Market Position Statement for working age adults aged 16 to 64

Warwickshire’s overall health outcomes are above the national average; however, these outcomes vary among its residents. In more deprived regions, individuals experience shorter lifespans and spend a substantial portion of their lives in poor health. Contrarily, in less deprived areas of the county, males anticipate living over nine years longer, while females expect to live five years longer than their counterparts in the more deprived regions.

Notably, people are facing an extended duration of poor health in their extended lives, with men enduring 17.6 years and women 19.3 years in suboptimal health. These discrepancies in health outcomes are avoidable and closely tied to living and work conditions, alongside lifestyle choices encompassing smoking, alcohol consumption, nutrition, and physical activity.

While numerous individuals continue to enjoy a healthy, active, and independent lifestyle in their later years, some face an escalating risk of frailty, longterm medical conditions, dementia, terminal illnesses, dependency, and disability, including falls, as they age. Furthermore, individuals from certain ethnic minority groups and lower socio-economic backgrounds are more likely to experience inequalities in aging well.

Evidence indicates that people with learning disabilities have poorer health than people without a learning disability and have differences in health status that are, to an extent, avoidable. The health inequalities faced by people with learning disabilities in the UK start early in life, and often result from barriers they face in accessing timely, appropriate and effective health care. Autistic adults similarly experience inequalities in terms of quality of life, physical health, mental health, employment and social relationships. All providers and carers have a role to play in supporting people with healthy lifestyles and access to healthcare, including reasonable adjustments where necessary.

Warwickshire is less diverse than the West Midlands region and England as a whole. The majority of the population in Warwickshire identifies as White, accounting for 89.1% of the population. Our care records systems show that our working age adult care home population appears to have a different ethnic composition compared with the West Midlands. However, the ethnicity of 10% of our residents in care homes is undeclared. Because of this, work needs to be undertaken in this area to understand more accurately what the real diversity of care is in Warwickshire, and we will seek to work with providers and local communities to help ensure the care provided meets the specific needs of the wider community.

• Warwickshire Insights
• Projecting Adult Needs and Service Information (PANSI), Oxford Brookes University Institute of Public Health (other data sources are available) - PANSI

Out-of-county placements involve individuals requiring social care services being situated in a local authority area different from their residence or origin. The rationale behind such placements varies, contingent on the specific care needs, local service accessibility and quality, and the preferences and well-being of the individuals.

The above table details the number of out-of-county placements for individuals receiving Warwickshire County Council (WCC) funded Supported Living packages from April 2018 to April 2023. Notably, the highest number of such placements are users of Mental Health and learning disability services. While there is a sustained number of learning disabilities individuals placed out of county, a significant increase in Mental Health placements is evident from April 2022 to April 2023.

This data underscores the need for ongoing collaboration with our service providers. It is essential to ensure adequate resources are in place to address the increasing demands, particularly for the local population requiring mental health services.

Supported living provision in Warwickshire

The WAA Community Services Framework consists of 75 providers across the different services. For those services that require CQC registration the majority, (77%) were rated as ‘good’; with 2 providers rated as ‘outstanding.’ 10 providers are rated as ‘requires improvement.’

Alongside our commitment to quality, our Commissioning and Quality Assurance teams continue to collaborate closely with WAA providers through ongoing communication, visits and access to training to support providers to improve quality of their services.

We will continue to work closely with our Social Care Providers to drive quality improvement through our ‘See, Hear and Act’ approach through which we gather and triangulate intelligence from multiple sources to identify any quality themes or concerns. Where concerns are identified we undertake quality assurance activity to understand these in more detail and this could include a visit to the provider to validate the intelligence.

Where necessary support improvements through Service Improvement Plans (SIP). Significant concerns are escalated to Service Escalation Panel (SEP) where remedial actions are discussed, agreed and monitored. Remedial actions could include restrictions on admissions to the service until sufficient improvements have been evidenced and sustained. This could be a Voluntary Placement Stop (VPS) where the provider agrees to restrictions on admissions and enables them to have the resources to implement improvements as identified in the SIP.

This collaborative approach benefits the service users whilst building supportive partnership with the providers.

Future demand

The graphs above show the projected demand for Warwickshire County Council (WCC) funded Supported Living packages categorised by service need, spanning from 2018 to 2027. Projections indicate a universal increase in demand, with an aggregate increase of 23% from April 2023 to April 2027. Notably, physical disability and mental health exhibit the most substantial growth rates, increasing by 66% and 40%, respectively, during the period from April 2018 to April 2027. Concurrently, learning disability sees a more modest 11% increase over the same timeline.

The impact of the COVID-19 pandemic has presented us with a challenge estimating future trends, due to significant drops in occupancy levels during the pandemic and then increased levels of demand over the last 12 months after restrictions were lifted in March 2022. Because of this we will continue to gather information and intelligence regionally and nationally and work with providers to understand trends in demand and we will be engaging with our local providers to come to a view regarding the right level of investment and development for our market through provider forums and mutual aid calls.

Analysis of referrals and sourcing of Supported Living reveal the following challenges in Warwickshire:

• Geographical preferences - Sourcing Supported Living in the southern or rural areas of the county.
• Sourcing smaller packages of support - The majority of referrals entail low-level customer needs, translating to a demand for a relatively modest number of hours per week, typically less than 35 hours.
• 16 to 18-year-old support requirement – Sourcing Supporting living packages for individuals aged 16 to 18 years old.