-term accommodation with support.

The dedicated extra care team within the housing, technology and sustainability team works closely with the operational schemes, providing support on a day-to-day basis. When the need for a scheme has been identified, the team is involved from the beginning, through to the planning, design, and development stages through to becoming operational. For all queries relating to extra care please contact extracareenquiries@northyorks.gov.uk.

The dedicated supported housing team manages the supported living waiting list across North Yorkshire. In partnership with colleagues across health and adult services, housing and our landlord and care and support providers, the team identifies suitable homes for people who have been assessed with personal care and/or practical support need that can be best met within supported living. The team also manages the short-term supported housing accommodation and support contracts. For all queries relating to supported housing please contact HAS.supportedhousing@northyorks.gov.uk

The team is also responsible for the assistive technology contract, working closely alongside NRS to deliver TEC solutions across the county.

Brokerage team

The brokerage team is responsible for sourcing care to meet assessed health and social care needs for adults across North Yorkshire. Brokerage contact external providers, who are on our approved provider list, via telephone or email, to check for vacancies and availability following the best value best match process. Brokerage then confirms the placement or package of care start date and cost with the provider prior to care starting. Contracts will then be issued in order for payments to be made. You can contact the brokerage team at:

• Scarborough and Whitby: brokerageswr@northyorks.gov.uk
• Vale of York: brokerageselby@northyorks.gov.uk
• Hambleton and Richmondshire: brokeragehambletonrichmond@northyorks.gov.uk
• Harrogate and surrounding areas: brokerageharrogate@northyorks.gov.uk
• Craven: brokeragecraven@northyorks.gov.uk

Contract management

The contract management team for health and adult services is responsible for contractual oversight of all approved provider list contracts and individual block contracts for adult social care and public health. The team offers support and advice in contractual matters and looks for opportunities to improve outcomes and value for money. The team manages the annual inflationary award for out of county and are the first point of contact for queries relating to fees. To contact the team, you can email HAScontracting@northyorks.gov.uk

Area finance support

Area finance support are responsible for making payments to providers and charging clients for their care. Our teams work in periods, each period is four weeks long and there are 13 in total in each financial year. We make payments in advance to providers on a four-weekly basis, and we process amendments in retrospect. The team also supports providers with their initial training on how the e-invoicing process works, and we have a dedicated contact from the team for each provider where queries can be sent in relation to payments.

We have three area finance teams responsible for non-residential services, and a county-wide residential area finance team, who are responsible for residential and nursing services. Our residential team also supports with deferred payments.

Primary contacts are as follows:

Non-residential

• East - East.InvoiceSystem@northyorks.gov.uk
• West - West.InvoiceSystem@northyorks.gov.uk
• Central - Central.InvoiceSystems@northyorks.gov.uk

Residential and nursing - AreaFinanceAdmin.Countywide@northyorks.gov.uk

Quality team

The quality team is made up of staff from health and adult services and the Humber and North Yorkshire Health and Care Partnership. The aim of the quality team is to support adult social care providers to continuously improve the service they offer to the people they support. The quality team also coordinates the provider failure and service interruption process, where a provider is unable to continue to deliver commissioned services, and also the response to major and significant incidents, such as adverse weather, industrial action or power outages.

The quality team can be contacted at HASQuality@northyorks.gov.uk

Care and support teams

If you need to contact our locality care and support teams in relation to a person you support, please either contact their social worker directly or contact the customer resolution centre on 0300 131 2131. For urgent social care issues that cannot wait until the next working day and the situation requires an emergency response, you can contact our emergency duty team on 0300 131 2131.

Make Care Matter

Get help with recruiting your care workforce from Make Care Matter by visiting the Make Care Matter website or contact the Make Care Matter team at  MakeCareMatter@northyorks.gov.uk

Table 3: Number of workers (Source: Capacity tracker 30 April 2024).

Table 4: Percentage of good or outstanding rated CQC services by locality.

Table 5: Primary support need of people in receipt of direct payments (March 2024)

Table 6: Number of community-based support service types by locality (May 2024).

Table 7: Number of people using community-based support services.

Table 8: Average number of weekly unsourced packages of home care per quarter.

Table 9: Number of people receiving a home care service within 2023-2024.

Table 10: Number of home care hours commissioned per year.

Table 10: Supported living supply and demand - April 2024.

Table 11: Supported living demand by area.

Table 12: Average weekly number unsourced residential and/or nursing placements

Table 13: Capacity in North Yorkshire care homes (source: Capacity Tracker 11 April 2024).

Table 14: North Yorkshire Council actual cost of care.

Table 15: Care home placements by service type.

Residential placements

Nursing placements

Dementia residential placements

Dementia nursing placements

Table 16: Diversity of care home market.

Table 17: People living in a care home with or without nursing, projected to 2040 (source: POPPI)

Table 18: People living in a care home by locality

Number of people with a client category of learning disability, sensory, physical disability and mental health

Table 19: Number of people with a client category of learning disability, sensory, physical disability and mental health

Table 20: Numbers of people aged 18 to 64 by service type

Table 21: Specialist bed capacity in North Yorkshire