Commissioning Priorities from 2024 to 2026
Commissioners will be focusing on the following priorities from 2024 to 2026.
Commissioning decisions are informed by Medway’s Joint Strategic Needs Assessment (JSNA).
Further specific profiling for adults who need care and support can be found under the Adult care and support chapter.
Day Care services
We want to commission a framework(s) for Day Care Services across Medway. This will include:
- services for Older People and Working Age Adults
- traditional day care services
- innovative approaches to providing day care to the residents of Medway.
Medway Integrated Community Equipment Service (MICES)
Medway Council and NHS Medway Integrated Care Partnership have partnered to procure a single Integrated Community Equipment Service (ICES) for the people of Medway.
Older people have a higher usage of health and care services compared to other age groups. There is an expectation that demand for loaned community equipment increases in line with the increasing aging population of Medway.
The scope of the service is to provide community equipment to service users of all ages who have a temporary or permanent health need or disability and require equipment on a loan basis. The service is available to patients of any age who have a Medway GP and live in the Medway area.
At any time, there are around 1,200 residents in Medway that access the loaned equipment service. Around 530 professionals prescribe loaned equipment via an online ordering system in Medway.
The vision for care in Medway sets out our goals and priorities to support the people of Medway to live full, active and independent lives for as long as possible in their local communities. The provision of a community equipment service is a key element of making our vision a reality.
The contract term ends 31 August 2025.
The following core principles underpin the Medway Integrated Community Equipment Service (MICES) contract:
- choice and control - guaranteeing service users choice and control over their own care to meet their specific needs.
- prevention - investing in a service that helps people stay healthy, happy and independent for as long as possible.
- facilitating hospital discharge - preventing delayed transfers of care and facilitating safe return of service users to their place of residence after a stay in hospital.
- flexibility - responding to identified needs through supporting service users at stakeholder engagement events.
- respect and dignity - showing respect and understanding of service users and carers:
- gender
- sexual orientation
- age
- impairment
- race
- religion
- culture
- social background
- lifestyle
- privacy
- safety and cleanliness - ensuring the highest levels of safety and cleanliness by abiding to all current and future safety standards and legislations published by whatever means
- efficiency - timely service delivered in a safe and efficient manner.
Residential and nursing services
The current framework contract for residential and nursing care for older persons and working age adults was developed several years ago and there's a need to update the specification, terms and conditions of the contract. The commissioning of good quality nursing and high-frailty dementia nursing care continues to be a top priority, ensuring we meet the complex needs of our most vulnerable population.
We're looking to work with providers that will:
- collaborate with the acute hospital discharge services and all relevant partners, including adult social care, other commissioned services, the voluntary or community sector as required, to enable safe timely transfers of care
- facilitate planned and timely admissions of new residents in the care homes 7 days per week, including the evening
- work within a trusted assessor model, as appropriate
- complete the NHS Capacity Tracker daily to support system flow
- continue to engage with quality officers and commissioners to further improve quality standards
- join new framework agreements for the provision of residential care
- ensure the use of Medway's Integrated Community Equipment Service (MICES) that will deliver good care and timely admissions.
Our intentions are to:
- recommission the care home contracts for older people and working age adults (currently underway) involving widespread consultation with:
- service users
- stakeholders
- providers
- consider increasing the number of block contracts in the sector
- increase overall provision and encourage more providers into the specialist care home market and diversification amongst existing care homes, particularly in:
- dementia nursing
- physical disability nursing
- working age adult mental health
- working age adult dementia
- multiple complex needs.
Supported living
The service has recently been commissioned. Our intention is to focus on the successful delivery of the current contract. This will be in line with the original commissioning intentions to maintain high quality and robust performance monitoring.
Work will be ongoing to monitor key performance indicators and support providers to improve quality standards and ensure care support is provided using a person centred approach. Right now, we have no intentions to change the way services are commissioned.
Commissioning models
A few long stay residential and nursing placements in Medway are made by spot purchase. Whilst this is largely successful, we face increasing pressures in sourcing certain types of residential care at a sustainable cost.
Whilst the intention is to commission a framework agreement, as part of the commissioning process, we will consider increasing the number of block contract arrangements with providers where our ability to manage supply and cost is proving difficult.
The block contracts we already have in place are viewed favourably as they:
- provide long term assurance on placement numbers
- support budget management and long term financial planning during this demanding time economically.
Market shaping
Market shaping involves us working with partners and those with lived experience to promote a sustainable, diverse, and high-quality care market, with contingencies for provider failures. This collaborative effort is essential for developing a resilient, diverse and vibrant market. It’s about co-producing outcomes and fostering an environment of honesty and transparency that encourages innovation and cooperation.
Our Market Position Statements provide clarity on the services needed, and our commissioning intentions. This transparency allows providers and suppliers to align their delivery models and business plans with our objectives and values, ensuring a collaborative effort towards enhancing care services.
By stating intentions and setting clear expectations, these statements:
- facilitate a proactive and adaptive approach in the marketplace
- encourage providers to innovate and evolve in response to the outlined needs.
It’s a forward-thinking strategy that fosters a dynamic and responsive care sector, capable of meeting the demands of the community both now and in the future.
Factors influencing the market
The concerning factors faced by Medway’s Adult Social Care services are significant and have many aspects. The challenges and opportunities facing Adult Social Care in Medway are a reflection of the broader trends affecting social care across the UK and globally.
- aging population: with people living longer, there's an increase in complex health needs
- quality and choice: ensuring that people have access to high quality services and a choice in their care
- workforce: retaining and developing a skilled Adult Social Care workforce
- funding: addressing the uncertainty of long term funding for Adult Social Care.
The COVID-19 pandemic has only intensified these challenges, affecting financial stability and service delivery.
However, these challenges are being met with a proactive and collaborative approach. This approach to commissioning is a positive step towards utilising community strengths and resources effectively. By working with partners and the community, there's potential to co-design support systems that are responsive to the needs of our residents, embedding innovation and efficiency into our services.
Our commissioning activity and strategy development is informed by Medway’s JSNA, which contains over 30 topic specific chapters, grouped into the 5 themes of the Joint Health and Wellbeing Strategy, as well as other supporting information, such as an overview of people and place.
The Medway JSNA Executive summary provides a high level overview of the current health and social care needs within Medway.
The emerging JSNA Chapter on Care and Support - Adults with be published in May 2024.
Mitigating opportunities:
- collaborative commissioning: adopting an asset-based approach to commissioning, focusing on community strengths
- innovation: creating an environment where transparency leads to innovation and shared solutions
- co-design: working with residents to co-design support that meets their needs
- flexibility: ensuring services can adapt to changing demands and requirements.
Our focus on flexibility and adaptability in service provision is crucial, especially in times of change. Establishing the right contracting arrangements with suppliers who are ready to adapt will be key to meeting both current and future demands.
We are committed to:
- transparency
- innovation
- shared outcomes.
Despite the challenges, there's a strong resolve to transform and improve Adult Social Care services.