Outcomes focussed models – providers jointly set with the LA/ NHS service user outcomes and are paid to achieve these more flexibly over a given period. The Council to give an indicative budget for a service user or area and asks providers how they might solve the problem. Outcomes-based payment mechanisms through more block type contracts and maximising independence incentives.
Market Position Statement 2025 - 2040 Community-Based Services - Future Possible Models Of Community-Based Services In Walsall
MPS co-design sessions with providers have been exploring future models of community-based services. There are various models nationally and internationally that have been considered to inform the future of service design in Walsall. Below are some of the ideas and discussions to date that are informing future design and the re-commissioning of the CBS Framework in 2027.
Homecare: Different Models For The Future In Walsall
The list below gives a feel for different homecare models that commissioners have been looking at as reference points in thinking about the future of homecare in Walsall. These models have been discussed with providers in co-design sessions.
Summary Of Key Considerations In New Commissioning Models
Model 1
Model 2
Outcomes focussed models – providers jointly set with the LA/ NHS service user outcomes and are paid to achieve these more flexibly over a given period. The Council to give an indicative budget for a service userr or area and asks providers how they might solve the problem. Outcomes-based payment mechanisms through more block type contracts and maximising independence incentives.
Model 3
Place-based Well Being Teams e.g. Monmouthshire and Devon: Integrated NHS/social care staff place-based teams work around a group of service users in set geographical areas. Staff get to know service users, and packages of care are altered through joint reviews with providers, social workers, physiotherapists and occupational therapists together provide a seamless approach. Working in limited geographical areas prevents time being spent travelling between service users.
Model 4
Gesundes Kinzigital Model, Germany – established in 2006 as an integrated care management company. It holds long-term contracts with funders and operates on a membership model, with Gesundes Kinzigital holding accountability for the budget for the population group and new models of home care, negotiating a range of contracts with local providers. The approach includes a focus on prevention (including healthy lifestyles), a patient-centred approach (including individual treatment plans and a named health care professional chosen by the patient who provides continuity of care), and an integrated IT system.
Model 5
Buurtzorg model, Holland – These are self-managing, nurse-led integrated self-managing teams working in communities – OTs, physios, nurses, carers.
Model 6
Micro-enterprise - In Somerset, the County Council works with Community Catalysts to support and encourage local micro-enterprises. Local authorities are responsible for ensuring that there is a market in which individuals can exercise their choice, and microenterprises may suit some service users using DPs and different types of PAs and care workers.
Japanese Case Study – a community-based service with an emphasis on inter-generational contact and mixed care offers. Aoi Care, in Fujisawa, 50 km south of Tokyo is a service for older adults, which puts intergenerational relations at the centre of its care facility. It’s founder Tadasuke Katou had been working in an intensive care home for elders, but became disillusioned with the care there, which seemed to only consist of older people lying in bed, sleeping and taking their medicine. He quit his job to set up Aoi Care (website in Japanese). Aoi Care consists of two sections: a residential area with a capacity for seven older adults coping with dementia and an ‘open’ section where older adults can visit and can stay for a short period if they want to. Daily life in Aoi Care puts a priority on participation of older adults from the surrounding neighbourhood, productivity and independence of older adults and intergenerational contact.
Aoi Care is physically and metaphorically close to the community. Weaving through its buildings is the public street, on which the neighbours of all ages to travel from home to the City, school and their work. So children going and coming home from school go along the street coming in contact with the older people in Aoi Care. Contact with younger children is also made possible by the fact employees at Aoi Care can take their children with them to the day-care facility.
Summary Of Key Considerations In New Commissioning Models
Below summarises key aspects of future community-based services models that Council commissioners are now exploring with the ICB and other partners.
New Walsall Homecare models
- Walsall Council to only commission homecare providers rated CQC ‘Good’ or better and those with good local quality assurance assessments
- Continue to encourage providers to work with people with DPs and self-funders and to grow their businesses to meet needs other than Council commissioned support. Consider an e-system for people to select their own homecare providers
- Strong possibility of locality zonal lead providers. These models enable economies of scale for providers, use of local assets and support services and support environmental sustainability with walkers and use of local transport to reach clients
- Less commissioned providers – this is to enable economies of scale for providers and a more sustainable market and to enable the Council to manage relationships better with fewer providers
- Continually improve the Council’s support offer to providers in terms of access to training, DBS checks, workforce development, payments, brokerage
- Consideration of joint models with health e.g. care and nursing joint teams for care at home and in communities such as Wellbeing Team models
- Payment on agreed area/ zone and individual outcomes with devolved budgets and/or staggered payments: upfront, mid package and end of package payment structure
- Homecare services well connected to other community assets that prevent and delay the need for formal care e.g. clear locality ‘offers’ with signposting, shared care, co-location.
Extra Care Housing
- Stimulate the ECH provider market to develop several new schemes by 2040 to meet community-based services demand
- Improve referrals into existing ECH provision and best utilise commissioned care hours
- Work with providers and developers to re-vision ECH of the future - community assets, multi-need, multi-purpose schemes mixed with other all-age provision
- Improve use of ECH flats and reduce voids in existing provision.
Walsall’s Future Day Services Models
- Better mix of buildings-based and outreach day opportunities
- Transport offers for people to use day opportunities
- Consideration of whether the Council should return to commissioning day opportunities
- Specialist day opportunities embedded in communities to meet different needs.
Walsall’s Future Reablement Services
- Continue to expand reablement services in Walsall and move to more of an outcomes-based commissoning model
- Appoint a Phase 2 Reablement Service strategic partner(s) better connected to the ICS Reablement offer
- Providers to be part of Multi-Disciplinary Teams working more closely with the NHS and the Council on cases and maximising independence
- More and different use of digital, TEC and AI in reablement services.
Walsall’s Future Carers services
- Wider respite offer for carers and the cared for
- Continue to champion carers support in Walsall with a wide offer of support and to continue to uncover the unmet needs of carers
- Improve direct payment take up by carers and the cared for
- Dementia support models for carers and continued investment in preventing carer breakdown
Walsall’s Future Prevention And Early Intervention Services
- Falls Prevention approach is being prioritised as a key preventative service
- Improved investment in preventative services and early support with Public Health, Resilient Communities, Children’s Services and other partners
- Increase the amount of Adult Social Care investment in preventation and early help services
- Develop pilot initiatives to build the capacity of VCSE anchor organisations in localities who can deliver these services.
These are all considerations that we welcome conversations about with providers and partners. In order to achieve our vision and intentions for community-based services of the future, we need to transform and to commence that transformation process now.
Please do send comments on this Market Position Statement and market development ideas you have to using the below link. We look forward to hearing from you.