Our two key aims of the Care Act are to;

• prevent and delay of the need for care
• support people in control of their care

Self-Care has been identified as an enabling work stream of the Healthy Wirral Plan. The Self-Care work stream builds on the Wirral Plan Healthier Lives Pledge to “Support local people to take control over their own health and wellbeing”. The focus of the Self-Care work stream is to help build connected, resilient communities and empower people in their own health and wellbeing. The Healthy Wirral Self Care work stream aims to build upon the good work in this arena in Wirral and ensure the development of a coordinated and systematic approach to Self-Care activity.

Wirral’s Health and Wellbeing Strategy 2022-2027 was approved by the Health and Wellbeing Board on 29th September 2022.

Our Market Position Statement describes to the market what our commissioning intentions are for the future, and what we will consider to be our main priorities. Links to the Wirral Intelligence service and other intelligence sources will help providers of care and third sector to research Local Intelligence to support their business thinking and decision-making.

New models of assessing and working with a range of providers, including our community care market to deliver Trusted Assessment will strengthen our local responses and streamline processes so that people in receipt of services will see a more coordinated response.

We will aim to increase the numbers of people who are accessing services online, both for self-assessment and financial assessment, as well as being able to source a local offer for themselves via the Wirral Infobank.

We will further develop Outcomes Based Commissioning and collate data and intelligence from our providers to support evidence of improving outcomes for our communities and people. We will report this across our Health and Care system and ensure we capture this as part of our Health Wirral reporting requirements.

One of our key areas of focus will be to improve the quality and Care Quality Commission ratings of our commissioned regulated services. We will be assessing our providers on a frequent basis and will publish decisions on suspended services via Wirral Infobank.

Working with our Liverpool City Region Commissioners we will continue to work with a Flexible Purchasing Framework, supporting providers to access work across the region, enabling easier access for local teams to work a wider group of providers and offer choice to people who need services.

We will work with Our Cheshire and Merseyside Colleagues on a digital transformation programme. One of our main focuses for the future will be to deploy a range of technologies, with an ambitious roll-out to support both health and care outcomes. This will include a range of technologies including remote monitoring, electronic support planning, equipment to help people remain at home and also to make them more independent. Our aim will be to improve safety and quality and to enable both people and providers to manage risks and reduce negative outcomes, facilitating where people will be able to use readily available technologies themselves to improve their quality of life. Technology will be a key feature for all of our service areas and will be described all service areas.

We will continue to work with Wirral Community Care market to improve the quality of services provided and to ensure that Care Quality Commission ratings improve.

We look forward to continuing the good work that we are already doing together to develop and improve services for people in Wirral.

Vision

Our Neighbourhood Working Model and “Good Lives”

To ensure the best possible outcomes for our population across Wirral, we will work with our commissioned social work providers, our community care market and our third sector.

We will draw upon the broad range of resources, including voluntary and community sector as well as public services, using the full breadth our community assets ensuring that whilst working in partnership we are using all of their skills knowledge and cultural expertise

To do this we need strong system leadership, with an asset-based approach including strong local relationships and effective delivery networks across all sectors.

Place based care is about working in partnership to improve services; this requires us to build capacity in the voluntary sector and local communities to support people to be as healthy and well as they can be, taking collective responsibility when things go off track.

Our starting point is people, not organisations, this means putting our residents before organisational self-interest.

Key principles:

• engage stakeholders across all sectors in decision-making
• move to place based and strength-based commissioning
• co-production with individuals and the wider citizenship
• critical thinking and problem-solving with people with lived experience
• local flexibility
• long-term commitment from all partners

Key messages for our vision

Care and Support at Home, with Technology Offer

• Our first offer will always be to take people “home first” from acute settings where possible
• We will always aim to keep people at home and not admit to residential or nursing settings including hospitals
• We will have a robust domiciliary care market offer, which is flexible and responsive
• We will ensure people are transferred safely between care settings in a timely manner when they need it
• People will be supported to help themselves
• We are working with Health and Care system partners to develop a full reablement offer
• Invest in and embed existing and new technologies to support care and support initiatives in both community and complex placement settings, which improve outcomes and reduce dependency on services
• Promote technology solutions which complement workforce strategy challenges.

Day Services and Employment

• We will continue to develop a range of day and work experience opportunities across all ages and client groups
• Develop employment services to support people with disabilities into employment
• Promote independence and support people to access universal and community services
• Develop innovative technology to support people to access services more independently
• Commissioned Day services for older people and people with Early Onset Dementia are available

Supported Living

• To review the supported living model to ensure that it meets the needs of the individuals
• Decommission supported living services that are not fit for purpose in the new model, and recommission new “front door” accommodation for people
• Further test the outcome-based commissioning pilot
• To develop and utilise a whole range of technologies.
• Pilot the introduction of trusted assessment
• Review the model of night-time support
• We will explore a range of housing options working with Liverpool City region colleagues and plan also explore how people might own their own home.

Extra Care

• Continue to develop Extra Care accommodation to meet the growing demand for Older People and Specialist learning Disability and Autism services
• To ensure that this accommodation is the first option for people with disabilities
• Review technology to ensure that we keep up to date with new equipment

Short Breaks Care

• Continue to promote Direct Payments as an option for purchasing short breaks
• Review the current commissioned short breaks and ensure that in future the service meet the changing needs of the people who access this
• Residential and community Short Breaks for older people will remain under review to ensure value for money and good quality care is available
• Provision of Direct Payments will continue to be promoted to increase choice and personal preference

Specialist Residential and Nursing

• Further move towards supporting people in their own home
• We will not place young people into residential and nursing care

We will only place people with the highest needs in a residential and nursing care setting

Advocacy

• Advocacy is NOT advice and information, or assisting with the completion of forms
• We will continue to commission services that meet our statutory responsibilities for targeted advocacy
• We will continue to develop self-advocacy and peer advocacy

Mental Health Services

• Continue to review opportunities for innovation and collaboration promoting best practice
• We will improve the quality of the services delivered
• We will introduce remote monitoring and technology offer working with Cheshire and Merseyside
• We will work in collaboration with NHS colleagues to explore new housing options support for people with mental health requirements

Residential and Nursing

• Reduce numbers of long-term beds
• Increased choice and control for people
• Improve the quality of care in care home settings and publish on Wirral Infobank where we have suspended services
• Support the care market and deploy innovative technologies, equipment Electronic Support Planning Tools
• Improve quality of life for people
• Create better outcomes for people
• Care Home development plan to be put in place
• Provide equipment to support falls and safe management of falls to avoid hospital admissions

Wirral Independence Service

• Promote and continue to implement digital technological innovation to support people and the community care market by developing the supply of innovative technologies and equipment.
• Increase confidence and wellbeing enabling people to live longer in their own homes.
• Early Intervention and prevention – delay the need for long term care.
• Reduce hospital admissions
• Support carers in the community
• Enable the domiciliary care market to order equipment

Shared Lives

• The council has developed its own Shared Lives service offer which went in January 2023, and will also establish a Shared Lives framework

Support for Carers

• We recommissioned services for carers in 2022 to improve services for carers
• We have implemented a direct payment for carers offer
• We will build Carers into the 3 Conversation model to increase the identification of Carers and support Carers receiving an assessment
• We will keep under review Carers Support services as part of the Early Intervention and Prevention contract
• We have coproduced a new Wirral’s Strategy for Carers, in line with local and national requirements, and this will go live on our website in Summer 2023

Early Intervention and Prevention

• We recommissioned services for our early intervention and prevention in 2022
• Third sector providers will work together to offer support to vulnerable residents, to support to improve health and wellbeing and improve outcomes for individuals.
• Providers will promote the self-help model, building on an asset-based approach to community development, and support our care act assessment initiative “3 conversations”

Sensory Services

• We will develop a service that will support people with sensory impairments to access community support that promotes independence.
• We have improved our offer of translation services to support assessment activity, including launch of the on-line GP Interpreter service, promotion of the new BSL111 and BSL999 services
• We have reviewed services for people who are blind or sight impaired. Sensory services for people who are deaf, or hearing impaired, blind, or partially sighted have joined up with the Wirral Health and Wellbeing CIC as part of the EIAP and Carers contract

Healthwatch

• Healthwatch Wirral and Independent Health Complaints Advocacy service went live September 2021. This is a 5-year contact with an option to extend for a further 2 + 1 years

Managed Accounts and Payroll services:

• Increase take up of people using Prepaid cards
• Full review of service, linked to Direct Payments

Social Value

Wirral Council will increasingly measure the impact on social Value to Wirral, which its commissioning activity has.

Social Value refers to wider financial and non-financial impacts of programmes, organisations, and interventions, including the wellbeing of individuals and communities, social capital, and the environment.

The Public Services (Social Value) Act 2012 (the ‘Act’) requires commissioners and Category Managers to consider securing additional economic, social, or environmental benefits (Social Value) when procuring services (including goods and works contracts procured in combination with services), to which the Public Contract Regulations 2015 apply. Wirral Council have however elected to adopt an approach of explicitly evaluating Social Value when commissioning services to demonstrate its commitment to a performance and evidence-based approach to Social Value.

Based on the National Themes, Outcomes and Measures (TOMs) developed by the Social Value Portal, bidders for Wirral Contracts are required to propose credible targets against which performance (for the successful bidder) will be monitored. The TOMs within this tender process have been adapted only to reflect the specific needs of the organisation. A copy of the Wirral MBC TOMs is available via the Social Value Portal

Read Wirral’s Social Value policy

Wirral Council will embed its Social Value Policy within all commissioning arrangements wherever possible and in all cases where procurement activities are valued at £100,000 and above. Social value will also be applied to appropriate contracts below this threshold and Commissioners are expected to give this consideration during the analysis phase of the Commissioning Cycle.

Measuring and reporting on Social Value is a developing field and Wirral Council recognises that flexibility and a collaborative approach are required. Agreed Social Value commitments may require a certain amount of refinement as a result. A key requirement is the willingness of the contracting partner to work openly and transparently with the council whilst bearing in mind that the overall value of Social Value commitments made must be delivered by the winning contractor.

Population

Where to find out about data and intelligence to support Health and Social Care in Wirral

Wirral Neighbourhood Information

Wirral Community Insight provides content to match our 4 Localities and 9 Neighbourhood areas. These bespoke reports can be found on Community Insight.

Wirral population and life expectancy

More information can be found via the Wirral Intelligence website.

Wirral Population and Data Information

The Wirral Plan 2021-2016: The Vision underpins our journey for Older People.

Read more about our Older People (65+) including the projections to 2030

Carers

Carers make up a large part of the Wirral Population. Find out more about carers.

Learning Disabilities

Many of the people we support in Wirral have a diagnosed Learning Disability, Autism or Mental Health. You can find out more about this area here:

• Learning Disabilities
• Autism
• Mental Health

Information from the Institute of Pu:blic Care

• Date about people with additional needs
• Data about older people

Dementia

The estimated number of individuals in 2019 living in Wirral with Dementia was 5,086 and projections show this will increase to 7,135 by 2035, which is a 40.7% increase. The prevalence of early on-set dementia (ages under 65) is estimated to decrease by 12% by 2035 in Wirral.

More information can be found here Dementia

The consequences of falls are serious, with half of older people unable to live independently following a hip fracture arising from a fall. 40% of all admissions to Wirral care Homes are as a result of a fall. The estimated cost to Wirral’s health and social care economy is approximately £8.9 million per annum which equates to around £5,657 per fall.

More information can be found here: Falls (Older People)

Diabetes

Wirral's population predicted to have Type 1 or Type 2 diabetes is expected to increase from approximately 13,000 in 2015 to around 17,000 in 2030:

You can find our more here: Diabetes

Different types of cardiovascular disease will have different impacts on Social Care with for example prevalence estimates implying there are over 2,200 residents, rising to over 2,500 by 2030, that may have a longstanding health condition as a result of a stroke with the consequences that translate to increased needs for social care and the support it requires.

Find out more here: Heart Disease

Chronic Kidney Disease

The prevalence rate for Wirral of 6.9% which equates to approximately 18,000 Wirral residents, aged 16 and over, with the condition.

Further information is located here: Kidney Disease

Cancer

Estimates suggest that 2 in 3 people living with cancer have personal or practical support needs and that 4 in 5 people have emotional support needs. With a figure of approaching 1,700 people in Wirral with cancer suggests there are a number of residents who could require support due to their diagnosis.

Find out more here: Cancer

End of Life care

Will continue to be a major consideration in terms of support for individuals, their Carers and families. Follow this link: EOL

Useful websites

You can find information on paying for adult support: https://www.wirral.gov.uk/health-and-social-care/adult-social-care/paying-adult-support

Wirral Council are extending the number of services on offer to Direct Payment users and more information can be located here: https://www.wirral.gov.uk/health-and-social-care/adult-social-care/direct-payments-prepaid-cards

View more information about finance support and money advice

You can find out more information on the Deferred Payment Policy here: https://www.wirral.gov.uk/health-and-social-care/adult-social-care/paying-adult-support

You can find out more information about the Wirral Independence Service here: https://www.wirralinfobank.co.uk/Services/255

Wirral Infobank is a directory of local care and support services, information and activities for Knowsley, Liverpool, and Wirral. You can find out more here: https://www.wirralinfobank.co.uk/

Healthy Wirral is an initiative designed to encourage re-shaping of health services and social care in Wirral, while promoting you to take more responsibility for your own health. You can find out more here: Healthy Wirral Plan 2019-2024

Read the Wirral Health and Wellbeing strategy 2022

The Wirral Local Plan sets out how the Borough will be shaped between now and 2037. You can read more here: Local Plan

Market Overview

Our market continues to change and develop to meet local need, and we continue to see reduction for Demand In some areas and growth in others. As we grow our extra care offer and care and support at home offer, our need for residential care diminishes.

We will keep under review vacancy levels in both the residential and nursing market and supported living services to inform our view about future commissioning intentions.

Real Living Wage

Since 1 May 2020, the council have urged all providers to commit to pay the Real Living Wage (RLW). Our agreed fee models for 2023/2024 include the continuation of this opportunity for those providers who wish to take it up.

The council agreed in March 2023 to approve funds to continue to support the RLW initiative (£12ph for front line domiciliary care staff), and the fee model for 2023/2024 continues to include this as an option for providers.

Our Offer to all Community Care Market Providers to take up the RLW offer of an enhanced rate remains in place.

Market Sustainability Fair cost of Care

The council completed this exercise during financial year 2022/ 2023 and allocated £4.2m of fair cost of care funds allocated to the council in addition to £10 form the council for fees for 2023/2024.

• The Market sustainability plan can be found here: https://www.wirral.gov.uk/health-and-social- care/fair-cost-care/market-sustainability-plan
• The annex B output for care homes can be found here: https://www.wirral.gov.uk/files/annex-b-wirral- residential-report-03.02.23.pdf/download?inline
• The annex B output for domiciliary care can be found here: https://www.wirral.gov.uk/files/annex-b- wirral-domiciliary-report-03.02.23.pdf/download?inline

Market Activity Level Tables

1st April 2022 – 1st April 2023 - Care and Support at Home Service inclusive of Reablement, Dom and CHC (18 -85+)

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1st April 2022 – 1st April 2023 - Supported Living

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1st April 2022 – 1st April 2023 - Residential and Nursing (incl Specialist Residential)

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Commissioning Intentions

Care and Support at Home

Wirral Council are committed to reforming the Care and Support at Home services within the Borough of Wirral and ensuring they are equipped to meet the changing and growing demand from the population it serves. Wirral Council need to ensure there is a robust community offer for Care and Support at Home Services in Wirral and that there is continual capacity and opportunity for workflow to support hospital discharge processes and respond to community cases to prevent acute admissions.

We have worked with the Care and Support at home market to co-produce a new model of care that is focused on delivering improved outcomes for individuals who live in Wirral, maximising where possible the use of people’s natural assets and community support networks.

The Care and Support at Home Service will deliver a reformed model of care and support in the community, delivering early intervention and preventative support through to intensive health and social care interventions. The service will support people to sustain and improve the quality of their life living at home, preventing deterioration and social isolation through regular monitoring and support, diverting people away from inappropriate and long-term reliance on health and social care services unless they are necessary.

The Care and Support at Home service will work in partnership with Wirral Council, local health services and other agencies / organisations to develop a model of Care and Support at Home.

Care and Support at Home Providers have adopted trusted assessments roles which promotes greater consistency for individuals and carers this is an enhanced approach to improve the timelessness of response, improve continuity for the individual and seek to increase flow across the market as a whole. It promotes appropriate decision-making closer to the individual and enables Providers to make informed decisions as part of a wider and shared model to promote independence and achieve outcomes for individuals.

Trusted Assessment plays a key part in facilitating more cohesive working relationships between social care practitioners and Domiciliary Care providers.

Wirral Council are working with Providers in the Community Care Market on joint recruitment initiatives to support this sector to both recruit and retain staff. The creating and establishing a “Wirral Career Pathway” with a range of small, medium, and large enterprises.

Wirral Council will work collaboratively with these commissioned services to further develop the model and understand the costs of the service using an Open Book Accounting and Contract Management approach. This model will enable us to grow and develop together a shared understanding of the costs attached to the service with our providers and the best ways in which to work effectively and collaboratively to achieve this.

Wirral Council are working closely with colleagues in the WCHCFT, Wirral University Teaching Hospital (WUTH) and Care Providers on the co-production of a home first pathway with the aim to have people home first with assessments and care being provided instead of in a hospital / residential setting. There will be an improved community equipment offer with other commissioned services wrapping around this model , including enhanced technologies, community health services which supports “right care, right place, right time” for people in Wirral

We are aiming for a much-increased community and domiciliary offer and a reduction in residential and nursing placements, and we will continue to invest in the domiciliary care market to achieve this.

Technology, Digital Telecare and Enhanced Support at Home

Health and Social Care services remain under increasing financial pressure, driven by the re-profiling of national budgets, Government policy and, locally, by an ageing population. Existing services, delivered in traditional and orthodox ways will not be able to meet the ever-increasing demand. While efforts are being made across the system through the Healthy Wirral Programme and other system transformation, new and existing technologies can be utilised to save money, avoid costs, and enable new models of service delivery that in turn will enhance outcomes for people and impact positively on their lives.

The clear expectation is for all Providers within the Community Care market in Wirral to work positively and collaboratively with us in deploying and using technology, both with residents and within the organisations themselves.

The Covid-19 pandemic has revolutionised the acceptability and availability of technologies to deliver care in new ways, often enabling people to live more independently, taking charge of their own lives and being less dependent on traditional care. For example, video consultations with GPs, smartphones, and iPads to stay connected with family and friends, the increase in online ordering and delivery of groceries and the growing use of technologies to monitor health conditions such COPD, heart disease, along with monitoring the symptoms of Covid-19 itself.

Wirral Council is leading the the way nationally, delivering a new digital Telecare Service at scale. This transition will be completed by 2025. The service will offer the ability for services to intervene earlier when problems occur, avert crises, and prevent avoidable serious incidents. Families and friends will be able to access information to enable them to be more engaged and active in their loved one’s care. The council continues to pilot and trial new equipment to identify suitability / solve problems. We are open to working with and supporting any provider considering using technology to deliver better care, avoid costs and reduce reliance on traditional care. We predict that people will remain in their own homes for longer, living healthier and better lives, supported using new technologies, in conjunction with the wider community. This reduces the costs to statutory services and makes better use of community-based services.

Key priorities for the community care market over the next 3 years are:

Digitised Falls Risk Prevention

This technology is now deployed in over 80% of older peoples care homes in Wirral and has proven to reduce the number of falls by 30%, especially serious falls that result in injury. We aim to deploy a community-based version of this app for use across domiciliary care. The community care setting synthetic estimate of the cost of falls in Wirral for people aged over 65 is £32M in 2019, rising to £36.9M in 2030. Successful use of the app could reduce these costs by 25% to 40% in high-risk settings.

Improved falls pick up services in care homes

The use of a falls pick-up risk assessment app allows care workers to accurately determine whether it is safe and appropriate to attempt to move a resident that has fallen. When it is safe, the use of an approved lifting device enables the person to be lifted safely and comfortably, avoiding any additional harm and eliminating the risk of a long lie. The self-management of falls in this way also reduces the need for paramedics to be called for minor falls with no injuries.

Digital Telecare

Creating greater opportunities for people to live safely and independently, reduce intrusion and decreased reliance on care services. The primary technology is discreet remote activities of daily living sensors (ADLs), working alongside automatic falls detectors and panic buttons, linking to a secure data management platform highlighting alerts and alarms. Alerts and alarms are responded to by appropriate health and social care services to ensure the person’s wellbeing and offers a safe alternative to leaving home and moving to extra care or residential care. With the person’s permission, information can also be shared with family members to enable them to play a greater role in their loved one’s care.

Digital Assistants

New technologies utilise tablet computers and smartphones to provide guides to common personal care and household tasks offering prompts and step-by-step instructions to take a shower, prepare meals and keep the home clean and tidy. The same device also provides video-calling capability, safe ways to explore the Internet, arrange shopping deliveries, arrange transport and make appointments with health and care professionals. Hybrid styles of working are being tested, all to create opportunities for more independent, but not disconnected, living.

Wirral was an early adopter of Electronic Care Planning and nearly all domiciliary care providers in the area use it to deliver quality care. Now, supported by the Department of Health and Social Care,

electronic care management systems will be offered at subsidised rates to all care providers. Systems offer:

• Improved care through greater compliance of plans, verification of visits, improved safety, reduced costs by tackling inefficiencies within the care market
• Enables and facilitates contract management
• Facilitates payment by activity (actuals v commissioned), with domiciliary care providers reporting that it allows more effective service delivery
• Providing care staff with the information they need when they need it
• Simplifying monitoring processes
• Additional reporting facilities will allow tracking of outcomes such as punctuality and length of visit
• Permits sharing of care package details (and annotation) by other authorised individuals, for example Carers, Community Nurses and Podiatrists

Tackling dehydration

In conjunction with the NHS, Wirral Council is leading a programme testing novel technology for people at high risk of harm through dehydration. Older people, people with learning disabilities and vulnerable patient groups will be offered a cup that that monitors how much liquid has been consumed by the individual. This programme fits neatly with wider work designed to manage frailty and enhance health in care homes and a national antimicrobial resistance programme. This continues to demonstrate how the careful and considered use of technology can improve outcomes, benefit the lives of Wirral residents whilst also reducing the cost of care.

Improving Supported Living Services

Technology will play a key role to increase independence for people receiving Supported Living services, offering more choice and control, and reducing reliance on traditional care and support. A programme of work beginning in 2023 will focus on service improvement with the introduction of technologies designed to increase the development of abilities and skills enable people to live with greater independence.

Supporting acute care

Supporting hospital discharge is a national priority. Wirral Council and its community care providers are playing a full role in supporting local hospitals to discharge patients safely, with a wraparound offer of technology and community care. This promotes faster, and more complete recovery, while reducing pressure on hospital wards. The use of technology improves the skills and knowledge of care workers, enriching their role and demonstrating their skills and professionalism. Care workers will be supported to continue to develop new skills and become confident and competent in the use of technology.

Day Services and Employment

Learning Disabilities and Mental Health:

There are a range of Providers who currently offer day opportunities to people in Wirral, these are commissioned through the Wirral Council and are commissioned either on a block contract or a spot purchase basis.

Wirral wants to establish a framework of providers who are commissioned to provide day services and work with these providers to ensure that there are a variety of activities for people to access which will provide more choice and control.

Working with the Liverpool City Region we have established a Flexible Purchasing System (FPS) for Providers who provide day activities and employment services. Procurement activity will continue to take place and will be led by Liverpool City Council.

The aim of the FPS is to increase the number of providers that the Wirral will be able to commission day opportunities within the community. This will give individuals more choice about the activities they take part in and move towards a reduced building-based day opportunity offer. Providers will be expected to focus on outcomes for individuals and supporting people to be more independent and more specifically moving into work, volunteering, leisure, and learning.

Wirral will continue to develop and research a range of innovative technologies which will support people to access these services and move towards more independence.

Wirral will continue to work with providers to pilot Employment Support Services, ‘Job Ready’ training to gain qualifications and Employment Pathway Programmes creating opportunities for individuals to access paid employment, and or work placements.

Wirral will continue to work with providers to develop skills in action services to enable people to gain life skills which enable them to access more independent living within their communities.

Older People

For older people including those with dementia, there are a range of day care models available in Wirral for people who meet the eligibility criteria under the Care Act. This includes commissioned services with the third sector or by accessing alternatives with a direct payment. Some of the services are available 7 days a week in order to ensure that people have a choice about when they attend and to be flexible around Carers needs. Day care for people with early on-set dementia is provided in a specialist centre.

Daytime Support for older people with dementia, frailty and people with early onset dementia is part of the Early Intervention and Prevention and Carers commission from March 2022, this is a 3 -year contract with an option for 1 + 1 year extension. The service is developing a flexible approach to service delivery depending on demand and client’s needs.

These services are being developed following consultation with people who use services, please see useful links page.

Supported Living

Supported Living services can be accessed by all client groups and there are approximately 849 people to date accessing this type of accommodation.

We will move towards actively improving the outcomes for people who live in shared supported living settings by working with providers to promote independent living and operate a positive risk-taking approach.

We will decommission shared accommodation services where they are not delivering the best outcomes for the people who live there. We have recently commissioned Extra Care schemes where people live with ‘their own front door’ and can have access to background support when needed. We will continue to develop new schemes in line with the Wirral Plans specialist housing target.

While we are aware that for some people the shared accommodation offer will be the most appropriate type of support, we want to ensure that the properties that people live in are of a high standard and we will work with housing providers to deliver this type of accommodation.

When reviewing packages of care, we will utilise a range of technology which will ensure that people are receiving the right support at the right time, and which will assist people to sustain/improve their independence. We are already utilising Just Checking and activities of daily living monitors.

As part of the Transforming Care Programme, there is an expectation that those people who have been placed out of Borough, will be supported to relocate back to the area. To do this, Commissioners will work jointly with Providers to develop appropriate accommodation to meet the needs of those people, this will also include ensuring that staff have the appropriate skills, knowledge, and training in order to support a range of needs.

During the next 12-18 months Wirral Council will engage with providers, people who use accommodation services and families to review the current model of supported living and develop a more appropriate and sustainable model to commission.

We will work with our colleagues in the Liverpool City Region to review our models of care for supported living and determine a model to best meet needs

We will work proactively with the sector to introduce electronic support planning by 2025.

Extra Care

There are 8 purpose-built extra care schemes funded by the council to provide 319 general tenancies and 10 specialist dementia related tenancies. The schemes provide on-site domiciliary support and leisure facilities to enable older people to lead active and independent lives for as long as possible, in addition to this there are 8 specialist LD Extra Care schemes (106 Units) now active with another 12 units due in December 2023 within the Extra Care schemes, individuals have a range of needs, and as people grow older, there is acknowledgement that their needs will increase. Extra Care gives people the opportunity to continue to live in their own accommodation with care on site for when they need to access it. Extra Care will be increasingly used as an alternative to residential care.

Recently we have been working with developers to increase the number of Extra Care units for older people, and to develop this type of accommodation for people with disabilities. Within the Extra Care accommodation for people with disabilities the emphasis is on promoting independence for people with learning disabilities or autism. This has been identified as an area for growth. As we know that people with learning disabilities or autism want the opportunity to live in their own home, with their own front door, but to meet their needs they may require access to support which is based on site. For people with disabilities this accommodation will be the first offer that people will receive when they are assessed to live independently.

We will review all existing schemes and when working with developers, the range of technology that can be used to maintain the person’s independence and support them to be independent and ensure that we are up-to-date with new technology offers.

Short breaks

To support Carers and family members with their caring needs, Wirral provides a range of options for people with disabilities and older people to access. These are services that have either been commissioned on a block contract or on an individual spot purchased basis. People can choose to either access the contracted short break services that have been commissioned by Wirral Council, or they can access a direct payment in order to organise their own provision. Wirral wants to ensure that while Carers are receiving a break from their caring roles, the Service User has an enjoyable break, and their short break outcomes are met.

Wirral will promote Direct Payments to people who require short break services, this will ensure that people access the type of service that they feel will meet their outcomes.

Wirral has commissioned a 10 bedded short break and emergency unit for people with learning and physical disabilities who require care and support. This service has been commissioned up to 2024. The service will be reviewed on a regular basis, while we continue to monitor the need of people in Wirral; future commissioned short break services are in place to meet the needs of the Carers and the people who will access the services.

We are working collaboratively with our colleagues from the Integrated Care Board (ICB) on a wider short break offer as an alternative to existing health funded arrangements.

Beds are available to provide a break to the Carer of an older person following an assessment of need. Beds are pre-bookable, so that the Carer can plan their breaks from Caring, but also available for unplanned short break placements. We are currently reviewing our short break offer, post pandemic

We will keep under review the number of short break beds currently commissioned and adjust to reflect value for money, quality, and demand.

We want to ensure that residential short break support focuses on a quality service and that providers offer greater diversity of experience for people using this service through links into the community and third sector support.

Specialist Residential and Nursing

Wirral currently commission a small amount of specialist residential and nursing care for people with disabilities. The Local Authority is developing a range of other accommodation to meet the needs of people with disabilities, with specific emphasis on Extra Care accommodation.

The aim of the Local Authority is to reduce the number of people who are living in residential and nursing care, particularly those people with low level needs and younger people. Wirral wants to support people with disabilities to be as independent as they can be with the same opportunities of living in their own accommodation, enabling them to have more choice and control over their lives. In order to support people, we will be accessing a range of technology which will enable the person to have the actual support that they require at the time that they need it.

While we want to reduce this number, we do acknowledge that there will be people, specifically those people with complex needs who will require this type of accommodation. Our aim will be to only place those people with the highest needs into residential and nursing care, and not to place young people with disabilities in residential care settings.

We are working collaboratively with ICB colleagues to jointly develop specialist services for those who need it, to allow them to return to live in Wirral if currently out of borough or to return from acute settings. This work is in support of the transforming care programme.

We are working with providers to commission a 9-bed residential specialist service for individuals with complex needs and or Autism due June 2024 and 3 accessible bungalows due November 2023 and a further 3 ‘own front door’ accommodation for people with high complex needs

Advocacy, Advice and Reablement

The Care Act 2014 states that individuals who require advocacy support should have a trained advocate who is able to support them in all aspects of their lives, ensuring that individuals do not have to work with a number of advocates at the same time. Wirral’s Advocacy offer is in line with the requirements set out in the Care Act 2014 and can offer all targeted advocacy support from well trained and experienced advocates through one channel, the ‘Wirral Advocacy Hub’.

The Advocacy Hub offers the following advocacy support:

• Care Act Advocacy
• Independent Mental Capacity Advocacy,
• Independent Mental health Advocacy
• General Advocacy
• Self-Advocacy
• Support for Peer Advocacy.

Wirral Council also commission Healthwatch to deliver Independent Health Complaints Advocacy, this service provides advocacy to people who have negative experience through health services.

The Local Authority has a statutory duty to commission Advocacy services for Independent Mental Health Act, Independent Mental Capacity Act, Care Act Advocacy and Independent Health Complaints Advocacy.

Wirral also want to further develop its self-advocacy and peer advocacy, this has been included in the Wirral Advocacy Hub commission, however, there is a need to develop this area to enable individuals to develop their skills to advocate on their own behalf.

Mental Health Services

In July 2018, Wirral Council transferred its social work service for mental health services formally to Cheshire and Wirral partner (CWP) to deliver within an integrated arrangement with health services.

Services for people with Mental Health issues is an area that the council are continuing to develop as part of this new offer, and we will increasingly deploy a “Lead Professional “model to ensure that people who require assessment and support can work with the right professional at the right time.

Mental health is a key priority for the Healthy Wirral workstream with the following objectives:

• Crisis Care - ensuring that the provision of Crisis services meets the needs of the local population and improves community provision to support people to access time at the right time, right place and by the right person. Wirral’s Care Crisis Concordat group meets on a frequent basis and this group aims to promote the effective and efficient delivery of mental health services in Wirral ensuring that all statutory demands are met
• Talking Together, Living Well Wirral – Improving Access to Psychological Therapies and providing a seamless pathway across Mental Health services supported by the TTLWW partnership board – group comprising statutory and non-statutory partners,
• Physical health in Mental Health – Deliver annual physical health checks to people with an SMI and consider wider Mental Health support in line with Primary Care Networks and Neighbourhood model.
• Dementia care – reviewing dementia provision across Wirral in line with the Dementia Clinical Strategy, ensuring a key focus on post diagnostic support overseen by the Dementia Strategy Board.

Wirral’s plan and commissioning intentions meet the requirements of the Mental Health Five Year Forward View and will look at further transformation in line with the NHS Long Term Plan.

Commissioned services to meet need continue to develop and grow and we will have a stronger focus on improving the quality of the services provided

We are continuing to work with providers we have commissioned 13 apartment-style supported living apartments across 2 sites for people with a mental health diagnosis

We are moving towards maximising opportunities for innovation and collaboration and to promote best practice across the Cheshire, Merseyside and Wirral area. The work of this group will inform the council’s future commissioning strategies for this area with a focus on adults of a working age and older people.

We will be actively working to deliver a remote monitoring and technology support offer for people, with Severe mental illness as a Cheshire and Merseyside priority

Residential and Nursing

The council is aiming in the long term to continue to reduce the number of long-term placements in residential and nursing settings as it continues to both improve and grow its domiciliary care offer and increase the number of Extra Care housing units.

The council will continue to support and place people with only the most complex needs such as dementia. We will continue to provide short break care for people where all options of supporting in the community have been considered. We will de-commission and reduce the number of placements for long term care in a care home setting and look at alternatives accommodation models and we will increase care and support at home offer so that more people can be supported in their own homes.

We will work with and support the care market to improve the quality of the care provision in line with the Care Quality Commission (CQC) whose fundamental standards and ratings system sets the benchmark for the quality-of-care people should expect. Our expectation is that providers should be rated as either ‘good or ‘outstanding’ and we will work in collaboration to jointly commission services that deliver improved outcomes for adults in Wirral and will work with providers that ‘require improvement’ to achieve a better quality.

Through innovation and technology projects we are supporting care homes that provide services for more complex needs by successfully deploying technology within a care home setting for people with dementia, increasing personal independence, choice and control and to create better outcomes for people, reducing dependency on statutory services.

We have deployed a Falls Application – “Safe Steps” and are supporting care homes enabling them to improve safety and prevent and reduce the number of falls. We are continuing to explore a range of technology options across the breadth of the service areas including early intervention and prevention, falls prevention, medicine management and electronic care planning so that we can develop and deploy digital technology to improve outcomes for people who require support. We are working closely with the care home market to deploy technology to enable people to become more independent and create a safer and quality environment in which people can thrive and improve their quality of life.

We will develop a care home improvement plan, which incorporates quality, GP input and intervention, technologies and other initiatives

Provider Assessment and Market Solution (PAMMS)

The Provider Assessment and Market Management Solution (PAMMS) is an online assessment tool, designed to help assess the quality of care delivered by Providers of Adult Social Services. The digital toolkit supports a consistent approach to monitoring commissioned providers.

The PAMMS auditing toolkit will:

• Enable Providers and Quality Improvement Teams to work together to achieve better outcomes for residents of Wirral
• Give Providers the opportunity to sense-check their internal quality audits against Wirral Council’s independent audit
• Enable an objective quality audit to be undertaken. This will support providers in establishing what is working well and what areas may require improvement
• Help identify where we can provide additional support, signposting, or referral to expert teams. For example, infection control, medicine management or diabetes management
• Lead to improved Care Quality Commission ratings for providers

Guidance and support is available throughout the assessment period from the quality improvement team.

The Quality Improvement Practitioner (QIP) will work with providers to plan, prepare, and carry out the assessment and will support providers to reach an agreed measure of the quality of the service and help identify any areas for improvement.

If a service receives an overall rating of ‘requires improvement’ or ‘poor’ following an assessment, the PAMMS online system will show where the improvements are required. The QIP will work closely with providers to provide guidance and support to help address these areas and improve the quality of the service.

Sufficiency in the market for self-funders is a responsibility for the Local Authority under The Care Act; we will continue to support people in finding a service and or by arranging their care offering the deferred payment scheme and top up agreements for long term care needs.

Urgent Care

Wirral is committed to improve performance around Urgent Care building upon the positive response during the covid pandemic

We will continue to develop a resilient, responsive and effective urgent care system that focuses on patient care and quality, and makes best use of resources.

There continues to be a focus on the main areas of the urgent care system:

• Admission avoidance and reducing non-elective admissions
• Improving the flow through the hospital from admission to discharge
• Timely discharge and supporting ‘Home First’ and ‘Discharge to Assess’ principles.

In relation to unplanned care, this is defined as urgent and emergency healthcare which is not scheduled activity for illnesses or injuries that are not life threatening but that require an urgent clinical assessment or treatment. Examples are Emergency Department (ED), ambulance services, emergency social or mental health services, GP out-of-hours, walk-in centres, minor injury units, 111 telephone advice and triage, NHS Direct.

For adults and children with urgent care needs, we should provide a highly responsive service that delivers care as close to home as possible, minimising disruption and inconvenience for patients, carers and families. For those people with more serious or life-threatening emergency care needs, we should ensure they are treated in centres with the right expertise, processes and facilities to maximise the prospects of survival and a good recovery.

Key deliverables include:

• System wide capacity and demand modelling to identify the range and volume of services required
• Implementation of the result of the consultation exercise around community urgent care services
• Delivery of the urgent treatment centre with redesigned and improved urgent care pathways
• Implementation of the Integrated Urgent Care Clinical Assessment Services (IUCCAS)
• Making the best use of the Better Care Fund to ensure we have the right services to provide the care needed
• Support development of neighbourhoods to provide the right level of support, closer to home, for people with complex needs.

Remodel services based on outcomes of a system wide capacity and demand review to enable delivery of operational priorities, ensuring;

• Continued focus on further reducing Emergency Department attendances and Non-Elective Admissions
• Achievement of the 24-hour standard
• Improving internal hospital flow from the point of admission to discharge with particular focus on reducing long stay patients
• Improving length of stay in both acute and community settings whilst reducing bed dependency and particularly improving our integrated commissioning approach and requirements within the community home first and T2A model
• Rapidly improving the 7-day home first pathway and community model to meet system requirements, optimising the future model
• Full implementation and review domiciliary care contract, with contingency plans in place for periods of high demand
• Maximising 7 day working by reviewing roles and responsibilities to improve efficiency supporting current and future workforce challenges, maximising technology solutions

Wirral Independence Service

The Wirral Independence Service is a key component of the achievement of independence, safety, dignity and wellbeing of adults. Wirral has brought together a range of services through a single lead provider operating a 7-day service 8am-8pm 365 days a year resulting in a more efficient service and a positive experience for our customers. The service meets the outcomes for customers with an integrated customer pathway across different services, reducing non-elective hospital admissions, reducing in care home admissions and reducing the number of falls at home. The service is offered to people living in Wirral, in close proximity to Wirral with a Wirral GP, or to people who have been discharged from acute settings from neighbouring authorities to Wirral.

Approximately 5000 people in Wirral are benefiting from Assistive Technology in their home reducing burden on carers and increasing confidence and peace of mind and maximizing quality of life.

This service is a ‘foundation’ commission which underpins all other commissioning activity within the borough, and we will continue to grow this offer

The service includes:

• Community Equipment
• Equipment for pressure care
• Equipment for adult visual impairment and hearing impairment Equipment for mainstream schools
• Assistive living at home
• Assistive Technology (Telecare and Telehealth, equipment, installation, maintenance, decontamination and repair and recycling)
• Falls prevention
• Falls pickup service
• Carers emergency card response

We will continue work with the Wirral Independence service and domiciliary care providers to enable them to order low level equipment.

Early Intervention and Prevention and Carers

The new Early Intervention and Prevention and Carers contact went live March 2022. This is a 3 + 1 + 1 year contract length.

People living in their own homes can access support from a range of natural networks and assets based within their own communities. There is a full range of networks including;

• Family, friends, and carers
• Community and faith sector
• Local neighbourhood groups
• Third or voluntary sector
• Digital technology solutions

When people make a request for an assessment, the care and support they already receive via the community offer is considered, prior to any commissioned services being put into place. Providers will be increasingly asked to tie people into their local community offer to reduce dependency and promote independence. This is reflected in all new commissions going forward.

Third sector providers will work together to offer support to vulnerable residents, to support to improve health and wellbeing and improve outcomes for individuals. Recent developments include:

Wirral Health and Wellbeing CIC are working closely together to improve the pathway to support for vulnerable people.

Community, Voluntary and Faith Forum (CVF) Forum established during Covid, organisations meet regularly to improve coordinated support for Wirral residents.

One Wirral CIC independently established and launched 2021. A social enterprise to bring people and organisations together. To build healthier and more resilient communities by ensuring people have equal access to services

Providers will promote the self-help model, building on an asset-based approach to community development

Wirral Council commission services to support Carers in the community and to meet outcomes identified by the Carers, either as a discussion with the Carer or through the Carers Assessment process.

Services for Carers re-commissioned as part of the Early Intervention and Prevention and Carers (EIAP and Carers) contract, from March 2022 – February 2025 with an option to extend 2 x 12 months.

With the implementation of the Care Act 2014, Carers have a right to a Carers Assessment if they appear to have needs. The commissioned Carers Offer in Wirral reflects the wellbeing and preventative principles set out in the Care Act. The 6 priorities for improvement in support for Carers are also included in Wirral’s Adult Carers Strategy

1. Information and Advice
2. Carers Health and Social Care Support
3. Carers Health and Wellbeing
4. Finance and benefits
5. Carers Short Breaks
6. Communication with professionals

Carers Direct Payment process established March 2022, for Care Act eligible Carers through the CWP and Wirral Council social care teams.

Wirral Council actively encourage organisations to work collaboratively to provide a range of support available to Adult Carers providing care and support to people across a range of conditions and disabilities. Services supporting Carers will adopt an asset-based approach to support Carers to access non-commissioned and universal services, including the roll-out of the 3 conversations work. Carers will be supported to access assistive technologies that can support them in their caring role.

It is difficult to accurately state the number of people providing care in Wirral, the 2021 Census reports the number of people with caring responsibilities as 33,499 (10.5% of the population, this is a drop of 6,501 from the 2011 Census. More can be found out here: Carers

The Wirral Adult Carers Strategy 2023 - 2026 has been co-production in-line with local and national directives, and what Wirral Carers told us was important to them.

Sensory Services

• We will develop a service that will support people with sensory impairments to access community support that promotes independence.
• We will improve our offer of Interpreter services to support assessment activity, including launch of the on-line GP Interpreter service, promotion of the new BSL111 and BSL999 services
• We will review services for people who are blind or sight impaired. Sensory services for people who are deaf, or hearing impaired, blind or partially sighted have joined up with the Wirral Health and Wellbeing CIC as part of the EIAP and Carers contract

Healthwatch

Healthwatch has a statutory duty, as part of the Health and Social Care Act 2012 to: Gather the views and experiences of people using health and social care services.

Feedback the views on services to contracts managers and commissioners to assist to improve services.

• Enter and View Care home settings for CQC registered providers and to feedback to the CQC through Healthwatch England with issues or concerns.
• Support people to access information and advice on services.
• Represent the views of Wirral residents on the Health and Wellbeing Board
• Support people who require to access advocacy support for NHS service complaints.

A new Healthwatch Wirral and Independent Health Complaints Advocacy service went live September 2021. This is a 5-year contact with an option to extend for a further 2 + 1 years.

Managed Accounts and Payroll Services

The Managed accounts and payroll service are for people in receipt of a Direct Payment and require support to manage payments for the care they receive.

The Direct Payments Review identified – the need to increase take up of the number of people accessing Direct Payments, using Prepaid cards and, improving support in recruitment of Personal Assistants and Managed Accounts and Payroll services.

Stakeholder Voices

As part of all our commissioning activity we aim to engage and work with a wide variety of stakeholders to coproduce services and to ensure their views have been considered. We work very collaboratively with our colleagues in Both Public Health and Wirral ICB.

We engage with our customers, their Carers and families, our partners, other council services, NHS providers, social providers, statutory services, the local community (our stakeholders) and the social sector when we plan, design, commission, deliver and evaluate adult social care and support services.

The Care Act 2014 requires much more integrated and partnership working between social care, health, partners, providers, customers and carers. It puts customers and their Carers in control of their care and support. It aims to increase transparency and openness, together with driving up the quality of care across the system. As well as seeking to ensuring more choice, it requires better provision of customer information in order to make decisions about the right care and support, and better opportunities to engage in the design and delivery of the support and services they need.

Different levels of engagement are detailed in the council’s Engagement Framework. The approach which has the most relevance to us is ‘Working Together.’ This is defined in the strategy as “Local people and public organisations working together to carry out work or run parts of a service.” For Social Care this would equate to customers and carers working with staff, partners and providers in the design and delivery of support and services. This is very close to the concept of ‘co-production’.

Co-production can be summarised as working collaboratively with stakeholders to provide people with an equal voice in the design, planning and delivery of services. It challenges expert / non-expert models of working. It assumes that all different perspectives have an equal value. It aims to produce support and services where all stakeholders have been equal co-creators.

We are currently developing a new engagement strategy, and this will be available in 2023/2024.

If as a provider you wish to contact us, you can do so by mailing Wirral Contracts team on, wirralcontractsteam@wirral.gov.uk and we will respond to you as soon as we can.