North Tyneside Council: local authority assessment

North Tyneside worked with local people and stakeholders and used available data from the JSNA, the Provider Portal and the voluntary and community sector to understand the care and support needs of people and communities. This included people with lived experiences of accessing services and evolving analysis of JSNA data linked to specific conditions or needs. Data allowed targeted geographical analysis of deprivation and inequality, and population groups who were most likely to experience poor outcomes.

Senior leaders told us there was a ‘golden thread’ linking the Council Plan, the Health, and Wellbeing Strategy, and the JSNA through to services commissioned to meet people’s needs. The JSNA and local intelligence about the needs of people accessing support informed the local authority’s commissioning intentions to meet the changing needs of the local population.

Data provided by the local authority showed in 2023-2024 there had been a 3% rise in contacts with Adult Social Care. Short-term support had seen a 3.7% increase and long-term support had grown by 4.7%. The number of older people living in nursing homes had increased by 20%, however, there were fewer working-age people in residential care. Figures showed North Tyneside had the third lowest percentage of people aged 65 and over needing long-term community care in the North-east.

Staff and leaders told us the local authority recognised accommodating a rapidly ageing population was a significant challenge. Data provided by the local authority showed a predicted 30.80% increase in people over 75 years of age in the borough by 2030. This had led to focused investments in prevention, early intervention, and reablement services in line with the Council’s home first approach. While the number of working-age individuals needing adult social care remained steady, there was an upward trend in young adults entering adult social care with complex support needs.

Whilst feedback from unpaid carers wasn’t always positive, there was a recognition of the recent changes made by the local authority to address the concerns raised in the 2024 commissioned voluntary and community sector survey of carers support and an acceptance of changes being made to improve access to respite services and support for unpaid carer’s mental health and wellbeing.

Partners told us the JSNA and Market Position Statements clearly identified the current and future needs for services in North Tyneside. The principal areas of focus were the increase in demand from an ageing population and the upward trend of young people with complex needs, however there were also identified shortages in complex dementia support, bariatric care, and short-term support for people with delirium coming out of hospital. Senior leaders also highlighted a need for more local residential support for autistic people.

Senior leaders told us there was a strategic move away from residential placements being the priority following a Care Act Assessment, with home and community-based services (such as extra care) being preferred. Partners told us how a regional approach to future supported accommodation was being explored and a review of the current homecare provision locally aimed to improve the offer for more rural, hard to reach areas.

People told us access to services was generally good, though there were some issues with the quality of homecare services. Some areas in the borough were seen as 'hard to reach' due to poor transport links, proportionately lower rates of pay compared to neighbouring local authorities, and increased travel times leading to difficulties in sourcing support, particularly for people organising and paying for their own care and support needs.

Senior leaders told us commissioning arrangements were flexible in these areas to offset the perceived financial disadvantages for service providers and the recent homecare review planned to address accessibility issues further. At the time of our assessment, it was too soon to see the impact of these changes for people accessing support.

People told us they had access to a diverse range of local support options which were safe, effective, affordable, and high-quality to meet their care and support needs. Commissioning strategies and market shaping activity supported this. Commissioning strategies were aligned with the strategic objectives of partner agencies and included the provision of suitable, local housing with support options for adults with care and support needs.

There was specific consideration for the provision of services to meet the needs of unpaid carers. National data provided by SACE (2024) showed 32.65% of unpaid carers in North Tyneside accessed support or services allowing them to take a break from caring for more than 24hrs. This was a positive variation on the England average of 16.14%. The same data source showed 20.83% of carers accessing support or services allowing them to take a break from caring at short notice or in an emergency. This was again a positive variation on the England average of 12.08% but showed at the time of our assessment the changes to improve unpaid carer’s support in the borough were not embedded enough to understand the full impact as most unpaid carers were still not accessing respite services.

Staff and leaders told us the local authority commissioned models of care and support in line with recognised best practice. Commissioning supported new and innovative approaches to care provision where this led to better outcomes for people. For example, the recent review of step-down services following discharge from hospital had led to increased placements in community-based, extra care services, supported by improved rehabilitation and occupational therapy support.

Partners told us the local authority had recently commissioned a review of their Housing Needs Assessment and developed a Housing Market Position statement. This covered a range of housing solutions across older people, people with learning disabilities, neurodivergent people, and people with mental health conditions. Senior leaders told us they were working with NHS England to identify capital funding to support the development of housing provision for people with learning disabilities and mental health needs currently in hospital to deliver on the national ‘Homes not Hospitals’ agenda.

The Council’s Housing Strategy 2023-2028 detailed the shared commitment to preventing and meeting housing support needs by tackling homelessness and increasing support for people’s mental health and wellbeing. Delivered in partnership between adult social care, housing, and support providers, the scheme supported approximately 150 people in supported accommodation and 100 who received floating support any one time. In addition, the local authority provided 5 crisis beds to support people at immediate risk of homelessness.

There was sufficient care and support available to meet demand, and people could access it when, where and how they needed it. Some services were commissioned jointly with other agencies. In these instances, there were clear roles and accountabilities for monitoring the quality of the services being provided and the outcomes for the people using them.

There was sufficient capacity for unpaid carers to have access to replacement care for the person they cared for, in both planned and unplanned situations. However, the local authority had identified key areas for development to meet future demand and the changing needs of the people of North Tyneside.

Data provided by the local authority showed despite an increase in demand, there was sufficient capacity to meet people’s adult social care needs. Partners also told us hospital discharges were not impacted by service provision. We received initial concerns from service providers of reduced packages of care following Care Act reviews. However, data provided as part of our assessment showed this was not the case, with only a small percentage of care packages reducing, and an increase in care hours seen overall in the last 12 months.

Senior leaders told us North Tyneside’s Market Position Statement and Market Sustainability Plan were reviewed annually, reflecting current and forthcoming requirements over the next 2 years. The local authority had regular Provider Forum meetings which highlighted where additional or different provision needed to be in place and providers confirmed frontline teams and commissioners were working closely with them to support the move to community and home-based care.

The local authority's Market Sustainability Plan for older people’s residential and homecare services identified 30 care homes currently operating in North Tyneside primarily supporting older people. There were other care homes operating and supporting people with a learning disability, physical disability or with mental health needs. Of the 30 older people’s care homes there were 17 homes delivering residential care only, 12 homes delivering residential and nursing care, and a care home delivering nursing care and CHC support only. Senior leaders told us there was a mix of new build provision and converted older properties. Market diversity was therefore good, and the local authority was not over reliant on any one type of provision or provider.

There were 12 care homes delivering specialist support. This covered care homes supporting working age adults with a learning disability, mental health needs, and physical disabilities, including specialist support for forensic needs. This included a dedicated residential respite unit. The local authority's market sustainability plan for learning disability and autism detailed 36 people waiting for homes from the local authority’s Independent Supported Living (ISL) services.

Staff and leaders said there was an ongoing strategy of supporting people with a learning disability, people with mental health needs, and autistic people to live independently in their own homes in the community as opposed to living in a residential care setting. North Tyneside had 209 supported living services with 313 people living in them. They ranged from single-person properties to core and cluster properties with up to 16 people living in self-contained units with joined communal facilities.

People living in residential care homes who had mental health support needs expressed a desire for their own space to enjoy more privacy and independence while still having access to on-site support. In response, the local authority created a new supported living scheme, featuring 16 individual flats with 24-hour support available. Collaborating with local providers and the Mental Health Trust, they helped people transition from residential care and hospitals into these flats in 2024.

There was good provision of extra care across North Tyneside and 2 new schemes opening in 2024. Senior leaders told us they aimed to support the development of, and access to, extra care provision as an alternative to residential care. This included delaying the need for a move into a care home or as a direct alternative. There were 11 extra care schemes in operation across North Tyneside, including hospital discharge step-down support and support specifically for people with dementia.

The local homecare market was made up of 3 types of providers. There were 21 locally owned and operated services, as well as 3 franchised services and 8 services owned and operated by large organisations. Staff and leaders told us there was a range of day services in place across North Tyneside supporting older people, people with dementia, learning disability and mental health groups. Some services were directly commissioned, and some were accessed via direct payments. These services offered either building-based or community support, with therapeutic services and others linked to daily living skills or supporting employment pathways.

People told us the local authority’s Shared Lives service primarily supported people with a learning disability and people with less complex needs. Staff and leaders explained how they planned to work with providers to grow and develop this service, so it supported more people and those with more complex needs.

The Market Position Statement stated the top 3 challenges for market provision were recruitment and retention of care staff and nurses, provision of complex dementia support, and short term-support for people with delirium coming out of hospital. Feedback from partners highlighted the need for improved bariatric provision and an improved offer for autistic people needing residential care. There had been reduced waiting times for homecare recently, with a waiting list of fewer than 20 people which has contributed to a 34% decrease in the number of short-term residential placements needed during 2023-2024.

Data provided by the local authority showed so far in 2025 there had been a 36.6% drop in short-term residential care admissions and a 15.4% reduction in long-term placements due to initiatives aimed at boosting homecare capacity. In the past year, the number of providers and the number of overseas workers in care home and homecare provision had increased, enabling the market to continue to meet demand.

There was some need for people to use services or support in places outside of their local area. When support was being accessed from outside of the area, there were plans to provide it in the local area, so people could move back there if they wished to do so. Data provided by the local authority showed in September 2024 there were 113 people living in residential care provision and 66 people living in nursing care provision outside of North Tyneside. Of these, 32 (total) were placed in the last 12 months. Reasons for out-of-borough placements cited personal or family choice and specialist support needs.

The local authority had clear arrangements to monitor the quality and impact of the care and support services being commissioned for people and it supported improvements where needed. At the time of our assessment there were 83 provider services in North Tyneside registered with CQC. Data on CQC ratings showed 81.25% of nursing care homes were rated good or outstanding, with 18.75% rated requires improvement. 96% of residential care homes and 90% of supported living services were rated good or outstanding. 79.41% of homecare services had received a good or outstanding rating. 3 adult social care locations had been de-registered in the previous 12 months.

Data provided by the local authority showed there had been 1 embargo for homecare in the last 12 months, the reason for this was not given. There had been 3 residential and nursing home embargos over the last 12 months due to concerns around the physical environment, organisational safeguarding and a CQC notification of removal of registration.

The local authority’s Procurement Plan and Approach to Quality and Value for Money (2023-2026) detailed the arrangements for ensuring high quality sustainable services to meet people’s needs and deliver value for money. Senior leaders told us they had a monitoring plan for all commissioned care services and had recently completed the annual monitoring of all homecare services.

Staff and leaders told us they worked closely with providers, including self-assessments, planned and unplanned visits, and feedback from people receiving services. When quality assurance concerns were identified, frontline staff worked with the provider to address and review these. Service improvement plans were put in place and the local authority and health partners visited regularly to monitor progress and to provide training and advice. Provider forums took place quarterly and were used to share information, development and best practice, and a provider portal allowed the local authority to closely monitor performance data such as visit times and support hours provided.

Feedback from providers was mixed, with some feeling the quality assurance process had changed recently, leading to confusion and a lack of clarity of actions needed to improve quality. However, this feeling was not share by all providers. Most found the local authority to be supportive of quality improvement processes, including training and development.

People told us their experience of the quality of provider services was mixed, with homecare services identified as not always offering quality support. Staff and leaders told us they were responsive to these concerns and had clear processes in place to work with providers to improve outcomes for people. People confirmed when they raised concerns with the local authority they were listened to, and issues were acted on in a timely manner. Data provided by the local authority following a survey of provider services in September 2024 showed 88% of people surveyed who were receiving homecare support were ‘happy’, or ‘very happy’ with the service they received.

The local authority collaborated with care providers to ensure the cost of care was transparent and fair. To understand the costs associated with providing care, the local authority consulted with local care home and homecare providers. To understand the costs associated with providing care and support recruitment and retention, the local authority consulted with local care home and homecare providers and incorporated National and Real Living Wage increases into their Medium-Term Financial Plan (MTFP) for 2022-2023. This aligned with their goals for market sustainability and workforce planning to ensure there was enough capacity.

The local authority’s contracting arrangements were efficient and provided stability for providers and allowed them to plan ahead. However, providers told us recent changes to banding criteria and the upcoming National Insurance changes presented genuine financial risks to their ability to sustain high quality, safe services. Staff and leaders confirmed the banding system for residential payments had recently changed, citing quality improvements and market stimulation as the reason for the move. All providers could move up to the top banding if they achieved the required quality assurance scores.

Senior leaders told us they had recently completed a homecare needs assessment and performance review as part of the wider commissioning exercise for the new homecare contracts. It provided a data analysis of demand by area and service group and considered future need. Some providers had reported in some areas they were making a loss. The analysis considered where the current contract was not effective and areas to increase efficiency and save money. It considered feedback from providers and national comparisons and looked at areas for future analysis such as the experience of self-funders, and the increasing nature of assistive technology.

Feedback from providers was that their main areas of concern were financial pressures and the recruitment/retention of staff. Providers told us the local authority worked with them and other stakeholders to understand current trading conditions and how providers were coping with them. Engagement and monitoring arrangements enabled the local authority to get early warnings of potential service disruption or provider failure; contingency plans were in place to ensure people had continuity of care provision.

Data provided by the local authority showed there had been 1 contract handed back for supported living in the last 12 months. This was due to staff recruitment and retention issues. There had also been 1 contract handed back for homecare in the past 12 months. This was due to quality concerns. There had been no residential or nursing care home contracts handed back in the last 12 months. There had been 1 care home closure in the last 3 years. This was because of low numbers of people living there. People were given the option to move to a ‘sister’ home the provider operated in North Tyneside.

The local authority understood its current and future adult social care workforce needs. National data provided by Skills for Care Workforce Estimates (2024) showed adult social care staff turnover rates in North Tyneside were 0.31, tending towards a negative variation compared to the England average of 0.25. Sickness rates amongst adult social care staff were also higher in North Tyneside, with an absence rate of 8.22 tending towards a negative variation compared to the England average of 5.33. And the number of adult social care staff with a Care Certificate in progress, partially completed, or completed was 41.93%, showing a negative variation to the average for England of 55.53%.

Senior leaders told us they worked with care providers, including PAs and other agencies, to maintain and support capacity and capability. North Tyneside council launched North Tyneside Care Academy in 2023 to encourage individuals to pursue careers in adult social care and to develop the skills of the current workforce in the borough through a cross-sector adult social care strategy. A dedicated Care Academy Coordinator worked with schools, colleges, and the local Job Centre Plus to create a website showing career paths, training opportunities, job openings, and positive stories from the adult social care field. The Academy was guided by a steering group made up of managers from adult social care providers and representatives from various sectors.