Community Services – Day Opportunities
Last Updated: 30 April 2024
Where are we now
Day opportunities are an essential part of the health and social care landscape, providing support to local people of both working age and beyond.
Services work with people, many of whom may be vulnerable through age, frailty or disability, providing social contact and activities during the day. Such services can improve health and wellbeing, helping people to stay independent for as long as possible.
Service models vary – from ones where the services take place within a building to those where the focus is upon helping people to access community facilities. Services may have a focus upon leisure or be more structured and, for example for younger adults, be based upon gaining skills which might lead to accessing or a return to education and training and also employment.
Currently, Sutton applies a ‘lighter touch’ to day opportunities which, rather than entering into a series of contracts, supports people to make their own choices over where and how their care and support might best be met. To this end, we are encouraging individuals and their families to use our Sutton Information Hub where they can view local services provided by service providers registered with the hub, to see what the service offers. We are also encouraging service providers (and those who may be thinking of providing day opportunities) to explore the hub and where appropriate, register.
Whilst traditionally people may have attended day services for a full week, people are increasingly selective over days or sessions attended, perhaps complementing other services and or activities.
Sutton supports individuals to access day opportunities in two ways; either through Sutton paying a provider directly for the service or via a direct payment paid to an individual to make their own arrangements. Direct payments are payments made to individuals who have been assessed as needing help, and who would like to arrange and pay for their own care and support services. Individuals receiving direct payments can choose to mix the services they buy and can opt to increase or decrease use/frequency of services in line with what they decide best meets their needs.
The cost of day opportunities are variable, depending upon the services provided, the intensity of support that may be required and the business model applied, including, for example, where other services provided contribute to service overheads. For individuals with a direct payment, comparative costs along with factors such as quality, activities offered etc. will be a factor in decision making to use a particular service. As at February 2024, the approximate total weekly cost of day opportunities to Sutton was £64,850 of which approximately £31,930 was spot purchased by the Council on behalf of clients and £32,920 to individuals via direct payments (including any related DP transport costs).
Our Day Opportunities Market
Currently, Sutton supports 306 people to access day services, 134 are using services for which Sutton pays the service provider directly and 155 are in receipt of a direct payment with a day service element. The remaining 17 individuals access more than one service paid as a combination of both.
Diagram 1: Service Users Age and Gender
Source: Adult Social Care Sutton (February 2024)
Of the 306 individuals accessing day services either spot contracted by the Council or via direct payments, 171 (55.9%) are male and 135 (44.1%) are female. There are 77 individuals aged 18-25, of whom 58 are male and 19 are female; 108 aged 26-49, of whom 69 are male and 39 are female; 26 aged 50-64, of whom 12 male and 14 female, 30 aged 65-74 of which 15 male and 15 female and 65 individuals over the age of 75, of which 17 male and 48 female.
As part of the adult social care assessment process, individuals who are identified as having an eligible need for ongoing care and support have their ‘primary support reason’ identified and recorded. Individuals may have a number of identified needs, however a primary reason for support will always be identified.
Diagram 2: Service Users Primary Support Reason
Source: Adult Social Care Sutton (February 2024)
Learning Disability Support is the recorded primary support reason for 204 (66.7%) of individuals, followed by Physical Support for 58 (18.9%), Support with Memory & Cognition for 21 (6.8%), and Mental Health Support for 12 (3.9%). Other primary support reasons include Sensory Support and Social Support.
Diagram 3: Day Services Types of Funding
Source: Adult Social Care Sutton (February 2024)
Currently Sutton supports 306 people to use day opportunity services, 134 individuals (43.8%) are using day services paid by Sutton to the Service Providers, 155 (50.7%) are in receipt of a direct payment and 17 individuals (5.6%) have opted for a combination of both.
The graphs below show that those individuals whose day support is paid directly to the provider are generally older and more likely to be female than those who are receiving a direct payment who tend to be younger and male.
Diagram 4: Age and gender of individuals accessing day services paid by the Council to the Service Provider
Source: Adult Social Care Sutton (February 2024)
Of the 134 individuals whose day services are paid by the Council to the Service Providers directly, overall, just over 50% are female. When we compare the two age groups of under 50 and over 50, the majority of the individuals in the younger group are male whereas in the older group are female.
Diagram 5: Age and Gender of Individuals Receiving a Direct Payment with Day Service Element Recorded
Source: Adult Social Care Sutton (February 2024)
Of the 155 individuals receiving a Direct Payment, 94 (60.5%) are male and 61 (39.5%) are female. When comparing age groups, the 118 individuals aged 50 or below, are predominantly male, whereas of the 37 individuals over the age of 50 the majority is female.
Diagram 6: Primary Support Reason of Individuals Receiving Day Support Paid Directly to Provider by the Council
Source: Adult Social Care Sutton (February 2024)
Of the 134 individuals accessing day services paid by Sutton Council to the Service Providers directly, 73 (54.5%) have Learning disability recorded as the Primary Support Reason (PSR), 32 (23.9%) Physical Disability and 12 (9%) Memory and cognition. Among the remaining 17 individuals, other PSR include Mental Health and Sensory Impairment.
Diagram 7: Primary Support Reason of Individuals Receiving a Direct Payment with Day Service Element Recorded
Source: Adult Social Care Sutton (February 2024)
Of the 155 people receiving Direct Payments, Learning Disability is the recorded Primary Support Reason (PSR) for 116 individuals (74.8%), followed by Physical Support for 25 individuals (16.1%). 14 individuals are recorded as having “Other” PSRs including Mental Health, Sensory Impairment and Memory & Cognition impairments.
Where we want to be
We would like to see a variety of accessible, affordable services as close as possible to where people live. The services should offer quality and person centred support that avoids a ‘one size fits all’ approach but is as far as possible tailored to individual needs, helping people achieve greater independence, choice and improved wellbeing.
Services should promote greater inclusion and participation with an expectation that people will be actively supported to be part of their communities, having access to community based resources and everyday services such as support to use local leisure centres, cafes etc. and to utilise their own skills to choose their own day opportunities.
The Council intends to develop an overarching Prevention Strategy which will include a review of how day opportunities are commissioned in order to understand and promote a consistent range of services.
Challenges and Market Influencers
Marked increases in costs of living have in turn affected the costs of services. Against this background, pressures on the Council to manage spend carefully at a time of great uncertainty, it is evident that providers will be required to seek a range of funding solutions including the efficient use of resources as well as creative staffing recruitment strategies.
The move to a more person centred approach to services does pose some challenges to a more traditional model of services, balancing group activity with individualised opportunities within our community. This requires greater flexibility in the deployment of staffing and increased knowledge of and co-ordination and working with community based resources.
With day opportunities being based increasingly upon individual decision making and choice, day services are experiencing demand from a collection of individuals choosing to purchase their services, rather than, for example, the Council commissioning a set number of places for a given period. This means that attendance and income for day opportunities providers can be variable.
The current approach of spot purchasing services, for those clients not receiving a direct payment, in an ad hoc manner has led to a discrepancy of costs for comparable services and a lack of consistency. Over the next year, the Council intends to explore a new model for commissioning day opportunities in a way which continues to promote individual choice whilst providing greater commissioning oversight.
Need and Demand
Demand is seen in particular areas and is noticeable in younger adults wishing to access more active services which provide choice with the ability to undertake activities with those with similar interests.
Our Joint Strategic Needs Analysis tells us that the population of the borough is growing. Between 2011 and 2021 we saw an increase of 9.6%. A higher proportion of Sutton’s population are under the age of 18 than the London and England average with growth among school age children being particularly high. The proportion of Sutton’s children with an Education, Health and Care Plan has increased to 4.7%
It also tells us that Sutton has an older population than the London average, with adults aged 65 and over making up 15.2% of the population. Between 2011 and 2021 we saw an increase of 16.8% in this age group. Projections show that over 65s will be the fastest growing age group in Sutton this decade, with an 23.8% increase in population amongst adults aged 85+ between 2027 and 2032.
The borough profile indicates the continued and growing need for day opportunities for young and older adults. We are therefore keen to promote services which are attractive to people who will require day opportunities, many of whom may be making their own decisions about how and where their care and support needs might be met. This provides both a challenge and an opportunity to the market.