Market Position Statement - Messages to the market

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

Richmond has 8 nursing care homes with 474 beds and 35 residential care homes with 442 beds in total as of January 2023. In Richmond 93% of these care homes (40/43) are rated ‘good’ and ‘outstanding’.  Residential and nursing care services are commissioned by a mix of block contract and spot purchasing, through individual placement agreements. 

Residential and nursing care per client group in 2022 is shown in the table below.

Client group	Residential care beds	Nursing care beds
Older people/physical and sensory disability	228	468
Memory and cognition	49	0
Learning disability	152	6
Mental health	13	0

Messages to the market - residential and nursing care

• We want to work with providers to drive up quality and safeguarding practices through agreeing clear standards and monitoring provision through the standards of the PAMMS quality assurance system
• We want to encourage providers to develop links with local communities to increase the choice of activities and social stimulation
• We want to encourage providers to engage in the use of technology enabled care to support independence and improve quality of life
• We  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:

• Although there are vacancies in care homes locally, there are too many basic residential care beds and not enough specialist dementia beds. Therefore, we want to work with providers to increase in-borough capacity of specialist care home provision for enhanced dementia-related care in both residential and nursing settings, as well as supporting people with behaviour that is seen as challenging, and the 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).
• To provide this more specialist care, providers will need to reconfigure or develop new services, and to review the training and skills of their staff.
• We are working with providers to consider dementia friendly environments when developing their service delivery models, as part of the Richmond Health and Care Dementia Strategy 2022-2031.

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 and risky behaviour. 
• This will require providers to employ highly trained and skilled staff. 

Adults with learning disabilities:

• There is a continuing need for some in-borough specialist residential and nursing care for younger and older service users 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 carers. 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.

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 two extra care schemes contracted by us providing 66 units. There are also two private schemes offering specialist support/alternative tenures in the borough.

Messages to the market - extra care

• We want to work with providers to develop flexible, age friendly supported independent living options and explore innovative models such as those that promote mixed communities and intergenerational living.
• We are seeking to work with existing providers on new and creative ways to use to technology to deliver 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:

• We will continue with service development within our existing extra care schemes, which provide a bridge between independent living and residential care homes.  This includes working with our care providers and housing providers to develop a community hub model which support family and community links and connections.

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 degenerative 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 service users 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. 

What we want for our residents - We want to ensure a sufficient choice of good quality, flexible supported living services in Richmond 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.

Current provision

We currently block commission 19 supported living schemes for people with a learning disability and/or autism in Richmond, which provide 88 units.  We also spot-purchase supported living for people with a learning disability and/or autism both in borough and out of borough. We are in the process of recommissioning accommodation-based care and support for adults with a learning disability and/or autism in Richmond, including supported living, through a procurement framework which will go live in April 2024.

Most of the supported living accommodation available in Richmond is in shared housing. We are expanding the range of options available and seeking to improve overall quality and accessibility. We are also opening a new service in 2023 which will provide self-contained flats. A further new scheme is in design and development in South Richmond ward and will deliver 7 new flats by the end of 2025.  

For those with a mental health need, there are currently 9 schemes which hold around 109 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 are undertaking a review of our mental health provision with a particular focus on accommodation based services and alternatives to accommodation-based provision. As part of our mental health review, we are also examining low level and preventative provision including proposals for floating support, and we will update once our review have been completed.

Messages to the market - supported living

• 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 service users 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 service users 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 service users.

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.
• 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.
• We are seeking single bedded accommodation with good access to transport, community, and health facilities.
• We have been working with our key providers and partners 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 service users with more complex needs.
• 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 service users to aid move-on to independent living whilst still providing a stable and supportive living situation.
• We also want to work with providers to develop some specialist supported living and housing support and preventative services, that might be beneficial for younger service users with mental health needs and often autistic spectrum disorder in transition from children and young people’s support to adult provision.
• 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.
• We are also interested in commissioning provision for people requiring long-term accommodation-based support, primarily in older age range (55+), possibly using an extra care model.
• We want to strengthen links and work with our housing partners, registered providers and private landlords to increase capacity of step-down provision including general needs and private housing options, deploying floating support more effectively to enable service users to independence.
• We want to explore and take forward opportunities for joint commissioning arrangements with the South London partnership.

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.
• We also want to work with providers and partners to ensure that our accommodation offers improved service user 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 are commissioning a framework for accommodation-based care and support in Spring 2023 which will include supported living services.
• 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 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 Richmond.
• Small sized supported living schemes might be useful for people with a 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 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.

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.  

Current provision

There are 16 home care agencies registered in the borough, these range from small independent organisations through to regional or national provider brands.

In January 2023, we launched a ‘platform’ for home care services. Providers can apply to join the platform at any time, and they can be appointed if they meet our evaluation methodology and award criteria. In future this platform will also be extended to commission rapid response and reablement services.

We intend to place the majority of business with contracted providers. Where we are unable to place with these contracted providers, we will place with the spot market.

Messages to the market - home care

• We are experiencing an increase in demand for more specialist packages, particularly from those discharged from hospital and we want to work with providers who can manage increasingly complex packages which may include service users with multiple needs receiving services from a variety of agencies.
• Richmond is a diverse borough, and it is important that home care services are inclusive and provide culturally responsive services.
• We want providers to be positive about working with digital technology to support users in achieving greater independence.
• To support the varying levels of client 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.

Older people and people with memory and cognition:

• We have commissioned a new community equipment provider to ensure there is suitable and accessible equipment to support people at home and in care homes and 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.

Prevention and the voluntary sector

What we want for our residents - The vision for preventative services is that vulnerable and/or older adults in Richmond who are most at risk of a decline in their independence and wellbeing can access a range of culturally responsive and inclusive preventative services. The community and voluntary sector will be at the centre of delivering these services. 

Prevention is at the core of our approach to improving overall outcomes and 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 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 sector.

Current voluntary sector provision

Richmond has a thriving and vibrant voluntary sector with 100 active local voluntary organisations working in partnership with us, NHS, residents and other stakeholders. Through the Community Independent Living Service (CILS) partnership, we ensure the delivery of a range of preventative services to support residents to improve, maintain or reduce the decline in their health and wellbeing, managing the demand for targeted social care.

There are two main components of CILS, including an information navigation service delivered by Richmond Advice and Information on Disability (AID) which supports residents to identify and access services that can support their health and wellbeing and maintain their independence. The second component is a suite of Health and Wellbeing (H&WB) services managed as a lead provider model. Age UK Richmond is the lead provider and subcontracts with 19 local voluntary sectors partners. 

These services include a focus on prevention and early intervention, developing active and supportive communities, facilitating access to transport, leisure, health and wider services and enabling vulnerable people to remain independent as much as possible. 

Messages to the market - prevention and the voluntary sector

• We see the community and voluntary sector as key partners in the planning and delivery of preventative services.
• We are committed to supporting the borough’s diverse range of organisations and is committed to exploring new opportunities for doing things better and achieving a greater impact for all equality groups amongst residents and communities.
• Therefore, we welcome providers who are committed to developing services that focus on delivering on the key outcomes from CILS, as well as providing innovative services that will further develop the preventative and voluntary sector within Richmond.
• There is a need to recognise the needs of young people with Special Educational Needs and Disability (SEND) with a particular focus on young people with SEND in transition from child to adult services, and their aspirations and service needs including housing and employment as they grow into adulthood.
• Social prescribing is a key tool to connect local residents to support and inclusion in the community, which helps combat loneliness, isolation and low-level mental health needs. We encourage community and voluntary sector partners to embed and develop social prescribing in their services.

Day care opportunities and outreach

What we want for our residents - Our ambition is to ensure a wide 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. There are currently three council run specialist or intensive day centres for people with assessed eligible need run by us, supporting older people with a diagnosis of dementia, physical and neurological needs. These centres provide personal care on-site and staff trained in supporting clients with complex needs and behaviour that may challenge. They also provide opportunity for unpaid carer respite. Work needs to be undertaken to assess the full impact of the pandemic on day service demand, and what will be needed now and over the next few years.

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.  
For people with a learning disability there is a vibrant and well-established voluntary and community sector offer. We currently spot purchase outreach support for those with eligible assessed needs to help them to engage with this offer and access wider opportunities within their local community. 

Messages to the market - day care opportunities and outreach

• It is recognised that there is a need to respond more flexibly and creatively to the varying demands and needs of service users, from all backgrounds, and ensure services are future proofed.

Mental health:

• There is a need for outreach support to enable residents with a mental health need to remain in their own homes.  
• Additionally, there is a need for planned and unplanned respite, short breaks and emergency support for those with or without accommodation. 
• Alongside the NHS led community mental health transformation fund, we want provision of daytime activities to support residents to participate as members of the community.

Adults with learning disabilities:

• For people with a learning disability the learning disability big plan for Richmond (2023-2028) will be published in summer 2023 and sets out Richmond learning disability partnership priorities for action across a range of themes identified by people with a learning disability in Richmond including travel, employment, housing, transition, technology and relationships. Outreach and community activities can support people to reach their personal goals in these areas.
• We want to develop the range of opportunities for adults with a learning disability in Richmond to develop skills for independent living and employment, improve their wellbeing and quality of life and is keen to work with local providers to do this.
• We are commissioning a framework for accommodation-based care and support in Spring 2023 which will include outreach support for people living in their own homes or with family/carers.  This will make it easier for adults with eligible assessed needs to access outreach services which can help them reach their goals both at home and in the community.

Adults with physical disabilities:

• Younger adults with a physical disability want to access community services with their peers and not necessarily at a building-based day centre.

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.

Messages to the market - employment

Adults with learning disabilities:

• We want to create more opportunities for people with a learning disability to gain work. Our new supported employment service which launched on 1 April 2023 will work with people accessing the service, providers, other partners, and employers to develop the support available for people both seeking work and in-work.

Adults with mental health needs:

• There is a drive to develop and increase employment and supported employment opportunities (full or part time) and voluntary roles, by working closely with the NHS. Specifically, there will be further focus on those with a mental health condition receiving education and any additional training and or/retraining.

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.

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 maximise choice and control over their own care giving them more independence and flexibility.

Current provision

DPs are actively promoted as the preferred means of delivering personal budgets. We are in the process of undertaking a review of our direct payment processes to improve service user experience and outcomes to encourage take up of direct payments.

We currently commission a direct payment support service to provide information, advice and guidance for anyone with a direct payment, including a payroll service, financial management support and employer support. We have recently reviewed the existing direct payment support service to inform a new specification and the new contract will commence 1st July 2023.

Demand

During 2021-22, 522 service users received their personal budget as a direct payment. This represents annually approximately 39% of people receiving community-based services in Richmond who receive their service via a direct payment.

As of 2022 older persons comprise 38% of the total on a DP, people with learning disabilities comprise 33%, those with mental health needs comprise 10% and people with physical disabilities comprise 20%. 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 2017 to 2022 is shown in the table below.

Key client groups	2017-18	2018-19	2019-20	2020-21	2021-22	% change from 2017 to 2022
Older persons	252	237	206	204	196	-22%
Learning disabilities	180	175	175	176	173	-4%
Mental health	59	56	52	49	50	-15%
Physical disabilities	135	120	112	108	103	-24%
Total	626	588	545	537	522	-17%

Approximately 65% 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.
• We are undertaking a review of our direct payment processes to improve service user experience and outcomes and increase uptake.
• 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. 

Carers services

What we want for our unpaid carers - We want carers in Richmond to be able to achieve their full potential, live their lives with confidence and resilience, and access circles of support and quality services that promote independence and deliver value for money.

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, carers’ direct payments and voluntary sector support.

Richmond Carers Hub Service is the main local carer support service. It comprises a group of six charities working together: Richmond Carers Centre (lead), Addiction Support and Care Agency, Crossroads Care Richmond and Kingston, Richmond Borough Mind (Carers in Mind), Homelink Day Respite Centre and Integrated Neurological Services. It provides universal and specialist (addiction, dementia, neurological, mental health) support information and advice; informal individual and group emotional support; a caring café for carers and people they care for living with dementia; a dedicated young carers service; training and learning opportunities for adult carers; events and activities/breaks; opportunities for carer engagement; carer awareness training for professionals and strategic leadership.

We undertake carers assessments, giving carers the opportunity to discuss the physical, emotional, and practical impact of caring on their life, enabling social care practitioners to direct them to services which can support them. Carers are offered a carer’s emergency card which enables access to emergency respite if the carer is suddenly unable to provide care due to accident or other exceptional circumstances. Young carers identified by adult services are referred to children’s services for appropriate assessment and help to access additional support.

Messages to the market - carers services

• We want to work with local service providers to raise awareness and understanding of the needs of unpaid carers, 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.
• 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.
• We want to providers to actively recognise and identify unpaid carers and provide them with information about options for support.
• We want providers to consider unpaid carers when reviewing services or undertaking new pieces of work to consider the impact on unpaid (family) carers and how to address any emerging issues.

Substance use disorders treatment services

What we want for our service users - 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 1010 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 user disorders treatment service

• 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 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 for some of the new services, although we would expect them to work closely with the consortium.
• 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 and equality groups in ways that do not depend on recruiting categories of staff that are in very short supply.

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. We are also trialling care technology in a supported living scheme in Richmond with the aim of embedding the use of technology and exploring how the staff can use the technology as part of the care they deliver.

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 client records and care plans.

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.

Older people and people with memory and cognition:

• 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.