East Riding of Yorkshire Council: local authority assessment

The local authority used available information, such as the Joint Strategic Needs Assessment (JSNA) to understand the needs of the population in the East Riding. Key documents, such as the Market Position Statement (MPS), used relevant data and identified that the county’s population was expected to grow from approximately 342,000 in 2021 to approximately 360,000 by 2041. This was a lower rate of population growth than the Yorkshire and Humber region. The local authority also understood that the proportion of the population of a pensionable age was predicted to grow at a faster rate than other areas from around 27% to 34% by 2043. The local authority identified this could raise the number of people in need of care and support in the county and add additional pressures to their health and care system, including in terms of provision and workforce.

Staff were able to use appropriate data, such as the JSNA and social care recording systems, to inform risk management and commissioning decisions, including to understand the demand and types of contacts made to services, which provided information on presenting needs. For example, staff told us they had recognised higher demand for carers services and demand data was being used to support longer term planning around ‘dementia villages’ to meet the future needs of the aging population in the local authority area.

It was not always articulated in published documents how much the local authority used and understood available data to support commissioning activity. For example, the MPS identified that 46,863 people in the area provided 1 hour or more of unpaid care per week, recognising how much this figure had changed in recent years. The document did not include information about the future number of unpaid carers in the area in line with national carer estimates, or further demographic information about carers which would support providers in the area to understand local need. This would have further supported the local authority’s commissioning intentions.

The local authority had provider forums in place to understand their experiences and the experiences of people who used services. Quality and contract monitoring included both demographic data and people’s views. Some providers however told us they had little opportunity to contribute their views and there were fewer options to do this than there had been previously. Where providers were involved, they felt listened to and valued. The local authority recognised further work was needed to engage seldom-heard communities to better hear their voice in understanding the local need for care and support. Some staff told us that data that would support them to understand equality and diversity was not available and they were working on their data reports to improve the use of this information.

The local authority delivered several provider services which offered a wide range of quality services to meet the needs of people, including day services, the Shared Lives programme, a lifeline responder service, reablement and accommodation for people with learning disabilities, mental health conditions, and advanced dementia, for example. Overall, national data indicated that 69.74% of people who used services in East Riding felt they had choice over services, which was similar to the England average of 70.28% (Adult Social Care Survey, October 2024).

There was a recognition that there was an oversupply of care homes in the area which did not always support people with complex needs. There was an identified shortage of nursing provision in the area. Some providers had deregistered nursing beds, and local authority analysis indicated there was increasing complexity which required targeted development to meet this need, including in the recruitment and retention of a skilled workforce. Reshaping the residential care market was identified as a key priority of the Market Sustainability Plan in 2023, which outlined that a base of evidence was being developed to set out the services required in the future. However, staff and leaders told us these issues were still significant concerns.

There were also concerns regarding the provision of home care in the local authority area. Staff highlighted that the home care framework had recently been updated, creating a ‘closed’ framework reducing the number of providers from 50 to 12. This created the opportunity for closer working relationships with the home care providers centred around locality areas and the opportunity for more consistency. The local authority set ‘I statements’ within the framework against which it expected to measure successful delivery. An approved provider list could be used as needed where there were capacity issues or in response to individual choice with framework providers or through direct payments.

The Market Sustainability Plan in 2023 outlined an intention to move away from a ‘time and task’ model of home care to deliver a more outcome focussed approach through a series of pilots with home care providers. Key issues such as capacity and increasing need were clearly identified. However, staff also told us the framework continued to deliver to a ‘time and task’ model and there was still work ongoing to identify providers and pilot activity and the ongoing need for further development in home care. The new home care framework set key principles of person-centred care that promoted independence and choice and an ambition for outcomes-based homecare.

Staff told us the move to 12 framework providers had not reduced concerns across the area about the provision of care, such as across rural locations. In one example, staff said that rurality rather than complexity was the reason some packages of care were delayed or could not be sourced. Additionally, there was limited choice in homecare for people with complex mental health, to the extent that some staff told us they took on further practical and personal support for people beyond their remit.

There was some joint working with internal and external partners on provision within the area. This included working with housing services internally to develop an understanding of the property market and give more people their own front door. One provider, for example, said there was poor provision for extra care housing and supported living. Between March 2025 and the end of May 2025, local authority data indicated 7 people waited for extra care housing for their internally operated services, with an average waiting time of 120 days. There were 2 private providers in the local authority area of extra care housing, but the local authority did not have data at the time of our assessment regarding waits for these services. The local authority identified they were developing a detailed needs analysis of the extra care housing they needed in their MPS and was working with Homes England to deliver further extra care housing, including the recent development of a 34-unit site. However, we received mixed feedback about the join up across local authority departments to support market shaping.. The local authority shared examples of consultation between housing strategy and adult social care regarding the building or extension of provision within the area. However, some staff said they tried to highlight areas of need to new provision but had little control over the new services that opened in the area.

There was some consideration for the provision of services to meet the needs of unpaid carers. Some unpaid carers told us the free ‘sit in’ service was helpful, though it could be limited and they would have liked more hours if they could. Staff were able to support access to respite, including one example when a carer was able to stay in a hotel near to their wider family to support their wellbeing. The local authority also operated a care home for respite, emergency and crisis placements for adults with learning disabilities, for example. There was some close working with leisure services at caravan parks, and a carers cottage, which supported carers to take a break. The local authority confirmed carers could contact the carers support service directly for emergency support, including the ‘sit in’ service, the community wellbeing team if allocated, or out of hours services, including at the weekend or bank holidays. Some staff told us they recognised the need to increase the respite offer for carers. One partner, for example, told us respite didn’t meet the needs of their community where the nearest respite provision was 50 miles away and difficult to access. This was supported by national data: 6.96% of carers were accessing support or services allowing them to take a break from caring at short notice or in an emergency, which was somewhat worse that the England average of 12.08% (Survey of Adult Carers in England – SACE, June 2024). There was a similar picture for other respite care: 6.90% of carers were accessing support or services allowing them to take a break from caring for more than 24hrs which was worse than the England average of 16.14% and 12.62% of carers were accessing support or services allowing them to take a break from caring for 1-24hrs, which was somewhat worse than the England average of 21.73% (Survey of Adult Carers in England – SACE, June 2024). Work was ongoing with neighbouring authorities to further understand what needed to be developed.

Local authority staff told us they considered best practice when designing services, including looking to other local authorities and wider learning from partner agencies when developing their commissioning frameworks, for example. However, while strategic commissioning intentions and a direction of travel were clear to some staff, commissioning strategies were not fully developed or available. The MPS referenced broader strategies, such as the Older People’s Housing Strategy, Learning Disability and Autism Strategy and Carers Strategy, which had ended in 2024, though some work was progressing to update these strategies. For example, the Big Plan and Autism Strategy were examples of the way the local authority was working to co-produce strategies with people who had lived experience of learning disabilities and autism, alongside their families and system partners, to understand community priorities to support ongoing development of strategic intentions. Staff told us measurable outcomes in terms of timescales, or the numbers of units or different types of provision had not been quantified.

There was not sufficient care and support available to meet demand for home care, nursing care or for younger adults with complex needs in East Riding. People who used services in the county told us there was a lack of appropriate service provision to meet specialist needs in particular.

The local authority reported weekly on the number of hours and people across the area whose home care packages were outstanding publicly on their online MPS. Significant improvements had been made to reduce the number of people who were waiting for home care packages to start in the last year to 18 months, for example with approximately 1800 hours of outstanding home care in April 2024, to 426 hours of outstanding home care in early May 2025. Publishing these weekly reports online made it easier for providers to see where there was demand to be able to respond. However, capacity issues persisted, especially in more rural areas. In one example, an older person whose home was well adapted to meet their needs was unable to return home following a hospital stay due to a lack of capacity in home care. The package was never sourced, and the person was not able to return home. We were told several similar examples. We heard from staff, leaders and partners who were concerned about the lack of capacity and its impact on people’s experiences and outcomes. Capacity concerns increased people’s dependence on care and reduced their opportunities for independence at home. Staff told us the homecare framework and other intended improvements to homecare capacity had not fully rolled out leading to inconsistent improvements for people depending on where they lived.

The local authority had 328 placements outside of the local authority area, with 50 of these starting within the 12 months prior to March 2025. One voluntary and community partner told us there was a lack of provision for autistic people meaning the community had tried to meet needs themselves. A carer, for example, said they, and their family member’s preference had been an East Riding placement but there was insufficient capacity to meet their family member’s needs within the area. They didn’t think there was a focus on supporting a return to the area by the local authority. Staff told us that resourcing care packages was a challenge, and they didn’t want placements to fail and so considered out of area placements. Local authority data in May 2025 indicated more people aged 18-64 were placed in out of area care homes than in area. If a more local placement became available, social workers would complete a review to explore returning to the local authority area. However, considering delays to reviews for some people, it could be difficult to identify these opportunities. Some staff agreed there was limited capacity to meet the needs of younger adults who had multiple needs, such as physical and mental health, meaning it was sometimes difficult to get the support right for people and their carers the first time. Approximately two thirds of the out of area placements were in neighbouring Hull or York. Local authority data indicated 69% out of area placements were due to personal choice, as people wanted to be near to family, friends or for other reasons, such as to be close to a person’s former home

There was a lack of complex residential care, including nursing care. In one example, a staff member described contacting over 100 homes and still being unable to get care that would meet the learning disability and nursing related needs the person had. Some staff were frustrated by the lack of provision to meet complex needs and there was insufficient nursing provision for the size of the population. The local authority identified the number of available nursing beds had decreased and there were a lack of options in the east of the area.

The local authority provided data which showed the average wait for services to begin in East Riding for March-May 2025 was 9 days for home care, 238 days for supported living, 15 days for residential care and 22 days for nursing care. Local authority data did not distinguish what would constitute a reasonable wait for a commissioned care package to start as they based these processes on need and risk. In that way they were unable to confirm the number of times people have had to wait for a service to begin due to a lack of capacity. Between March 2025 and May 2025, on average per month there were 104 outstanding homecare packages, 19 supported living packages, 121 residential care packages, and 4 nursing home packages. While some of these waits related to capacity, they also included the providers own assessment processes, delays in confirming offers, personal preferences, and process issues such as incorrect start dates.

Leaders told us they were working in partnership internally and externally aiming to improve some capacity issues that affected people’s waits for care to start. For example, considerations were ongoing regarding the use of housing stock, improving supported accommodation, and the investment in specialist services, including whether existing properties could be improved rather than sold. Partners in health identified there was ongoing demand and capacity modelling linked to hospital discharge. This had contributed to some improvements, for example in the number of people receiving reablement and a reduction in the need for long term care following a hospital stay.

The local authority had arrangements in place to monitor the quality of the care and support services that were commissioned for people. Contract and quality monitoring teams operated on a risk basis to prioritise quality monitoring activity, using safeguarding information, complaints, CQC ratings and quarterly provider returns. Staff were able to challenge providers to improve quality regarding person-centred care and additional monitoring visits could be in place where there were concerns. Staff teams adapted their approach to meet the identified concerns, including speaking with people who used services, completing observations of practice, and visiting more frequently or urgently. Where there were quality issues, they agreed improvement plans with providers. At the time of our assessment, the local authority had enhanced work in progress with 12% of providers, which included increased monitoring, formal improvement notices, and suspension notices. Robust arrangements for the quality assurance of internally provided services were in place for both registered and unregistered services.

The model of quality assurance generally reacted to risk and staff and leaders identified they wanted to take a more proactive approach to quality assurance. This had previously not been possible due to capacity. The local authority had completed quality assurance with all 12 home care providers on the ‘closed’ framework over the last year. The contract monitoring toolkit had been completed with 47% of providers on the approved home care provider list, and 25% of the care homes in the area. The local authority was aiming to complete all contract monitoring with all care homes and home care agencies within the 12 months following June 2025. The local authority had identified additional resource to complete monitoring visits for the 24 care homes which had not been visited in 5 years. This included shorter and short notice assessments. At the time of our assessment, 17 of these 24 services had been visited. The local authority was moving from reactive visits to baseline assessments for all providers and setting monitoring timescales for visits.

There had been 2 commissioning embargoes for care homes and 3 for home care services in the 12 months prior to June 2025. Reasons for embargoes included staffing, person-centred care, understanding of mental capacity, governance and a lack of engagement with the local authority. A provider of significant concern protocol had been recently used where a provider was not meeting requirements, to the extent there was an overall high risk to the safety, wellbeing and welfare of service users and the provider was not demonstrating a willingness or capability to improve standards and reduce risk.

The local authority’s analysis in their MPS indicated the CQC ratings in East Riding were lower than England as a whole and the Yorkshire and the Humber region. The local authority identified that 63% of homes in the area were rated good or outstanding in May 2025.

The local authority understood from providers where there were significant pressures linked to wage, food and fuel costs, alongside pressures on home care, uncertainty in residential care demand, recruitment challenges and hospital discharge.

Some staff told us there were regular discussions with providers to understand operational costs, pressures and specific issues that affected their sustainability. Some partners told us there were open and honest relationships with commissioners. The local authority ran sector specific provider forums to keep up to date on issues affecting the market. Analysis in 2023 for domiciliary care, residential and nursing care identified there were significant differences in the average price of care commissioned by the local authority and the result of the fair cost care exercises. Average cost increases of between 11-19% were identified as needed to bring the funding in line. In 2024, a decision was made to offer no fee uplifts to providers in the county in line with a corporate focus on cost reduction, despite analysis indicating rising pressures and demands on the market in line with local authority analysis as part of the cost of care exercises. Action had been progressed following our on site assessment to approve fee uplifts to private providers following a revaluation of the decision making process and the recognised impact on providers.

In the Market Sustainability Plan in 2023, the local authority identified recruitment challenges which affected provision, that some care homes had been unable to operate at full capacity due to shortages of staff and managers, including closing off parts of the provision. The MPS identified there were shortages of skilled workers in every area of care and support. Some providers used the local authority’s Choose Care programme, developed and run in conjunction with the sector. Choose Care advertised the opportunities of a career in care, including through recruitment events. Commissioned providers were also able to access free training for their workforce through the local authority. Better Care Fund (BCF) funding had developed a workforce education programme to support building care careers, practice skills, leading well and integration, for example. A workforce plan was in place, developed with partners, to provide ongoing support to the identified risk workforce skill mix, recruitment and retention issues had on the sustainability of the market. Overall there were fewer adult social care job vacancies in East Riding: the proportion of vacancies was 5.78% which was somewhat better than the England average of 8.06% (Adult Social Care Workforce Estimates, October 2024).

Some providers told us that there were delays and challenges in receiving payment for the care they provided. Where changes to packages were agreed with a provider by operational teams, these were not always updated in systems, suspending payments. Similarly, extensions to packages would not always be updated promptly, affecting providers payments. While care for individuals continued, this affected the way providers operated and created an administrative burden that could have been better managed.

Some sustainability processes were in place in which the local authority could provide emergency financial support for providers who were at risk of closure due to financial crisis to support care continuity. Strategic planning guidance was available and utilised to manage provider failure, including how to assess risks early. There were 2 care homes and 3 home care services which ended their contracts with the local authority in the 12 months prior to June 2025 as these services closed. A further 2 care homes ended their contracts due to a change of service type to supported living providers. The local authority told us they worked with their internal service provision to retain staff where providers had exited the market in some instances. The local authority worked with providers who had reached out for support to understand demand in the area, service quality, fees, and business proposals before offering financial assistance. ‘East Riding 4 Business’ was also a service in place in which organisations could search for national and international funding sources aimed at small to medium enterprises, in conjunction with business advisor support. This made wider business support available to the care market, improving sustainability.