Market Position Statement - Messages to the market

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Residential and nursing care

What we want for our residents - We want to ensure a sufficient choice of nursing care and residential care in the borough for those with complex needs so that every person who needs a care home placement is able to access a suitable local option of their/their family’s choice.

We want to ensure that care home placements are delivered in care homes that have at least a 'Good' rating from the Care Quality Commission.

Current provision

There are 13 nursing homes with 1,096 beds and 17 residential homes with 300 beds according to latest CQC data sources. Both boroughs have high quality residential and nursing care homes mostly rated good and above. The proportion of homes in Wandsworth that are good and above has reached 100% in part due to one home that was unrated being rated as good and also due to the closure of 3 homes in Q2. For both boroughs the indicators are higher than the benchmarking indicators: South West London 86.8%, London 85.5%, England 81.1%.

Residential and nursing care services are commissioned in and out of borough by spot purchasing.  

Residential and nursing care per primary support reason is shown in the table below.

Client group	Residential care beds	Nursing care beds
Older people/physical and sensory disability	186	845
Memory and cognition*	0	0
Learning disability	89	0
Mental health	25	251

*No specialist homes but some specialist beds available in older people's provision

Messages to the market - residential and nursing care

• We understand the needs of our local communities and embed these in our strategic commissioning, which is focussed on increasing provision where needed most.
• We are developing our care homes strategy for Wandsworth in 2025.  
• Our services are safe, effective, of high quality and promote innovation. We want to work with providers to ensure quality and safeguarding practices through agreeing clear standards and monitoring provision through the standards of the PAMMS quality assurance system.
• Supporting swift hospital discharge for our residents and NHS is critical.  We want to facilitate strong relationships between providers, our service acquisition team, social workers and the hospital to enable this and encourage providers to work in partnership with us and provide feedback on any suggested process, pathway or relationship improvements.
• We encourage providers to develop links with local communities to increase the choice of activities and social stimulation.
• Continuing our partnership approach with providers to have a shared vision and sense of purpose to meet local need and to make the market more sustainable is invaluable.
• We have a strong track record of integration with the NHS and council directorates. We will continue to work in partnership with Southwest London ICB to promote and develop the Enhanced Health in Care Homes programme and other technology enabled care projects. We welcome providers participating in these projects/ programmes.
• We are continuing our commitment to rolling out digital technology to support residents to remain independent.
• We encourage providers to engage in the use of technology enabled care to support independence and improve quality of life.
• We want providers to work with us to understand the demand for services from people who fund their own care.
• We want to offer inclusive and culturally responsive services and work in a person-centred way, tailored individually to meet the needs of people from all equality groups, for example lesbian, bi-sexual and transgender people.

Older people and adults with memory and cognition needs:

• We will always require residential and nursing care services that can meet the diverse needs of our population. We have a sufficient supply of basic residential care provision. In the future we need:
  1. Less standard residential care placements, as alternative provision such as extra care supports people to remain independent in their own home with intensive support in place.
  2. More residential dementia and nursing dementia beds for people who have complex needs and behaviours that challenge.
  3. Dementia friendly environments to be considered during developments of service delivery models.
  4. More providers who offer nursing placements for complex needs/ highest level of need.
  5. Provision of bariatric care (which focuses on providing compassionate care and support for those who have obesity to promote better health, through diet, equipment adaptations and purpose-built accommodation).
• Placements for older adults with a learning disability or mental health need within 65+ care homes can be hard to source locally, and this is a current gap in the market. We would like to work with providers to develop specialist provision in mainstream settings to avoid these residents being placed outside of the borough.
• We are keen to work with local care homes which seek to upgrade, reconfigure and specialise in these above areas to develop capacity in the areas that meet our resident need and increasing demand. We recognise this may require a review of workforce plans and want to work together to ensure that there is a sustainable and well-trained workforce that are able to meet the diversity of needs.
• Through our market shaping strategy, we are exploring opportunities for block contracts and refreshing our placements policy. We will be engaging with the market to design agreed definitions and pen portraits for the 4 care home bed types (residential, residential dementia, nursing and nursing dementia) to bring consistency and understanding across all stakeholders. We anticipate this will provide more stability for both the council and providers for existing placements and sustainable prices. We are interested in hearing providers view on this approach.
• From time to time there are new homes being developed which typically provide services with prices at the upper end of the market. We would welcome approaches from providers who can offer rates that support the council to manage its budget within available resources.
• We have arrangements in place for step down provision to support with hospital discharge and to allow a short period to review an individual’s needs and assess what long term care provision they may need. For now, we do not have a need to commission additional capacity.

Adults with learning disabilities:

• There is a continuing need for some in-borough specialist residential and nursing care for younger and older people who draw on care and support needs with more complex needs.
• There is also a small but emerging need for bespoke services for people who have been discharged from long-stay hospitals or who are experiencing crisis and require unplanned/emergency accommodation to prevent admission to hospital.
• There is a keenness to expand the range of short break and respite options available to people with a learning disability and their carer’s. We would like to hear from and work with prospective provider partners with creative ideas that can support carers with a welcome break and promote enjoyable new experiences for people with a learning disability.

Adults with mental health needs:

• There is a need for in-borough specialist residential and nursing care that support residents with mental health conditions, as well as those who are neurodiverse, and those who have challenging behaviour and other needs.
• We want providers to support residents with co-occurring conditions, including residents with a substance misuse need.
• This will require providers to employ highly trained and skilled staff who can support adults with a mental health condition.
• Our approach to developing pathway models from residential and complex care and forensic provision to supported living and outreach support requires us to work in a different, more strategic and relational way. We are seeking to develop strategic partnerships, improve the quality of our accommodation, bring inward investment and more innovative commissioning and procurement models. We are interested to hear from providers wanting to work in a network of provision and in partnership with the Council and others.

Extra care

Extra care housing provides an alternative accommodation based care option which promotes independence and wellbeing. The service provision is flexible and responsive to adapt to needs as they change. These schemes help keep people connected to the local communities for as long as they wish.

What we want for our residents - We want to ensure good quality, safe, accessible and adaptable extra care provision for older adults enabling them to live independently, avoiding or delaying the need for residential care. 

Current provision

There are three (150 units) extra care schemes in Wandsworth that are commissioned by us which are available for social rent (no provision for shared ownership) and there are also additional privately run schemes. Our commissioned services are generalist physical health, mobility and sensory needs provision for people aged 55+.  

A new 41 unit extra care service is under construction as part of a mixed development. This project is an exciting development featuring 95 homes including 54 shared ownership and 41 extra care homes for over 55s and is due to open in spring 2025, with a secured care and support provider in place.

Messages to the market - extra care

• We are interested in different models of extra care housing and exploring different models, such as shared ownership, as well as extra care schemes for working age adults in a mixed community.
• We have completed ‘fit for purpose’ assessments on our extra care schemes and sharing these with extra care housing providers to influence where we can for the schemes meet the requirements of current and future tenants.
• We are committed to promoting digital/assistive technology as a preventative and enabling tool to support people to live independently in extra care.  We intend to embed within future contracts and tenders an expectation that commissioned providers demonstrate how they intend to utilise care technology as part of their service offer. We will work with providers to build confidence with people who use services to benefit from digital technology. This can make a difference in reducing medication errors, reducing falls and improving hydration.
• We are expanding our extra care portfolio with the opening of Alder House in Roehampton by April 2025 to support older people age 55+, and 5 flats will be available for working age adults with a physical disability age 45+ to live in a mixed community.
• A key aim is to establish a strategic partnership with our extra care providers and housing providers by December 2025. Extra care services should play a key part in their local communities, connecting and building links  with nurseries, schools, voluntary, community and faith sector organisations. We work as partners to develop and seize opportunities for synergies across care, health and the voluntary and community sector to best maximise local resources and achieve shared outcomes to improve the social inclusion, health and wellbeing of people who live in extra care.
• Our commissioning priorities for Chestnut House and Ensham House extra care schemes are to secure high quality person centred care services, promoting social inclusion, health and wellbeing. The tender for a strategic partner to work with us to deliver these services will be published in January 2025, and the new contract due to commence in September 2025.
• Wandsworth is a diverse borough; it is important that all services are culturally appropriate and inclusive, sensitive to people's cultural identity or heritage with support delivered being person centred and tailored individually to meet the needs of people from all equality groups, for example lesbian, bi-sexual and transgender people.

Older people:

• Demand for extra care is stable and we have a sufficient supply of older people’s extra care housing in the borough. We are not looking to increase capacity at this time.
• We will continue with service development within our existing extra care services, which provide a bridge between independent living and residential care homes.

People with learning disabilities and mental health needs:

• Specialist provision within an extra care setting may be beneficial for those who are older. We want to work with providers to explore extra care models for those with more complex needs.

Adults with physical disabilities:

• We want to work with key providers and partners in exploring the possibility of a model that caters for younger adults including those with limiting long-term conditions which is flexible and accessible.

Supported living

Supported living is a person-centred and strengths-based approach to housing and care and support services. It is based on residents having a tenancy or license agreement which offers them the right to remain in their own home and have choice and control over their care and support.

Supported living forms part of a range of community-based care and support available for people with a learning disability and/or autism or mental health support needs. Support provided can vary depending on the needs of the individuals and may range from a couple of hours a week to 24/7 support.

We have established an ‘Expert partner panel for supported housing solutions’ and are keen to work with providers, investors, RSLs and developers to form strategic partnerships to deliver new commissioning models of care and support, focused on relationships and outcomes.  

Our mental health commissioning programme will act as a ‘demonstrator project’ to provide exemplar best practice in establishing collaborate commissioning with the aim of increasing high quality in borough supply and care and support in supported housing for our residents.  

What we want for our residents - We want to ensure a sufficient choice of good quality, flexible supported living services in Wandsworth which are outcomes-focused and person-centred. We want supported living to effectively support step-down from residential care and move-on into more independent living with a focus on recovery and rehabilitation for those with mental health needs.

We are committed to a thriving future supported housing market, supporting younger adults in particular, through the above approach. We need to shape our offer more closely to reflect the diversity of our community and those experiencing inequality.

Current provision

We commission a range of accommodation-based services locally, including supported living and housing support and preventative services (HSPS) to support people to remain as independent as possible in their own home.

Our approach to supported living for adults with a learning disability and/or autism has been developed in partnership with the learning disability partnership board and working groups and is key to the delivery of the Learning Disability Commissioning Strategy 2021-26. For people with a learning disability and/or autism, we block purchase 75 units of supported living from two providers, and there are a further 169 units across 11 providers. 

In Spring 2023, we commissioned the ROSE Framework for learning disability accommodation-based care and support services, including supported living which Is having a positive impact on our capacity and ability to place more locally. We have also developed a new supported living scheme, at Colson Way in Tooting, as part of our wider housebuilding programme. This includes seven self-contained flats with communal space and was completed in winter 2023. Colson Way is a high-quality service, exemplifying collaborative working between Housing Development Teams, Occupational Therapy, Social Work and Commissioning.

We have a pipeline of new supported living developments for adults with a learning disability (2025-2027), namely Bessborough Road and The Springfield Village. Bessborough Road will provide 7-specialist homes for adults with a learning disability (plus 24-hour staff accommodation). The property will also deliver high-quality landscaping including a sensory garden. The Springfield Village is a key development under the Homes for Wandsworth initiative. The site includes 54 one-bedroom flats, the flats will be split between a mixed cohort of residents, with approximately 8-10 flats allocated to adults with a learning disability. Developmental plans highlight the priorities around building accessible flats and inclusive shared communal spaces. We aim to collaborate with providers to secure high quality care and support for those living in our newly developed services.  

We are also developing new initiatives based on shared housing to support people with learning disabilities with intensive skills learning so that they can move on to greater independence with a focus on move-on. Some of the supported living accommodation available in Wandsworth lacks modern design features, does not have the connectivity required to make the most of new assistive technology, and is difficult to adapt to meet the changing needs of tenants. There is also a need for more accessible accommodation which can support people with complex needs and behavioural support needs.

For people with mental health needs, there are currently 37 services, with a total of 238 units. These are categorised as either high, medium or low support. Demand has increased substantially for supported living for those with a mental health need, due to a focus on stepping down residents in residential and nursing care, and from hospitals, into supported living to support more independence where appropriate. Additionally, the move on pathway is held up by the lack of appropriate general needs housing, further restricting residents to progress to lower levels of support.

We have undertaken a review of our mental health provision with a particular focus on accommodation-based services and alternatives to accommodation-based provision. Sufficiency of suitable affordable housing options across both general needs/social housing and the private sector is a challenge in Wandsworth and work is ongoing with housing partners to promote understanding of the accommodation needs of our residents facing a decline in their independence and wellbeing.

The work of our newly established expert partner panel will support us in developing innovative solutions to address these needs. 

Messages to the market - supported living

• We are keen to work with providers, investors, RSLs and developers to form strategic partnerships to deliver new commissioning models and supported housing developments of care and support, focused on relationships and outcomes.
• Our aim is to support people to remain as independent as possible in their own home through alternative independent living options, reducing reliance on residential care. Supported living accommodation is a key destination for residents aged 18-64 (particularly young adults who are aged between 18 and 35).
• We want to work with our housing partners and providers to develop more specialist supported living provision particularly for residents with complex, high-level needs and behaviours that are seen as challenging. The greatest gap being in relation to those with mental health needs.
• We want to strengthen our approach to working with providers, developers and partners to encourage the development of more local, flexible and accessible housing which allow ageing in place.
• We want to work with providers committed to the provision of good quality accommodation with modern configuration which is reflective of the Ministry of Housing, Communities and Local Government national statement of expectations (NSE), October 2020 guidance.
• We want providers to explore new approaches such as technology enabled support to help manage risk and health conditions. This will support people to enjoy increased independence and privacy, whilst also offering safety and security in respect of monitoring health conditions, or remote support being available.
• There is an expectation for providers to offer bespoke and targeted services to meet the diverse needs of residents.

Adults with learning disabilities:

• There is a preference for self-contained accommodation with the option of onsite support and communal areas including outdoor space to promote independent living and a sense of community. Accommodation needs to be near public transport networks whenever possible, as this is key for attracting and retaining staff.
• Some people prefer to live with others in a shared house, and especially for young people moving out of home for the first time, this mirrors the experience of the wider population. Where people are living in a shared house, en-suite bathrooms are preferred. Wheelchair accessible accommodation is also in demand.
• We also want to work with providers and partners to ensure that our accommodation offers improved residents choice and control and uses strengths-based and trauma informed care approaches to proactively support residents’ recovery, independence and move-on.
• Work is underway to develop a tiered pathway of accommodation, from lower level and short term to high intensity and long term, to respond to a wide range of needs and preferences.
• We have commissioned the ROSE Framework for accommodation-based care and support, this went live in Spring 2023. In the Summer of 2024, we finalised the mini competition for our supported living services under the ROSE Framework. This has created the opportunity for a series of new providers to work within both Richmond and Wandsworth. Moving forward, Framework Providers will be kept up to date with the pipeline of upcoming activity under the ROSE Framework.
• We are always keen to hear from and work with prospective developers and provider partners who are interested in developing creative new services particularly for people with more complex needs and young people transitioning into adult social care services from children’s social care services.

Adults with mental health needs:

• We have undertaken a review of our mental health provision with a particular focus on accommodation-based services and alternatives to accommodation-based provision.
• Our mental health commissioning programme will act as a ‘demonstrator project’ to provide exemplar best practice in establishing collaborate commissioning with the aim of increasing high quality in borough supply and care and support in supported housing for our residents.
• We are working towards effective strategies and approaches for demand and cost. Demand exceeds supply for medium to high support supported living provision for those with complex needs including for those with a forensic history and/or complex behavioural needs. We want to work with providers to increase capacity and develop specialist provision that is flexible and accessible, particularly in Richmond.
• There is a demand for single-bedded accommodation with good access to transport, community, and health facilities. Local engagement with residents and providers tell us that residents prefer en-suite facilities.
• In partnership with our key providers and other partners, we have been working to review our existing supported living provision to ensure it remains fit for purpose with a particular focus on remodelling provision to increase high support capacity for residents with more complex needs and aim to bring inward investment to resolve existing stock condition where possible.
• The commissioning model for mental health services is to rehabilitate and promote recovery and enable people to step down from accommodation-based services to live fulfilled and independent lives in the community in a safe manner, ensuring any safeguarding concerns are acted on. We are seeking innovative models of support which deliver the best outcomes for residents to aid move-on to independent living whilst still providing a stable and supportive living situation.
• For younger residents with mental health needs and often with autistic spectrum disorder in transition from children and young people’s support to adult provision, we want to work with providers to develop specialist supported living and housing support, and preventative services that might be beneficial to them.
• We are interested in exploring the feasibility of housing first models, which prioritise access to housing as quickly as possible and would be keen to work with providers to develop proposals for this.
• For those primarily in the older age range (55+), there is a need to commission provision that is long-term accommodation-based support, possibly using an extra care model.
• Developing strong links and working relationships with our housing partners such as funders, registered providers and private landlords is a key aim. This is to increase capacity of step-down provision including general needs and private housing options, deploying floating support more effectively to enable residents to gain independence.
• We want to explore and take forward opportunities for joint commissioning arrangements with the South London Partnership with our subregional borough partners.

Adults with physical and sensory disability needs:

• Key generic requirements are for flexible accommodation to promote independence, meet changing needs and ensure accessibility to communications (including BSL, Makaton and Braille). Proximity to local community and facilities and transport links as well as accessibility of premises is a key concern in Wandsworth.
• Small sized supported living schemes might be useful for people with long-term conditions looking to move towards independence.
• Accommodation should be accessible and adaptable for young people.

Home care

What we want for our residents - We want people to receive high quality support to live independently in their own homes as far as possible rather than in residential care.

We want home care services to be person-centred and flexible in supporting individuals to achieve their desired outcomes and aspirations, shifting away from ‘time and task’ based care with a focus on social and added value of care workers support to people in their own homes, taking a whole person approach and collaborating with others and the local community for good health and social outcomes for people.

We expect all home care provision to maximise individuals’ independence and to work to an ethos of reablement. Home care should increasingly be supported and supplemented by using care technology, and equipment aids and adaptations to support daily living in a way that promotes independence and reduces hours of care and the need for long term care.  

Specialist reablement provision is important with a focus on supporting timely hospital discharge. Our service focus needs to be collaborative providers working across the system with our hospital, Occupational Therapy and social work teams and service acquisition, maximising integration and seamless care for residents. We aim to increase the number of community reablement referrals and reablement support overall and maintain our high performance of people remaining at home 91 days after discharge. We are currently piloting a mental health reablement service.   

Current provision

Our home care capacity is good. We implemented an area based model for homecare services in July 2019, with 8 contracted providers. Additional capacity is purchased through the spot market where needed.

Across 2024/25 we will be completing a strategic review of our homecare services to ensure there continues to be a sufficiency of homecare  services to meet the needs of our local population, including a focus on ensuring culturally responsive services.

Messages to the market - home care

• We want to work with providers to increase the availability and responsiveness of home care, reablement, and short-term ‘rapid response’ provision to support hospital discharge for up to 14 days, as well as increase the number of community referrals from people living at home. We need packages of care arranged within 24 hours.
• Reablement services is a key priority for the local authority in supporting people to stay at home and prevent, reduce, delay need for formal support services.
• We have established a new area-based model for reablement in Wandsworth in 2024. This is a developmental model which will evolve over the contract term, with our providers working in a more integrated way with our social work and system partners. We aim to pilot trusted assessor arrangements in 2025 by December before full implementation.
• Additional capacity to achieve and increase in community referrals will be delivered through the London Borough of Richmond Upon Thames (LBRUT) innovative platform, lot 5 Wandsworth reablement contingency. We would encourage providers to apply to this platform.  
• We are experiencing an increase in demand for more specialist packages, particularly from those discharged from hospital, and as the number of individuals living with dementia grows, we want to work with providers who can manage increasingly complex packages which may include residents with multiple needs receiving services from a variety of agencies.
• We are also looking to develop more intensive home care models such as ‘live in care’ to support people returning home from hospital which will also reduce demand for more intensive care. Throughout our LBRUT innovative platform we have a live in care lot. We invite providers to join our Richmond platform, which also has capability to be used by Wandsworth Council for ‘contingency’ spot purchase. Whilst demand for live in care is low, we recognise this service is important to supporting people living at home. We would like to increase availability of providers in this ‘lot’.
• A strategic review is underway looking at the current homecare model to inform future service developments and arrangements. This will be completed by March 2025. Flexible and responsive services that can meet the needs of a diverse community and demands on an aging population is key.
• We will continue to facilitate and co-chair provider forums which gives the Council, providers and partners the opportunity to come together to discuss operational matters as well as having a strategic focus, give providers insight into our commissioning plans, a place for providers to highlight the challenges they face, and a place for co-producing solutions to meet current and future demand.
• Wandsworth is a diverse borough, and it is important that home care services are inclusive and provide culturally responsive services. We are committed to ensuring we have culturally responsive services. We are currently establishing and delivering a number of actions and delivering recommendations to support this and would like to involve our providers in this.
• We want providers to be positive about working with digital technology to support residents in achieving greater independence.
• Workforce is an ongoing challenge and focus, needing collaborative plans. To support the varying levels of residents need, providers will need to review the training and skills of their staff and employ a diverse workforce that reflects the local population, including language skills. Our Provider Workforce Working Group is now established and would encourage providers to get involved in helping us shape and deliver our ambition of ‘10 Tangible Actions’ together.
• Our new Richmond and Wandsworth Workforce strategy 2024-2027 sets out our ambitions and actions to address workforce challenges and opportunities.

Older people and people with memory and cognition needs:

• Commissioned integrated community equipment services ensure  there is suitable and accessible equipment to support people at home and in care homes. We want to increase focus on working with providers to engage in the use of digital solutions to help to prevent, reduce and delay care needs from increasing.
• We want to work with providers to promote dementia awareness through workforce training.
• Our community equipment contract is hosted by the London Consortium until 2028.

Day care opportunities and outreach

What we want for our residents - Our ambition is to ensure a wide, integrated and varied day and outreach opportunities offer which promotes independence, social inclusion, and healthier lifestyles. 

Current provision

For older people, most day care activity is building centred day care, with one specialist day centre providing an integrated service supporting older people, people with a physical disability, and adults with dementia who have assessed eligible needs. This service includes personal care on-site and staff trained in supporting residents with complex needs and behaviour that may challenge. It also provides an opportunity for unpaid carer respite.

In addition to this, there are several open access prevention centres which promote independence, social inclusion and healthier lifestyles as mentioned in the prevention and voluntary market sector section.  
Following an extensive review of the day opportunities across older persons, physical disability and mental health in 2019 and learnings from the coronavirus pandemic, it was identified that broadly speaking, the commissioning model of day service provision had remained fairly static and there was a need to respond more flexibly and creatively to the varying needs of residents and strengthen and build upon the day opportunities offer. A modernisation of council commissioned services has been implemented since 2021 and continues to evolve with the aim of providing a variety of community-based options to meet people’s positive outcomes. As part of this, all activities within the specialist day centre are also co-produced with those attending as a key priority for their daily care.

Our approach to commissioning day support and outreach for people with a learning disability has been developed in partnership with the learning disability partnership board and its working groups. We are commissioning a framework of life skills and wellbeing opportunities which will support people with a learning disability and/or autism at a range of times across the week. Services will include specialist place-based support, community support, home support, virtual support and independent travel training. This will enable people to access support, which is more person-centred, goal-oriented and flexible than traditional day service models.

The local authority commissions a range of support from the voluntary and community sector and Southwest London and St George’s NHS Mental Health Trust for people with mental health needs, providing daytime activities which support recovery and self-management in the community.

Messages to the market - day care opportunities and outreach

• We have contracts in place with local providers to support residents at all dependency levels, accessing building-based day centres and other community support services.
• We want to work with our existing providers to further develop flexible and creative provision across the continuum of need, ranging from people with low level needs to the most complex of care needs accessing a building-based day centre, complemented by services available in the community, in people's homes and on digital platforms for those who do not want or need to be building-based.
• We expect daycare provision to be inclusive and culturally responsive to meet the diverse needs of local communities. A needs assessment for older adults and other adults at risk of a decline in their independence and wellbeing from Black, Asian and Minority Ethnic communities and their carers has been undertaken to assess how well their needs are being addressed, informing our current service offer.

Older people and adults with memory and cognition needs:

• We want to work with partners and providers to offer older people opportunities that reduce social isolation, build their confidence to use digital tools, learn new skills and engage in new activities that maintain their strength and balance.
• Additionally, we want to work with providers to build links with community facilities to provide different choices and opportunities.
• We will work with providers to identify opportunities for dementia friendly environments and promote dementia awareness through workforce training.

Adults with physical disabilities

• We are keen to work with providers to develop strength-based approaches which enable people with physical disabilities or sensory impairments to live as independently as possible, in particular, extending pathways to enter and continue in employment.
• We will continue to work with our housing department and looking to both housing providers and private housing developers to develop accessible accommodation in the borough.
• We want to further embed the use of universally available digital and smart technologies such as apps, smart phones to support people with physical and/ or sensory impairments.
• We are keen to work with providers to develop strength-based approaches which enable people with physical disabilities or sensory impairments to live as independently as possible, in particular, extending pathways to enter and continue in employment.
  

Adults with learning disabilities:

• We are committed to ensuring all adults with a learning disability are active citizens, lead fulfilling lives and are able to feel safe accessing their local communities. We have also commenced a framework in spring 2023, which went live in October 2023, for life skills and wellbeing services, which will support adults with a learning disability with eligible care and support needs to access the following services: specialist place-based support, community support, home support, virtual support, travel support.
• We want to work with partners and providers to offer creative, flexible and non-traditional support models (e.g. non-building, using technology, agile working) which can help people to improve their wellbeing and quality of life, develop skills to for independent living and employment, and increase the choice and control people have over their own lives.

Adults with mental health needs:

• We want to work with providers to explore opportunities for outreach support that enables residents with a mental health need to remain in their own homes.
• Additionally, we aim to address the need for planned and unplanned respite, short breaks and emergency support for those with or without accommodation.
• Alongside the services funded by the NHS-led community mental health transformation fund, we want to work with partners to develop meaningful person-centred daytime activities that support residents to actively participate in their local community.

Prevention and the voluntary sector

What we want for our residents – The vision for preventative services is that older adults and other adults at risk of a decline in their independence and wellbeing can access a range of culturally responsive and inclusive preventative services. We recognise that the voluntary and community sector is at the centre of delivering these services and that a partnership approach to commissioning is imperative to achieving this.

Prevention is at the core of our commitment to improving overall outcomes for our residents and reducing health inequalities. The Prevention Framework has been developed which will serve as the umbrella framework for delivering a whole systems approach to preventing ill health and promoting positive health and wellbeing throughout the local health and care system, as well as wider services.

Our aim is to develop provision that enables people to get early help and support on things that might impact their physical and mental wellbeing, focussing also on the wider determinants of a person’s health and wellbeing. We will work with communities and the market to ensure support is available that promotes early intervention and prevents or delays admission into hospital or long-term residential care. We will do this by developing services which enable timely hospital discharge, including step-down beds, reablement and rapid response services, and through promoting community-based services. This includes the use of community equipment and care technology as well as a range of preventative services delivered by the voluntary and community sector.

Current voluntary and community sector provision

Wandsworth has an active and well-developed voluntary and community sector with over 900 voluntary and community sector organisations offering a diverse range of services.  The sector is supported by our Voluntary Sector Partnership team, part of the Community and Partnerships division, which works across both Wandsworth and Richmond.

During 2024, commissioners facilitated workshops at several events forming our development of a Voluntary and Community Sector Strategy that is co-produced with the sector and expected to be published in 2025/26. We are also working in partnership with Children’s Services and SWL ICB to co-commission a new Wandsworth Voluntary and Community Sector Infrastructure and Capacity Building Support Service during 2025 which will incorporate an annual review of service outputs and sector needs, ensuring it is ever evolving and fully responsive.

The Wandsworth voluntary and community sector preventative offer (WVSPO) represents a collection of commissioned services that are designed to improve the health and wellbeing of older adults and other adults at risk of a decline in their independence and wellbeing, to promote their independence and reduce the need for targeted social care services. The core service offer is delivered through eight open access ‘Age Well’ centres and projects across the borough and incorporates bespoke services with a specific focus on ethnic minority communities. Three of these services in Battersea, Roehampton and Central Wandsworth include a focus on the needs of deprived communities and support intergenerational activities to improve health and maintain independence within a targeted locality. These services are not building based, instead maximising opportunities for embedding support through local partnerships. 

We additionally offer an enhanced community navigation service through incorporation of the NHS model of Social Prescribing into our Adult Social Care Front Door. By providing residents with up to six months of support to access wider services that support their health and independence, we can reduce demand on targeted care services while strengthening our partnership with the NHS through synergy with the NHS preventative support offer.

Messages to the market - prevention and the voluntary and community sector

• We see the voluntary and community sector as key partners in the planning and delivery of preventative services, alongside our continued integration with the NHS and council directorates
• We are committed to supporting the borough’s diverse range of organisations, to exploring new opportunities for doing things better and achieving a greater impact for all equality groups amongst residents and communities
• We want to work with local voluntary and community sector partners to co-produce services with residents and other stakeholders, and welcome providers coming to us with new ideas for improving outcomes through innovative approaches to further develop the preventative offer in Wandsworth
• Connecting local residents to support and opportunities in the community that help combat loneliness, isolation and low-level mental health needs is key. We are committed to achieving this through stewardship of a sector-wide, collaborative approach to maintaining robust referral and signposting pathways across Social Prescribing and other information and advice services

Prevention and early intervention services for adults with a mental health need

Prevention and early intervention services play a huge role in preventing residents’ mental health needs from escalating and aiding residents to move towards a place of recovery. These services also have a role in reducing or even eliminating a need for medium and high support. Therefore, the focus of current and future services will continue to be very much on supporting residents to be at the lower end of the mental health continuum as opposed to the higher end that requires greater levels of support. Our mental health review is examining low level and preventative provision including proposals for advice services, floating support, health and wellbeing services, outreach and therapeutic hoarding services. We are open to considering new service models including collaborative models. 

Current provision

Wandsworth has a wide range of strategic partners including Southwest London Integrated Care Board, Southwest London and St Georges Mental Health Trust and a number of voluntary and community sector providers.

The provision in Wandsworth includes a mix of generalist and specialist provision. Some of the specialist provision is targeted at residents with mental health and includes advice services, emotional support, floating support and outreach services for deaf residents. These services enable residents to receive the help they need in a timely way to cope and recover. Broadly, the provision caters for residents who face an increasing number of complex issues including welfare benefits, cost of living pressures, domestic violence, substance use, homelessness and disability.

One of the major contributors to maintaining low level mental ill-health relates to being able to access welfare benefits which can vary in complexity. There are two existing contracts in place which support residents in hospital and those who are living in the community. Targets set mean that the contracts support 10,481 residents, maximising their income by up to £2.67m per annum.

Being supported to live independently through outreach services and floating support is vital, particularly for those residents stepping down from high levels of support.

Messages to the market – Prevention and early intervention services for adults with a mental health need

• A key focus will be in directing resources toward low level provision to ensure that residents are supported to live in the community in a way that prevents them from needing higher levels of costly care. A self-help, recovery and an enablement service approach will be favoured that connects residents to their community including accessing employment, volunteering, education or training opportunities where appropriate.
• Our aim is for services to work in a joined-up way with other existing provision and networks (including family and peer networks) to ensure service provision is seamless.
• Services commissioned will be high quality, culturally sensitive and/or tailored to specific groups including those from the LGBTQ+ community. 
• We are looking for innovative service models that are also able to flex the support up or down depending on individual circumstances. This is particularly the case for floating support services.
• There are gaps in service provision such as therapeutic hoarding services and we look forward to receiving input from our partners as to how this could be designed and delivered as this programme of work progresses.
• Along with our partners, we are keen to explore how advances in technology can support our work in prevention and early intervention so that residents are able to move from the higher end of the mental health continuum to the lower end and remain there.

Unpaid carers services

An unpaid carer is anyone who provides care to a friend or family member who, because of a limiting long-term condition or addiction, is unable to cope independently. Unpaid carers provide invaluable support to the people they look after; however, their lives can be hugely challenging. Carers may be at risk of social isolation, losing employment and education opportunities, as well as caring having a detrimental impact on their physical and mental well-being.  Our key priorities for carers are identification and recognition of carers and young carers, realising and releasing potential, supporting carers and young carers to stay healthy, and have a life alongside caring. There is a clear commitment to ensuring that people receive timely access to support, now embodied in the Carers and Young Carers Charter.

What we want for our unpaid carers - Our vision is to raise awareness of the vital roles played by carers and young carers; to collectively provide good quality personalised support to carers, and young carers and those they care for; to build solid networks ensuring that carers and young carers know where to go for information and support; to enable carers and young carers to balance their own lives with their caring.

Current provision

We are committed to recognising and supporting unpaid carers in their caring role and to offering a range of services including carer’s assessments, short breaks from caring, carer’s direct payments and voluntary and community sector support.

Wandsworth Carers Centre is our main provider of local carer support services, who sub-contract respite to Bluebird Care Wandsworth.

The services provided include information and advice, advocacy, peer support, carers’ respite, back care/therapies and health and social care liaison and training. The Carers Partnership is currently developing several new services including end of life care, mindfulness, support for young carers in schools, a wider range of short break options, greater support for carers from LGBTQ+ communities and the development of a carer’s passport. At the same time, work continues with other open access providers to improve the recognition and support they offer to unpaid carers through day activities.

Young carers (children and young adults) have the same right as other children to enjoy life as fully as possible. Young carers may have different needs to adult carers. Specific support for this age group in Wandsworth includes linking with services from the Carers Trust, Children’s Society and Children’s Services.

Messages to the market - supporting unpaid carers

• We want to work with local service providers to better recognise unpaid carers and their needs, from all different backgrounds, and create local carer friendly services and communities.
• It is important that providers develop services and systems that are flexible to allow carers to balance their own needs with their caring role. Providers should consider providing increased assistance as carers age or become less able to care.
• The Wandsworth Carers and Young Carers Charter has been developed by the Carers Partnership Wandsworth Board. The charter sets out our ambitions to improve the carers offer and ensure unpaid carers get the support they need to continue in their caring role.
• We want providers to embrace and use digital technology in creative ways to improve the quality of life for both carers and the cared for.
• We want to work with providers across all our commissioned services who are constantly considering how their services can better support the needs of unpaid carers.
• When reviewing services or undertaking new pieces of work, we want providers to consider the impact on unpaid carers and how to address any emerging issues.

Substance use disorders treatment services

What we want for our residents - Our vision is to enable residents to live their best life, free of the distress caused by the harmful and dependent use of legal and illegal substances and alcohol.  

Current provision

In 2018-19, Richmond and Wandsworth Councils went out to procurement for new services for the provision of treatment and recovery interventions for substance use disorders. The new contract which was a four year plus the option of extensions up to 10 years was awarded to a consortium led by South London and Maudsley NHS Foundation Trust.

The consortium included the following charities: St Mungo’s, We Are With You (formerly Addaction) and a local charity, CDARS, and represented a continuation of the service delivery when it mobilised on 1st April 2020. The service currently caters for around 1,010 people per year for substance use ranging across illegal substances including opiates and crack cocaine through cannabis and prescribed medication to alcohol. Currently our service is predominantly accessed by people who use opiates or alcohol.

Messages to the market - substance use disorders treatment services

• We want to work with providers to consider developments which would co-locate these existing services alongside a range of others which would be commonly accessed by people with substance use disorders. These include mental health, primary care and housing services.
• Providers have access to two government grants which are focused on improving pathways in criminal justice and for rough sleepers, as well increasing individuals accessing treatment and to reduce drug related deaths in the boroughs.
• Whilst our established consortium will continue to be responsible for the core of our service provision, we may look to other providers to complement existing services.
• We will work closely with providers to address the challenge of recruiting staff with clinical training in substance misuse, and we will welcome providers who are able to deliver effective services for different communities in ways that do not depend on recruiting categories of staff that are in very short supply.

Employment

There is clear evidence that being in work can help maintain physical and mental health and wellbeing. ‘Good work’ is defined as having a safe and secure job with good working hours and conditions, supportive management and opportunities for training and development. It is estimated that 65% of people with a learning disability or severe mental health condition want to work. However, there are significant barriers which impact these individuals' abilities to access and maintain meaningful employment in the community.

What we want for residents - We want residents to enjoy the benefits that employment can bring including purpose, self- esteem and the opportunity to build relationships and reduce social isolation. Our aim is to work with local providers, other statutory and non-statutory partners, and employers to reduce the barriers to employment that disabled people face in Richmond/Wandsworth.

Messages to the market - employment

Adults with learning disabilities:

• We want to ensure The Council, local community and voluntary and community sector providers and local employers confidently create more opportunities for people with a learning disability to gain voluntary employment or paid work, to maximise equity of opportunity and to promote greater independence.
• Our new Supported Employment service which launched on 1 April 2023 will work with people accessing the service, providers, other partners to provider comprehensive support available for people both seeking work and in-work.
• The Supported Employment Service will continue to expand their work with Local Employers and Partners, providing support and training to recruit and retain a more diverse workforce

Adults with physical disabilities:

• We want to work with our providers to ensure access to employment, education and training and volunteering opportunities, particularly for people with long-term conditions in accommodation-based care and support to enable them to live independent and fulfilled lives in the community

Respite (short breaks)

Respite (short breaks) is a key preventative service which supports the wellbeing of carers of adults with a learning disability and the people they care for. By providing regular breaks we can reduce the physical and emotional stress on carers and families that their caring role can put them under. This can help to maintain support and prevent family breakdown and premature admission of people with a learning disability into residential care and/or learning disability.

Current provision

In Wandsworth we have Wardley Street, Earlsfield. This is a five bed short breaks service provided by Certitude.

The building consists of three fully accessible rooms on the ground floor (these include hoisting facilities and wheelchair accessible wet rooms).

Messages to the market - respite

A key commissioning priority across 2025 is to work with relevant partners to develop a new respite/short breaks offer, which builds upon existing opportunities whilst also developing the existing offer to provide new opportunities which are attractive to local residents. 

• We want to explore the demand for structured activities for younger people to bridge the gap between college timing and carers working patterns. 
• We want to ensure that there is suitably skilled and sufficient home care capacity available to meet the anticipated increase in demand from older people with learning disabilities. 
• We want to work with outreach, community and day care providers to explore, develop and offer supported holidays. 
• We want to expand the respite options available locally particularly for those with complex support needs as this is an identified gap. 
• We want to explore a sustainable model for emergency respite. 
• We want to identify accessible or adaptable buildings that can meet the needs of the whole adults with a learning disability population.  

Shared Lives

Shared Lives is a form of social care where an adult with support needs moves in with a registered shared lives carer, and lives with them as part of their household in a family environment. Shared Lives offers a range of differing support, including full-time live in arrangements, day support and respite support. Shared Lives carers offer support with activities of daily living and importantly has a focus on helping an individual re-engage with and remain part of their local community.

Shared Lives (SL) is a model of social care that operates in ‘the local community’ (Fox, 2015). It offers support with activities of daily living and importantly has a focus on helping an individual re-engage with and remain part of their local community. At its core is the idea of ‘relational care’, that is providing support through the interpersonal relationships that are created and then sustained.

What we want for our residents - We want to ensure opportunities are available to our residents which promote community integration whilst also diversifying the options available when considering long and short-term support. 

Messages to the market - Shared Lives

• We want to continue to invest into our Shared Lives service to grow the number of carers registered with the scheme and the number of adults with a learning disability accessing the service. 
• We want to develop stronger relationships between the Shared Lives service and key stakeholders, with a key focus on promoting the value of the work our local registered shared lives carers deliver.

Direct payments

Direct payments (DPs) are monetary payments made by councils directly to individuals who have been assessed as having eligible needs, to enable them to purchase and arrange their own care and support.

What we want for our residents - We want people to have personalised support and be able to use their direct payments (DPs) to maximise choice and control over their own care, giving them more independence and flexibility.

Current provision

We work in close partnership with one local user-led organisation to deliver a comprehensive direct payment support service to enable more people across Wandsworth to take up DPs.

Demand

During 2023-24, 709 service users received their personal budget as a direct payment. This represents annually approximately 26% of people receiving community-based services in Wandsworth who receive their service via a direct payment.

As of 2024 older persons comprise 38% of the total on a DP, people with learning disabilities comprise 29%, those with mental health needs comprise 12% and people with physical disabilities comprise 21%. Take up has been impacted by several factors, including the availability of personal assistants and impact of the coronavirus pandemic.

Overall direct payments demand from 2018 to 2024 is shown in the table below.

Key client groups	2018-19	2019-20	2020-21	2021-22	2022-23	2023-24	% change from 2018 to 2024
Older persons	175	307	364	315	273	267	-53%
Learning disabilities	274	236	227	215	206	205	-25%
Mental health	134	120	100	100	89	88	-34%
Physical disabilities	174	180	187	172	146	149	-14%
Total	757	843	878	802	714	709	-6%

Approximately 50% use their direct payment to employ a personal assistant.

Messages to the market - direct payments

• We will continue to actively promote direct payments as a means of maximising choice and control and meeting support needs in new and more effective ways.
• There is an expectation for providers to offer a wider range of personalised, bespoke and creative services to meet the diverse needs of direct payment service users with differing needs including those with learning disabilities, physical disabilities, mental health needs and older persons, ensuring all protected characteristics are taken account of.
• Building direct relationships with direct payment users and having simple, transparent processes will help increase take up.
• There is a shortage both locally and nationally of personal assistants (PAs) with appropriate skills. We want to work with partners and providers in promoting the role of the personal assistant and the PA register to increase recruitment and develop the local pool of personal assistants.

Care technology and innovation

What we want for our residents - We want to use technology to empower and support people to do more for themselves and live the best life they can. 

Current provision

Care technology is offered to adults to support better outcomes and as a preventative intervention or as part of an ongoing care package to reduce and or delay the need for formal or intensive support. The Adult Social Care Digital Strategy 2021-24 sets out how we are embedding technology as a core part of the way we deliver services. There is an increasing range of digital tools to support the way care and support is assessed, monitored and delivered that support better outcomes for people.

Gloria care technology service is our new end to end care technology service providing a range of smart home technology and voice enabled devices. Other care technology initiatives include the brain in hand app which is primarily being offered to people with learning disabilities to help manage and support independence in daily living activities and travelling.

Canary motion sensors to help monitor movements are also being trialled in an extra care scheme in Wandsworth, to support with caring for residents and early detection of changes in normal activity.

Messages to the market - care technology and innovation

• There is an increasing demand for care technology devices to support better outcomes for a wide range of residents from all different backgrounds.
• We want to work with providers who will embrace and use digital technology in creative ways in monitoring and delivering care and support.
• We also want to develop a ‘digital workforce’ where professionals can communicate easily with each other and access residents' records and care plans.

Older people and adults with memory and cognition needs:

• We encourage the use of digital technology to assist in care and support delivery to help to prevent, reduce and delay care needs from increasing.

Adults with physical disabilities:

• There is currently a lack of services targeted specifically at young people with a physical or sensory disability. We would like to work with providers to ensure that this group is better provisioned for, specifically in terms of use of digital technologies as well as information and advice, and access to adapted housing.