North Yorkshire Council: local authority assessment

The local authority worked with local people and partners and used available data to understand the care and support needs of people and communities. This included people who were most likely to experience poor care and outcomes, people with protected characteristics, unpaid carers and people who funded or arranged their own care, now and in the future.

The Joint Strategic Needs Assessment (JSNA) for North Yorkshire provided a detailed overview of the current and emerging care and support needs across the county. The data highlighted a range of demographic, geographic, and socio-economic factors which influenced local planning and commissioning decisions. Ongoing updates to the JSNA ensured decision-making remained evidence-based and reflective of population needs.

The population of North Yorkshire was older than the England average, with 25.0% aged 65 years and above, compared with the England average of 18.4%. The JSNA data showed North Yorkshire faced significant demographic change, with a growing proportion of older adults. This trend was linked to rising demand for services related to dementia, frailty, and end-of-life care. The local authority had projected a 24% increase in demand for residential dementia beds and 14% increase in demand for nursing placements, and the provision for nursing beds was increasingly challenged for adults with dementia. In response to this, the local authority had heavily invested in plans to develop Care and Support Hubs which included the offer of intermediate care and specialist dementia residential care for over 250 people. It was also working with partners to co-design a new approach to commissioning residential and nursing care for people with advanced frailty and dementia.

The local authority’s extra care framework incorporated rural needs and cultural diversity by ensuring extra-care housing was designed to keep people within their communities, allowing them to maintain local social connections. Tailored housing solutions accommodated ex-servicemen under the military covenant, coordinating social care, health, and housing services to provide holistic support. Community Anchor organisations played a vital role in capturing local voices, feeding insights into service planning, and ensuring inclusion for smaller rural populations. Digital inclusion initiatives helped people access services, particularly in farming communities, through outreach at auction markets and local libraries. A person-centred housing process enabled people in rural areas to remain near their families, ensuring care was tailored to their specific needs and lifestyle preferences.

The JSNAs highlighted under-served populations including people with learning disabilities, unpaid carers, Gypsy Roma Traveller and Show People communities, and individuals with mental health conditions, indicating the need for targeted, culturally competent support. A leader told us about the success of the Reducing Exclusion for Adults with Complex Housing Needs (REACH) model developed in Scarborough. This model, designed for people with high and complex needs, was being adapted for other areas, with adjustments to reflect local demographics, rurality, and specific needs such as support for veterans and mental health. Another leader told us the local authority was tackling inequalities by including several services within their prevention offer. For example, a sexual health primary offer, substance use, community pharmacy and primary care offer. They said they were targeting areas with the greatest inequalities, for example, those in rural areas and specific seldom-heard groups with the key focus of prevent, reduce and delay.

People had access to a diverse range of local support options that were safe, effective, and high-quality to meet their care and support needs. Data provided by the Adult Social Care Survey dated October 2024, showed 74.58% of people who used services felt they had choice over services. This was similar to the England Average of 70.28%.

The Health and Adult Services directorate worked closely with public health, housing, and the local Integrated Care Systems (ICS) to ensure their commissioning strategies were aligned with the strategic objectives of their partner agencies. The North Yorkshire Market Development Board oversaw the local authority’s market shaping activities and oversight of the care market. It facilitated collaboration with partners to ensure provision of care and support was aligned with the diverse needs of local communities and contributed to meeting the Place Board objectives. The board’s ambitions to transform the market over the next 3 years were set out in the Market Position Statement. This included workforce development, better commissioning, and greater provider stability. Progress included improved quality ratings, new dementia and intermediate care models, the co-design of specialist services, the growing homecare market and refreshed data tools to monitor supply and demand, all aimed at delivering responsive, inclusive services.

North Yorkshire Council had heavily invested in extra-care housing to provide older people and adults with disabilities the option to live independently while receiving tailored support. 28 schemes were developed, offering people self-contained flats with 24/7 care available. These housing options reduced isolation by encouraging community involvement and included accessible amenities like restaurants and hair salons. Support packages were flexible, allowing people to recover after hospital stays or adjust care as needed. Many schemes followed dementia-friendly design principles and welcomed pets and guests. Compared to traditional residential care, extra-care housing was more cost- effective and produced significant savings for the local authority. The extra-care housing options promoted person-centred care, choice and control, dignity, and safety which demonstrate high-quality adult social care.

Commissioning strategies included the provision of more suitable, local housing with support options for adults with care and support needs. The local authority already had around 1,500 extra-care housing units, which had supported approximately 6,000 people over the last 20 years. The commissioning strategy focused on diversifying provision through 3 main ways, core, complex needs, and rural extra-care models, such as the Bainbridge scheme, which supported both residents and the wider community by including a shop and a post office. As part of the ‘Home First’ priority, the local authority worked to reduce reliance on short- term residential care, expand extra-care housing, and test new models like Live-In Care and community-led pilots. Four new extra-care schemes were in development, with strong demand evidenced by 510 applicants. The local authority also aimed to improve supported housing for people with complex needs, including mental health, learning disability and diversity, through an investment plan and a new integrated intermediate care model co-designed with NHS and voluntary sector partners and investment in Care and Support Hubs for people with dementia. Market shaping efforts included standardising previously fragmented supported housing contracts and rebalancing provision geographically, such as in the Craven area, to ensure more consistent, needs-led services across the county. In addition to this, work to consolidate and localise the provision of home care was planned with a home care alliance model in Whitby, the development of Individual Service Funds alongside an improving picture on direct payment provision and work directly with the care market to develop a new commissioning approach for specialist care.

The North Yorkshire Substance Use Strategy 2024–2028 acknowledged a gap in drug and alcohol services, particularly in areas such as Scarborough where alcohol-specific death rates were high and treatment access was limited. Guided by JSNA data, the strategy responded by prioritising prevention, improving access to tailored support, and tackling drug supply chains. It committed to market shaping activity which targeted unmet demand and at-risk groups, including commissioning flexible, person-centred services and promoting co-production with people with lived experience. The strategy also drove integration across public health, housing, social care and criminal justice to build a more responsive and inclusive support system.

North Yorkshire Council recently became the lead commissioner for the community equipment service which was a large, complex system involving 17 prescribing organisations and 8 NHS trusts, including hospices, specialist hospitals, and children’s services. Over 110 prescribing teams were involved. One key challenge was the financial pressure on care homes, especially around bariatric equipment, which was costly and rarely reused. In response, the local authority began co-producing guidance with community nurses, providers, and the Care Home Strategy Group to ensure fair access to equipment across all areas. Early plans were also being explored for an equipment library model to reduce waste and cost.

There was specific consideration for the provision of services to meet the needs of unpaid carers. The local authority had made several commitments to unpaid carers within its commissioning strategies, recognising their vital role in the care system. The local authority commissioned dedicated carers support services, including advice, emotional support, and carers’ breaks designed to promote carers’ wellbeing and help them sustain their caring role. These services were recommissioned in 2022 with a focus on outcomes, co-production, and long-term sustainability. Data from the Survey of Adult Carers in England showed 23.98% of carers accessed support or services which allowed them to take a break from caring for more than 24 hours. This was better than the England average of 16.14%.

The local authority also embedded carers’ needs into its Market Position Statement and Strategic Market Development Plan, identifying carers as a priority group. This included commitments to improve identification, access to information, and support for carers to maintain employment and wellbeing. The strategy acknowledged the importance of respite, financial advice, and contingency planning, and promoted the use of Carers Emergency Cards and direct payments to offer flexibility.

In line with Care Act duties, the local authority ensured carers were involved in shaping services through consultation, forums, and co-production, and were committed to refreshing the Carers Strategy to reflect lived experience and changing needs. These actions supported the development of a more equitable, responsive care market which valued unpaid carers as partners in care.

A voluntary sector partner organisation told us they worked together with the local authority to improve and broaden the understanding of unpaid carers in the area, particularly to build awareness of young adult carers. The partner told us they had the opportunity to be involved in the tender process for this with the local authority and felt this was a good example of co-production work.

Partners, staff and leaders across North Yorkshire recognised that adult social care services were not always consistent in timing, location or delivery. This shared understanding led to targeted efforts to improve access and quality, particularly in areas where people’s needs were not being met. The ongoing work focused on identifying service gaps, strengthening local provision, and ensuring that care and support were more responsive, equitable and person centred.

Data provided by the local authority in April 2025 showed there were 9 people waiting for a home care package with an average waiting time of 41 days. There were 3 people waiting for residential care, with an average waiting time of 91 days and 1 person waiting for nursing care with an average waiting time of 33 days. Leaders told us the 91-day average wait for residential care equated to 3 people with complex needs. By May 2025, these were all resolved. In May 2025, there were 4 people waiting for a care package. Three people had been waiting between 0-14 days, and 1 person had been waiting 2-3 months due to a complex situation.

Dementia care was a growing pressure. While there were many care homes across the county, there was a shift away from commissioning standard residential care toward services specialising in moderate to advanced dementia and frailty. The local authority had begun planning new specialist in-house and commissioned provision to address the growing pressures, starting with new Care and Support Hubs to be built in Harrogate and Scarborough.

Although the local authority had an ambitious plan to increase affordable housing stock to 40%, a partner felt the transition to a new unitary structure brought practical challenges, as delivering on these aims required coordination across services and careful planning to ensure housing supply met rising demand. To tackle these challenges, the local authority sought to bring services together through a single front door and assessment pathway for supported housing replacing the patchwork of legacy systems. This aimed to ensure more equitable access to services and better alignment of housing resources with local needs. One partner told us about a barrier for the people they supported was the limited availability of housing stock in the area. The shortage significantly disrupted people’s housing journeys, often causing setbacks as they aimed to move from emergency accommodation to hostels, managed flats, and, ideally, into permanent housing.

We also heard examples of the positive impact of targeted support. A notable success involved a person overcoming drug misuse, securing stable housing, and being reunited with their children, demonstrating the transformative impact of structured support. Staff told us an increase in crisis housing would support them to coordinate timelier discharges from hospitals, preventing homelessness for vulnerable people. Another example of specialist provision helping to meet a vital need was a service commissioned to provide support for domestic abuse and sexual violence. The service received over 1,000 referrals each week, with about half coming from the police. A long-term commissioning arrangement, with the option to extend gave the service stability to plan and improve delivery.

While concerns were raised from a partner about fragility in the home care market, particularly around Harrogate, resulting in perceived delays to hospital discharge and pressure on bed availability, the data shows that such delays were limited and often linked to complex individual needs rather than systemic failure. Leaders in the local authority reported most discharges proceeded without requiring social care input, with only about 20% needing such support, and an escalation process was in place but had not been triggered. In June 2025, of the 13 patients delayed over 14 days, only two were affected by market-related issues, both of whom were self-funding and declined available options. Despite the geography of North Yorkshire presenting challenges, overall discharge rates remained steady, averaging 24 per day in May 2025, suggesting that system resilience was maintained in most cases.

Leaders also provided data which showed the Harrogate and Rural Alliance area had the most pathway 2 discharges across all 5 localities and were the highest achieving in terms of discharge times for pathways 2 and 3. In Harrogate, only 1 older person’s residential care home had closed in the last 3 years and had since reopened under a new owner. Three care homes specialising in support for working-age adults had closed since 2023. Harrogate had the highest number of care homes across localities in North Yorkshire and there were 14 commissioned intermediate care beds. Data provided by the local authority showed in 2024/25, care home occupancy averaged 86%, with 57% of people returning home following an average stay of 24 days.

The local authority’s Brokerage team worked to match care packages with vacancies and wherever possible respected people’s preferences. For example, enabling a husband and wife to remain together in the same care home. However, limited availability in some areas, such as Whitby, reduced options and led to more people entering residential care, even when extra-care or supported living would have better met their needs. The lack of supported housing for people with disabilities, mental health conditions, and experiences of abuse was also identified by staff as a priority gap.

The local authority used services in places outside of North Yorkshire. However, there were plans in place to increase the capacity of specific services so people could move back if they wished to do so in the future, and some provision had recently been increased. Many placements were within a short radius of the North Yorkshire border, with neighbouring local authorities hosting placements. Leaders told us, these placements were often closer to family members and the community. Where services were commissioned jointly with other agencies, there were clear roles and accountabilities for monitoring the quality of the services being provided and the outcomes for the people using them.

Data provided by the local authority showed a total of 590 people living in placements out of the county, 93 of those had a service which started in the past 12 months, with the primary support reason being physical need (54%) and the placement type was residential care. Young people with higher support needs, requiring 24-hour care, often faced challenges in securing suitable placements beyond supported living. Out-of-county placements were sometimes necessary due to service gaps locally. Leaders and staff followed a strict protocol which fostered ethical decision-making for out-of-county arrangements. It promoted the Best Interest’s framework in conjunction with the Mental Capacity Act, and the need to support contact with family members for accessible and personalised care.

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.

An integrated Quality Team working closely with health partners acted as a single point of contact for providers, supported by regular joint visits and a clear risk-based assurance process. Weekly multi-agency meetings were held to assess provider performance and determine levels of contact based on risk. Each approved provider was reviewed, given a risk rating, and assessed through structured tools which aligned with the Care Quality Commission (CQC) and national quality frameworks. When concerns were identified, for example in out-of-area placements, the team liaised with host authorities and recommended contract suspensions, supported by time-bound intervention plans involving clinical professionals where necessary. These plans were closely monitored, allowing phased reinstatement when improvements were embedded.

Quality officers were aligned to specific locality teams, helping to build trust with frontline staff and respond swiftly to concerns. The team maintained positive working relationships with their colleagues and used feedback tools like the ‘PERSON Form’ to gather intelligence from service visits. Their focus remained on helping services to improve rather than close. One example highlighted their quick action following a sudden drop in standards at a care home. The team responded immediately, engaged with the interim manager, and supported the home to make lasting changes, leading to a “Good” CQC rating and national recognition for their Principal Nurse. Feedback was actively sought from people using services and their families through on-site visits, care reviews, and visible engagement tools. The team’s proactive, person-centred approach had earned them national recognition for supporting vulnerable people and enabling providers to improve and remain sustainable.

The local authority had a good provision of CQC registered adult social care services. This included home care, residential care, nursing care, and supported living services. Overall, 75.73% of those services were rated Good, and 4.75% rated Outstanding, meaning they were safe, effective, and provided a high-quality standard of care, which met people’s needs. A key success for the Quality Team was that of the 40 providers they supported in their first year of inception, 11 providers (28%) achieved an improvement in their CQC ratings from Inadequate and Requiring Improvement to Good, promoting market sustainability.

The Market Development Team had a close partnership with the integrated Quality Team to address concerns such as workforce challenges, financial risks, and service hand-backs. By tracking trends and delivering targeted interventions, they helped reduce provider suspensions and service failures. The Market Development Team consisted of 12 members, each responsible for different parts of the county and/or market sectors but working collaboratively across the council area. They offered one-to-one provider surgeries to address issues ranging from contractual queries to financial stability, acting as a “critical friend” and key contact point. Insights on provider performance and market dynamics were captured in a Market Share Report to support strategic planning around sustainability and service gaps. In response to the sector’s feedback, they had also begun rolling out dementia training through a train-the-trainer model and were developing a new bespoke contract to better support specialist care outside the current approved provider framework.

A partner highlighted the local authority’s positive working relationship with the CQC, with monthly meetings in place. They told us risks were well managed, and the Quality Team acted quickly and appropriately to prevent issues from escalating, using the necessary resources. A monthly CQC Strategic meeting, chaired by the local authority’s Assistant Director and attended by the Integrated Care Board, followed a set agenda. Topics included system pressures, updates on provider suspensions, and learning from incidents. There had recently been a focus on overseas recruitment, particularly where providers employed large numbers of international staff and risk assessments were planned in the event of changes to the rules about their employment.

Overall, partners felt there had been strong quality oversight, and the right support was in place for both people and providers. An NHS partner said the Integrated Quality Team had effectively supported struggling care providers. This helped prevent care home closures and kept beds available for their patients.

Data provided by the local authority dated February 2025 showed a total of 27 providers were in the stage of suspension or a phased uplift with key themes for suspensions including poor record keeping, late calls, and omitted medication calls.

The local authority provided wide-ranging support to help sustain and develop the local care market. It worked closely with the Independent Care Group (ICG), which represented providers and played a key role in shaping transformation and sustainability plans. The ICG also ran regular engagement events. To keep providers informed and connected, the local authority and the ICB hosted ‘Care Connected’, an online forum which enabled updates, questions, and sharing of good practice. High attendance and strong feedback showed it was well received.

The local authority collaborated with care providers to ensure the cost of care was transparent and fair, while striving to support the long-term sustainability of services. The Care Market Financial Sustainability Policy, March 2024 outlined how the local authority supported care providers facing financial challenges, including their approach to inflationary uplifts, risk-based assessments, and potential financial interventions. It also recognised sustainability extended beyond funding; it could also involve support with workforce pressures, training needs, or business model viability. When providers raised concerns, such as increased National Insurance Contributions or the impact of recruiting international staff, the local authority offered tailored support in response.

To strengthen service delivery and manage costs more effectively, the local authority had created a new contract management team. This team focused on building positive relationships with providers while improving contract governance and generated efficiencies through negotiations, issue resolution, and managing disputes. Governance arrangements were being strengthened to ensure a balanced approach between market sustainability and value for money.

In advance of its 2023–2024 Market Sustainability Plan, the local authority applied an ‘actual cost of care’ model to establish fair pricing for placements, ensuring fees reflected the real costs of delivering care. This approach was used alongside the Approved Provider List, which set quality and cost benchmarks for contracted providers. Despite these measures, around 75% of care homes charged fees above the calculated market rate, creating concerns about long-term financial sustainability and affordability. In response, the authority engaged in constructive dialogue with an independent care provider network, to explore collaborative, long-term solutions and support a stable, high-quality market.

Strategic efforts were also underway to develop the social care workforce, such as better use of data and case studies to shape future commissioning decisions. Challenges were identified in supporting young people who required personal assistants for independence and skill development. Some areas faced difficulties in providing tailored support, prompting trials in certain parts of North Yorkshire to increase pay rates for personal assistants and attract more staff to these roles.

The rising cost of building new extra-care schemes posed a significant challenge. Although Homes England had increased funding, a notable shortfall remained, requiring the local authority to contribute more. Additional barriers included limited access to suitable development sites and potential workforce shortages. Despite this, the local authority worked to make new schemes more community-facing, designing spaces with cafés and shared areas to encourage integration into community life and improve use of local authority-owned land.

Partners gave mixed feedback on the local authority’s contracting approach and its impact on service stability and forward planning. One voluntary sector partner said they welcomed the rare award of a 10-year contract, which allowed them to invest in long-term development. In contrast, another partner highlighted sustainability as a key challenge, noting their short-term funding made it difficult to maintain and grow their relatively new service.

Feedback from staff and care providers confirmed the local authority worked with providers and partners 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 in this event.

The provider failure policy outlined the local authority’s response to situations in which a care provider either failed or was at risk of failing. The policy aimed to protect people receiving care by ensuring continuity and safeguarding their well-being. It also promoted a coordinated, multi-agency approach involving health services, regulatory bodies, and other relevant partners. The local authority acted quickly and proportionately in response to failures which stemmed from financial instability, operational issues, or concerns over care quality. A key factor was the Risk Notification Return system, which enabled providers to report incidents that might indicate organisational instability, including missed visits, medication errors, or environmental concerns. These reports supported the Quality Team in monitoring risks and taking early, preventive action. In the event of a provider failure, the local authority assumed responsibility for ensuring continued care for all affected people, including those who privately funded their care. Clear communication with people and their families was prioritised, and lessons from each incident were used to strengthen future responses.

Data provided by the local authority showed throughout 2024 there were 4 care home failures affecting 23 people and 10 home care provider failures affecting 395 in their homes. Two day services had also been reported as a provider failure affecting 27 people. The reasons for failures were linked to consolidation of locations, financial viability, and the revocation of sponsorship licences. Leaders told us a notable development had been the creation of the integrated Quality Team to prevent market failure and promote quality of care and stability. To promote further sustainability, the local authority had introduced a Care Market Financial Sustainability Policy to provide financial support to providers.

The local authority understood its current and future social care workforce needs. It worked with care providers, including personal assistants and other agencies, to maintain and support capacity and capability. The Market Development Team worked in partnership with the workforce lead to support local recruitment initiatives and developed international workforce strategies where needed. For example, a pilot project in Whitby focused on building a place-based workforce model in partnership with home care providers and in-house teams, using packages shared between providers to improve flexibility and partnership working.

North Yorkshire Council have a vacancy rate ranged between 5% and 7% with a turnover rate of 5.3%. The local authority leaders recognised the significant impact of rural geography and competition from health partners. Lower pay rates in the independent sector (compared to local authority roles) further challenged recruitment in the independent sector. To address these issues, leaders focused on initiatives such as promoting social care careers in schools and colleges, maintaining a capacity tracker to monitor workforce capacity in individual services, and implementing targeted interventions.

The Yorkshire and Humber area secured funding in 2024 from the Department of Health and Social Care as part of a government initiative to provide support to displaced workers. North Yorkshire played a key role in regional efforts to strengthen workforce resilience through the Yorkshire and Humber regional international recruitment Hub which focused on helping displaced workers find suitable placements within the Adult Social Care sector. It aimed to ensure ethical and sustainable recruitment, connecting care providers with qualified people already in the United Kingdom who needed sponsorship. The hub provided support to care providers, including bursaries and training to enhance their capacity to recruit and support international workers. In cases where providers had their sponsorship licences suspended, local authority staff recognised affected overseas workers as potentially vulnerable people, working with the police to investigate well-being concerns such as modern slavery.

The local authority told us the ‘Make Care Matter’ campaign had supported around 400 providers through advertising, roadshows, and emergency responses, and had successfully placed 73 young people into care roles via a Prince’s Trust programme. It also contributed to international recruitment efforts by introducing a Graduate International Recruitment Officer and supporting care providers navigating sponsorship challenges. The local authority told us ‘Make Care Matter’ helped bridge workforce gaps, expand pathways into care roles, and strengthened the local authority’s capacity to respond to sector pressures. Additionally, the local authority's HR lead directed initiatives to support international recruitment, including free English language courses to address language barriers in home care. A partner representing providers praised the local authority’s efforts in training, recruitment, and business continuity, particularly the effectiveness of collaborative work between the ‘Make Care Matter’ team and the regional recruitment hub.