Market Position Statement 2024 - 2029

We promote upcoming business opportunities to the market and request any organisation interested in working with the Council to ensure they are registered on the Council's e-tendering system - CSW-Jets, where business opportunities are published.

When applying for any of these opportunities, we highlight the below requirements for consideration in the development and delivery of provision:

• Affordability: We appreciate the delivery costs of high-quality provision and on-costs in its development; however, we must remain conscious of costs to both the local authority and the individual in developing schemes alongside their long-term sustainability. We will work closely with potential providers to ensure transparency on costs and affordable rates within the city, and ensure provision is able to best meet the needs of the client group. 
• Choice and control: As noted above, developing alternatives to regulated support is a key commissioning priority. Alongside this, we want to ensure everyone has access to true choice and control in respect of their care choices and can access a range of provision available across the city that can meet their care needs.
• Equality of access: All residents of the city should have access to quality care provision, regardless of their background, ethnicity, or financial status. In considering current and future provision, we must ensure that this meets the varied, diverse needs of the city, is accessible, and is supporting uptake by underserved groups. We are aiding this drive through increased promotion of adult social care across the city and engaging with underrepresented groups to inform service design. This is aligned to the Councils One Coventry Plan working to ‘Improve outcomes and tackle inequalities within our communities.’
• Environmental Impact: The Council are committed to becoming a ‘zero carbon city’ with one of the key objectives within the One Coventry Plan ‘tackling the causes and consequences of climate change’. To achieve this, consideration is given to the environmental and social impact of care delivery on the city, for example, reducing travel distance within home support contracts. We ask all providers to consider their environmental impact and what they can do to mitigate this, wherever possible, and ensure this is made clear when tendering for business opportunities and designing schemes.
• Planning requirements: For new accommodation-based provision we highlight an upcoming refresh of the Council’s planning policy (Policy H8: Care Homes, Supported Housing, Nursing Homes and Older Persons Accommodation), which is being updated as part of the Local Plan Review process. It is subject to public consultation, due to take place in the Autumn of 2024 and independent examination, due to take place in the Spring of 2025, before it can be formally adopted as Council planning policy. Formal adoption of the revised policy and the Local Plan is currently targeted for late 2025. 

The Council are also exploring alternative commissioning arrangements going forward to diversify and strengthen our market. This will include:

• Invest to save models, where there is robust evidence of future cost savings with minimal risk.
• Explore possibilities for identifying lead providers/partnerships. This would entail the Council contracting with one or more lead providers and all new requests for care to be offered to a lead provider in the first instance.
• Pursuing opportunities with our joint venture partner
• Supporting opportunities for Small and Medium Enterprises (SME’s) and microenterprises to contract with the Council.
• Collaborative commissioning, taking a whole system, whole community approach to commissioning design.

To support integrated working across the ICB footprint, wherever viable the Council will work with neighbouring authorities to ensure continuity of care delivery systemwide and ensure efficiency. 

Example: Accelerating Reform Fund

The Council will be working jointly with local authorities across the West Midlands region to procure a digital carers support and assessment tool under the Accelerating Reform Fund. Working in this way will make best use of expertise and resources across the region, with this standardized approach also providing clarity and efficiencies for bidding providers.

Business opportunities:

To meet our identified gaps and challenges, over the next five years we will invite providers to consider how they can support us in developing provision in respect of the following areas.

Please note, our approximations in respect of demand and need are listed against each gap, however we anticipate this demand will be largely met through vacancies created by natural turnover. There will also be a requirement for some new provision in specific areas of increasing demand. Any additional service developments must be met within available resources.

Gap: High-level or complex needs, including for younger adults with a learning disability and / or autism and individuals of all ages with behaviours that challenge. 

Commissioning intentions and requirements (within available resources):

• Intentions:
  • Increasing the supply of good quality residential care provision in the city, specifically catering for individuals with behaviours that challenge. 
  • Ensuring existing care is being delivered to the highest quality, in accommodation able to adhere to stringent infection control practices and provide stimulating environments. 
  • We will also consider respite options as part of any new commissioning linked to this priority.
• Requirement 2024/2029: 
  • Approximately 25 people over the next 5 years requiring residential support for learning disability and/or autism. 
  • Approximately 50 people over the next 5 years requiring older peoples residential care / nursing, specifically with higher levels of behaviours that challenge or more complex needs.
  • Approximately 20 people over the next 5 years aged 65+ with complex dementia-related behaviours, and a further 20 people over the next 5 years under 65 with dementia will require appropriate residential or nursing provision. We are interested in the potential for a hybrid 5-unit residential development for individuals with young onset dementia to facilitate tailored support for these individuals.
  • Approximately 20 people over the next 5 years with mental health related requirements who have been through many of the current in city provisions and experienced placement breakdown.

Upcoming business opportunities:

• We invite conversations with existing and new providers to facilitate new care homes in the city. We have specific interest in the development of modern, purpose-built accommodation to refresh our current offer.
• The Council are currently exploring opportunities to develop the older people residential / nursing market with our Joint Venture partner. This includes the potential development of a care home with specific support for individuals with behaviours that challenge.
• We are open to exploring opportunities to transition to more purpose-built care home accommodation. 

Current provision and delivery: 

Care home provision in Coventry is split into three key areas:

• Learning disability and autism residential care (14 homes, 101 beds)
• Older people's residential care homes and nursing, including dementia residential (31 residential, 1106 beds; 14 nursing homes, 649 beds). Of these, one home is a specific mental health nursing home/recovery unit (14 beds). 
• Mental health residential care (12 homes, 129 beds)

Learning Disability and/or Autism: Whilst demand is managed, in the last three years three learning disability care homes have closed, with no new residential provision currently planned or in development to replace this capacity and few voids carried within the remaining provision. Though infrequent (approx. ≤ 5 people per annum) when required there have been some challenges in sourcing placements for individuals with complex learning disability and/or autism, with these requirements sometimes met through specialist provision located out of city. We therefore note potential upcoming need for additional residential care provision in city, specifically for individuals with higher level learning disability or autism requirements, to meet this need. Likewise, there is currently no dedicated nursing provision in city able to cater for individuals with specific nursing requirements, for example, acquired brain injury or individuals with a learning disability or autism below 65 years of age with nursing requirements where older people's provision is inappropriate. Individuals requiring this support are supported within general older people’s residential and nursing care homes, or outside of Coventry if more specialist support is required. As at May 2024, 19 individuals with these needs were placed in Coventry nursing provision.

Mental health/dementia: In respect of mental health provision, there has been a move away from use of traditional residential placements since 2020 in favour of supported living and hybrid residential placements that offer a greater degree of independence for service users. Despite an increase in the number of people requiring mental health support, we have only seen a small increase in the use of residential and nursing beds due to new hybrid and supported living schemes being developed. Since 2020 the market has grown by 7 hybrid supported living / residential facilities (39 beds) and 77 new supported living beds across 6 developments. Hybrid schemes allow individuals to live independently in individual flats within schemes registered as a care home, with a structured programme of support focused on promoting independence. While we continue to focus on models that allow the greatest degree of independence for service 
users, around 4-6 men aged 50+ tend to be placed in residential or nursing out of city per year, often having been through multiple in city provisions, therefore a new complex behaviour residential provision for this group would be considered. Additionally, 8-10 younger people per year are being placed out of city with extremely complex behaviour who would benefit from a dedicated younger people’s transition service which steps down provision quickly as they become more independent. While we would prefer to use supported living, a hybrid supported living/ residential model would be considered. We require a small number of flexible beds for people with young onset dementia – 4-6 people per year would benefit from a specific provision for people aged 30-65 who require dementia care, taking into account the specific needs and circumstances of younger people with dementia (such as space for young family to visit) but with the ability to provide nursing care when required. This will need to be able to cater for people with very complex and challenging behaviours. We also require 4-6 residential / nursing 
beds for older people with dementia who have very challenging behaviours.

Older People's: Regarding older people's residential and nursing care, in 2023/24, 776 people aged 65+ accessed long-term residential care and 237 people 65+ accessing long-term nursing provision via spot contracts in city. People generally on average reside in a care home for approximately 2 years. It is estimated based on vacancies and council-funded residents that self-funder market is approximately 30% for Coventry. 

Our market analysis based on the Capacity Tracker and commissioning intelligence shows that Coventry has a fair to good supply of older people residential and nursing provision within the City. Over the past 12 months, average vacancies were circa 10% for residential provision and circa 10-14% for nursing care. 

There is increasing demand for care for individuals with behaviours that challenge and complex needs; current provision for this requirement is limited in the city (approximately two homes able to cater for this) and more expensive, resulting in occasional use of out of city placements to meet these needs. We note the requirement for approximately 10-15 people per annum requiring older people's residential care/nursing, specifically with higher levels of behaviours that challenge. Please note this area is subject to further scoping and input from the ICB. We are also open to conversations to develop more modern provision where required. 

Gap: Supported living provision for individuals with a learning disability, autism, or mental health requirements, including transitions. This includes the requirement for single occupancy, affordable support living placements in the community.

Commissioning intentions and requirements (within available resources):

Intentions: 

• Develop links with Registered Providers to ensure availability of quality accommodation as required, without delay, at affordable rates.
• Consider alternative methods of growing single occupancy accommodation stock within Coventry.
• Enable more people to thrive independently within their local communities.

Requirements 2024/2029:

• Note, all supported living accommodation must be affordable and payable by housing benefit. Landlords must therefore be Registered Providers.
• There is a requirement that supported living schemes are in areas that are conducive to service users building an independent life – for example being close to shops, on bus routes to the city centre, near green space and in areas without significant issues with drugs. Please note that some service users will need accommodation to be away from schools and nurseries, so this is preferred where possible.
• Learning disability and or autism:
  • Requirement of approximately 75 people over the next five years who require core and cluster supported living provision.
  • Supported living accommodation for young people transitioning from Children's Services. As at May 2024, 29 17-year-olds will be transitioning to Adult Services who will require some form of accommodation-based support solution.
  • Approximately 20 people requiring single/dual occupancy units over the next five years catering for individuals with high-level learning disability and or autism requirements (note, single/dual occupancy homes must have an additional bedroom for a ‘sleeping’ staff member). We note a preference for bungalows in the community and properties with gardens to allow for sensory gardens/support.
• Mental health:
  • Approximately 50 people with forensic or high-risk needs. over the next five years requiring supported living accommodation.
  • Approximately 20 young people with mental health needs transitioning from Children's Services over the next five years with supported living requirements.
  • Approximately 25 people with complex mental health requirements. Please refer to the Mental Health Market Development Plan for further detail on specific requirements.

Business opportunities (ongoing): 

• We encourage providers able to offer the above to join our Supported Living Framework where they have accommodation available.
• We are keen to discuss further possibilities to meet this need with Registered Providers or supported living providers with strong links to landlords / with their own housing stock, who can support the Council in 

sourcing affordable accommodation for individuals without delay.

Current provision and delivery: 

The Council has been successful in developing a number of larger, core and cluster style supported living schemes with an additional 56 learning disability units available within the city in the last three years through call-off procedures via our Framework. An additional 5 mental health providers equating to 32 units have also joined the Framework in this time, with 77 new units since 2020. The need for mental health provision particularly has increased significantly in recent years, and there is a drive to create more supported living opportunities to meet continued growth in need.

In respect of learning disability and autism, whist there remains ongoing demand for core and cluster models of delivery, we note a gap in the provision of single and dual occupancy placements for individuals who require more bespoke accommodation within the community. Specifically, we note challenges in the availability of affordable accommodation to meet these needs as opposed to a shortage in available care. Whilst general accommodation (core and cluster) is plentiful in Coventry, the availability of large houses and particularly bungalows present as an affordability issue due to rent expectation because of high purchase prices and local authority rent levels for exempt housing. We require providers to work closely with Registered Providers to focus on resolving this gap to provide suitable accommodation opportunities across the city which can be afforded using housing benefit. Though requirements of this nature are infrequent (approximately 5 instances per annum) these can present sourcing challenges as well as impact to the individual concerned due to the subsequent sourcing delays. 

Gap: Accommodation for individuals of all ages who require support whose requirements sit outside of traditional supported living or housing with care models.

Commissioning intentions and requirements (within available resources):

Intentions:

• Develop a range of age appropriate, preventative, accommodation-based support options for individuals with support requirements to prevent escalation or deterioration in needs.
• Offer opportunities for individuals to build confidence, social skills, and friendship networks.

Requirements 2024/2029:

• Note, potential developments in these areas may be undertaken in conjunction with Coventry City Council Housing.
• Accommodation would be rented and must be payable by housing benefit.
• Learning disability and/or autism:
  • ​​​​​​​Approximately 20 people over the next five years.
• Mental health/learning disability:
  • ​​​​​​​Approx 30 flats across multiple locations, with typical unit sizes of around 4-6 flats alongside individual flats/homes available within the community. Units would offer a model of support which provides small packages of support (e.g. 1-3 hours of external support per week) for individuals stepping down from other provision, working towards independence or who require an ongoing level of monitoring or prompting to remain safe and well. 

Business opportunities:

We will commence scoping of demand in this area in 2025 and are keen to understand market appetite for such support schemes in the city.

Current provision and delivery:

We have seen an increase in the number of individuals presenting with requirements for accommodation with support (not requiring personal care) or prompting to maintain their overall health and wellbeing or tenancy. Whilst some individuals requiring this type of support would ideally be suitable for Housing with Care (HwC) schemes, CQC registrations or scheme constitutions prevent individuals of younger age groups living at schemes with HwC in the city, catering for individuals either 55 or 65+. Scoping of these requirements is also underway with Housing colleagues to better gauge holistic demand in this area. 

A level of capacity in this area is currently commissioned via one provider through our Preventative Support Grant, providing a step-down unit (17 bedrooms) for individuals with low to medium level needs offering support, prompts and guidance, including 1-2-1 interventions where required. The aim of this support is to enhance people’s skills to lead an independent life and to secure tenancies in the community in the future, where possible. Support is delivered on average across a 6–12 month period with flats funded by housing benefit and supporting approximately 17 people per annum. 

We are open to exploring opportunities with providers to work differently to support individuals in accommodation-based settings with non-personal care support requirements, focused on preventing an escalation in need, upskilling people to increase their independence and grow their own support networks. We aim for such support to mitigate general anticipated trends in individuals experiencing mental health issues and crisis, preventing the need for more intense support.

Gap: Increasing the range, choice and availability of respite and carers' breaks 

Commissioning intentions and requirements (within available resources):

We will consider respite options as part of any new commissioning linked to high-level or complex needs, including for younger adults with a learning disability and/or autism and individuals of all ages with behaviours that challenge.

In developing our respite offer we will deliver against the feedback from carers identified through engagement undertaken in 2023 in developing the Carers Action Plan 2024/26. Themes within the Plan include:

• Developing suitable provision available to individuals, especially for individuals with more complex needs.
• Ensuring that carers are aware of the break and respite options available.
• Ensuring availability and flexibility in the support available. Our data on usage also indicates:
  • Many of our respite placements are made as a result of carer breakdown and which can sometimes lead to a full-time residential placement.
  • Some placements are made in emergencies rather than planned and structured respite.
  • Utilisation of carers respite in 2023/24 is at its highest levels since pre-pandemic. 

Business opportunities:

In 2025/26 we will commence work to further develop a new respite offer to stimulate growth and choice in respite provision locally. Specifically, we are keen to develop a new offer suitable for individuals with:

• Learning disabilities and/or autism
• Multiple or complex needs
• Acquired brain injury
• Physical disability 

This will include both residential and accommodation-based provision, alongside more tailored community delivered models and alternative carers' breaks delivered through the Accelerating Reform Fund. All opportunities will be advertised through the Council's e-tendering system - CSW-Jets.

Current provision and delivery:

The Census 2021 noted 27,391 people in Coventry reported themselves as having caring responsibilities, however this figure is expected to be much higher recognising many people do not realise they have caring responsibilities and the context in which the Census was undertaken (during the Coronavirus pandemic).

In respect of respite usage, we are seeing this increase year on year and a return to pre-pandemic utilisation. Work is underway to understand specific gaps in provision across all age groups and requirements however to date we note specific gaps in delivery in respect of:

• Transitions service: there is a stark difference between children’s and adult’s provision, with no specific provision currently in place to support individuals who are transitioning between services.
• People with physical disabilities: demand for this area is currently met within mainstream learning disability provision.
• Individuals with an acquired brain injury: there is currently one residential / nursing scheme able to offer residential respite for individuals requiring support of this nature in city. This offer is however subject to occupancy and capacity of the home at the time of need.
• Individuals with dementia and behaviours that challenge, such as sexualised behaviour / aggression: currently this is met within dementia-specific residential and nursing provision.

Over the next two years the Council will be utilising the Accelerating Reform Fund (ARF) to facilitate several carer-related support projects, including the provision of alternative carers' breaks. The service will connect local carers with ‘breaks’ donated by local businesses, for example, hotel stays, theatre tickets and holistic therapies, to take quality time away from the caring role for themselves.