Written evidence submitted by Oxfordshire County Council (ASC0085)

Oxfordshire County Council’s Response to the Call for Evidence

Oxfordshire County Council welcomes the Health and Select Committee’s inquiry Adult Social Care Reform: The Cost of Inaction, and the chance to respond to the call for evidence. As a county council with a statutory function for adult social care, we are particularly focussed on managing the impacts that reforms, or lack of reforms, have on local authorities and the residents that we support.

In responding to this call for evidence, we have focussed on areas where we have managed to reduce the consequences of a lack of funding and inaction in social care reforms. These include our pioneering ‘Oxfordshire Way’ approach, which has enabled us to buck the trends in social care by managing demand and reducing the number of people waiting for an assessment.

We would like to offer the Committee the opportunity to visit Oxfordshire to see firsthand how our approach has successfully mitigated some of these challenges. We hope that our lessons can be part of wider solutions for the sector and the government to address longer-term and sustainable reforms.

Oxfordshire County Council’s Approach

The People at the Heart of Care White Paper, published in December 2021, set out a 10-year vision for adult social care around three objectives:​

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

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Moving towards this reform vision required measures and financial investment to transform the adult social care system in England, including technology and digitisation, supporting adult social care workforce, innovation and improvement, housing and home adaptations and support for unpaid carers.

Oxfordshire County Council was one of the six trailblazer local authorities testing the key aspects of the reform in advance of national implementation. This enabled us to work closely with the Department of Health and Social Care (DHSC) and other trailblazer councils, on how to implement changes locally to ensure the right care was available at the right place and time, for people who need it when they need it.

Our learning from the programme supported us to drive our own transformation programme at rapid pace, in particular through:

• Embedding the Oxfordshire Way.
• Digital transformation, including improving our information and advice offer, developing digital options for needs and financial assessments.
• Working with the sector leaders at national and local levels to support our workforce and make social care an attractive career.
• Investing in working collaboratively with our partners and social care providers.
• Investing in improving the quality of care including innovative and preventative options.

We are proud of our achievements in Oxfordshire since 2021 and are already seeing the impact of our transformation on people’s lives.

Although delays in charging reform may have created a level of uncertainty on people’s personal finances, we believe the structural changes we have implemented have enabled us to continue to support people in Oxfordshire effectively. Our financial position, such as pooling resources with the NHS and a focus on prevention, means that Oxfordshire County Council is in a stronger position than many authorities. However, the overall financial position is challenging, and like all councils we have had to make tough choices to ensure we can support our most vulnerable residents. Looking ahead, we have additional financial pressures as a result of national living wage increases and the change in employers’ national insurance contributions, which will have a considerable impact on our budgets, as well as on our providers’ financial sustainability to deliver high quality adult social care.

Implementing the 2021 reforms would need significant investment beyond the current funding gaps in adult and childrens’ social care faced by local authorities. So whilst the cost of inaction is important to consider, it is also vital to understand the funding pressures on local authorities associated with implementing reforms.

The Oxfordshire Way

Challenges of meeting the growing demand for adult social care within tightening local authority budgets is well documented. Building on our experience in providing high quality social care for residents, we have undertaken a transformation programme to support individuals who use our services while addressing challenges and maintaining the financial stability of the Council.

Working with our strategic and sector partners, we created our vision, the Oxfordshire Way, supporting people to live well and independently within their communities, remaining fit and healthy for as long as possible. The Oxfordshire Way vision has guided how we help people to live fulfilling, healthy lives in Oxfordshire. Our focus is on putting people first, building on their strengths. Rather than focussing on what they can’t do, at every interaction we focus on what people can do without formal social care support. We consider this through looking at the assets they have or that are in their informal network, such as their family, friends and community. We work with people and alongside them to achieve what matters to them.

The Oxfordshire Way vision enabled us to:

• Empower people of Oxfordshire to identify, access and manage their own support to live their lives as they would like to.
• Encourage our staff and partners to collaborate and focus on what matters to people and what they can do.
• Redefine how we deliver outcomes and manage demand so we can make best use of our collective resources.
• Build a greater focus on prevention so fewer people require formal support.
• Strengthen our partnerships so we can achieve more together.

The Oxfordshire Way is closely linked with our duties around prevention, which we deliver with our system partners, including the NHS and the voluntary sector. We believe that local government is uniquely positioned to effectively coordinate and manage this ecosystem. Our understanding of the local area, our communities, and our connections with statutory and voluntary sector organisations, as well as our links with residents at every level, enable us to perform this role efficiently.

In Oxfordshire, we are proud of our history of collaboration. Oxfordshire County Council and the Integrated Care Board has had a Section 75 agreement in place since 2013, which was previously set up through the Clinical Commissioning Group. It consists of Live Well and Age Well (Better Care Fund) pooled budgets, which totals £546m. In addition to pooled budgets, Oxford Health NHS Foundation Trust (OHFT) has extensive experience leading collaboratives for adult mental health, alongside with voluntary sector partners, and was one of the first wave specialist mental health collaboratives.

Our Place Based Partnership has been built on these strong foundations and offers a unique opportunity for executive leaders from health, local authorities and communities to come together, accelerate integration and find new ways to use our collective resources and improve outcomes for the residents we serve. It can make choices about how to leverage resources and prioritise actions and interventions that reduce health inequalities and increase our investment in prevention.

Our strategic vision and our commitment to transform adult social care in Oxfordshire enabled us to invest in our services in the way that would make the biggest difference to people’s lives. We have taken the option of charging an additional precept on our council tax without holding a referendum to assist the authority in meeting its expenditure on adult social care for the financial year.[1]

The Impact

We are proud of the sustained and tangible impact of delivering our vision on the lives of people. People who use our services say they:

• have a real and positive impact on their lives, they have higher than average satisfaction – 68.5% of people are very or extremely satisfied with their care and support compared to 64.4% nationally.
• find it easy to access information about services and have as much social contact as they would like.

These results were possible by continuing to invest in adult social care. The graph below shows 45% increase in the total adult social care spend in Oxfordshire since 2015/16 and a 35% increase since 2019/20. The stabilised position in 2023/24 represents the level of savings achieved for that year.

The Oxfordshire Way approach is also critical to shaping the market locally towards more preventative support where possible and more home-based care, rather than residential care. We are working with our providers and teams to ensure no-one enters a care setting through lack of choice in the community or through practice at the point of assessment and care planning.

We have started to see the impact of this empowering approach. The number of people waiting for an assessment has been reducing, as can be seen in the graph below

Furthermore, our reablement offer supports people in their homes following a hospital discharge, supporting them to gain or regain their independence. In Oxfordshire 92% - more people than the national average - are still at home 91 days after discharge from hospital.

People who need ongoing support with their daily activities receive this support at their homes rather than in care homes. The graph below shows a 7.5% reduction in care home activity and 61% increase in home support since 2017/18.

Our Adult Social Care Outcomes Framework (ASCOF) submission for 2023/24 shows considerable improvement on 14 of the 20 performance measures in the year. Overall, we perform better than average on 57% of all measures and 15 of the 20 measures perform better than the last national position (22/23), with one measure scoring at the same level.

We are proud of what we have achieved in the last few years in improving the delivery and experience of adult social care in Oxfordshire. We are bucking the national trend in managing the demand and reducing the number of people waiting for an assessment. We will continue to work with people, communities and our partners in delivering our transformation and meeting the needs of our residents.

Working with our providers

Effective working with our providers is key to delivering our vision and ensuring people have access to high quality care and support when they need it. We are proud of the quality of care provided in Oxfordshire, with 89.5% of social care providers rated good or outstanding as of November 2024 (as compared to 82.6% in England).

Since 2021, only five care providers ceased to operate in Oxfordshire (four home care providers and one care home). Home care providers stated the financial viability of the business including their inability of recruiting from overseas as the reason for their decision. We worked with 124 people who were affected and sourced their care from other local providers thanks to the capacity we have in the market.

We work closely with all of our care providers to ensure they continue to deliver good quality of care to people we support. Where we identify concerns, we put an action plan in place that outlines the improvements we require. In the majority of cases, this work results in improvements in service delivery. When this does not result in the improvements we expect, we terminate our contracts with those providers. To date, we have terminated contracts with 19 providers (17 home care, 1 supported living and 1 care home provider) due to quality concerns. One provider the Council took action against due to their reliance on overseas recruitment lost their CQC registration more than a year after our action.

Our commissioners work closely with our teams to understand the demand for care and the Oxfordshire market to ensure sufficiency in County. We have been successful in ensuring sufficient capacity in Oxfordshire for home care with our new Home Care Framework, and we also have sufficient care home places for people who may need residential care.

Like other local authorities, we have been facing the challenges for ensuring sufficiency in Oxfordshire for young people who have complex mental health needs and those who have Special Educational Needs and Disabilities (SEND). Lack of specialist educational places for children and young people with SEND in the county limits our ability to find local placements. The limited number of suppliers in this market and the restricted options available to local authorities result in high cost pressures for children's services and subsequent adult services when the young people reach 18, as well as poorer outcomes for our young people. We predict this pressure will continue given the increase in the number of ECHPs nationally and in Oxfordshire.

Adults’ and children’s services in Oxfordshire County Council work closely together to support young people throughout their lives. We commission services to provide suitable accommodation for young adults, including developing more supported living in Oxfordshire and we are about to open a 12-bed complex to support transition. We have also repurposed a number of existing supported living settings so that there is a greater focus on younger people. We also have a strong Shared Lives scheme in Oxfordshire and currently have 34 young people between the ages of 18-25 in a Shared Lives arrangement. We are currently exploring our investment opportunities in relation to Shared Lives and have a significant focus on our Care Leavers.

In addition to suitable accommodation, we are working to expand employment options for young people who have SEND and complex needs, to ensure they have independent and fulfilling lives. In December 2024 we are launching a SEND Employment Forum which will help drive and expand the offer in relation to supported employment for young people with SEND.

We are aware that there are national challenges in relation to young people with complex mental health challenges that are subject to Deprivation of Liberty Safeguards (DoLS) under the age of 18. We are exploring what our commissioning options in Children’s and Adults Social Care could be for this group of young people. The aim of this work will be to wherever possible keep our young people in Oxfordshire rather than out of county, but also to drive market competition with a view to keeping costs at a manageable level. We are keen to support work and discussion at a national level in this area.

Workforce

Workforce continues to be one of the biggest challenges for delivering quality care. The adult social care workforce is delivering an essential public service but can often be characterised by low pay and low job security, which in turn creates challenges of high turnover and high vacancy rates for providers.

We have a tradition of working closely with our providers in Oxfordshire. We established Oxfordshire Association of Care Providers (OACP) in 2014 to support building and maintaining capacity within the market. Our strategic partnership with OACP as the representative body for adult social care providers in the county enables us to work alongside our providers sharing insights and market intelligence to support delivering high quality care in Oxfordshire.

We also have a dedicated Adult Social Care Workforce Strategy, peer reviewed by Partners in Care and Health and informed by Skills for Care’s priorities for the sector, outlining our priorities and how we are working with our care providers, as well as schools and training providers to attract, recruit, train, and retain our workforce in Oxfordshire. The strategy is aligned to the Oxfordshire Way strategic vision and is supported by a delivery plan which was co-produced with key partners across our local network, including the people we support. The delivery plan accompanying the strategy ensures the council’s ability to respond to opportunities and contribute to the work on specific issues such as

• International recruitment, including changes in visa rules and deployment of International Recruitment Funding Phase 2.
• Supporting migrant workers and preventing exploitation.
• Changes to Learning and Development funding and availability of courses at the local level.
• Proposals for a National Care Service.
• Proposals for a Fair Pay Agreement.
• Budget announcements.
• Get Britain Working White Paper.

We know that the capability and compassion of care workers makes all the difference to the lives of the people they care for, and we want to better recognise these skills and the expertise they bring to their roles. We believe a national strategy for adult social care workforce and associated funding would support not only our work, but that of care workers across the county, and continue to improve the levels of care individuals receive. We believe such strategy and investment should include:

• Working in partnership with local authorities as local leaders and commissioners.
• Working with the sector in making careers in care attractive and a career of choice.
• Having a national adult social care workforce salary structure that reflects the skills and qualities required and career progression.
• Standardising the training requirements and providing care workers with a recognised passport to demonstrate trainings they completed.
• Supporting digital and technological skills of care workers.
• Ensuring equality and diversity within the adult social care workforce.
• Improving the working conditions of adult social care staff.
• Supporting the mental health and wellbeing of our workforce.
• Clarity on the future of the UKVI scheme and initiatives to support domestic recruitment of care workers.
• Longer term funding (to allow for investment and planning that gives certainty and confidence).

December 2024