Coventry City Council’s commissioning approach to equity in access to Adult Social Care - Print version

Adult Social Care commissioning for equity means ensuring that services are thoughtfully planned, purchased, and monitored to promote fairness, diversity, and inclusion. This involves addressing the unique needs of various communities and individuals, including those from marginalised groups, to ensure that everyone has equitable access to the care and support they need.

1. Needs assessment: understanding the diverse needs of the population including those of disabled people, older adults, and those from minority ethnic communities.

Coventry’s approach

Assessing needs is crucial in shaping our commissioning strategy. We rely on national data sources such as Census data, Projecting Older People Population Information (POPPI), and Projecting Adult Needs and Service Information (PANSI), as well as local data through the Joint Strategic Needs Analysis (JSNA). Local service uptake analysis is also conducted. This intelligence on needs includes information about Coventry's diverse communities. The results of these efforts are used to inform key documents like the Council’s recently published Market Position Statement, the Market Sustainability Plan, Market Development Plans, and service specifications.

Strengths and opportunities 

The Council can leverage the developing Population Health Management Needs analysis to inform commissioning based on the Coventry and Warwickshire Population Health Management Roadmap. Population Health Management (PHM) seeks to enhance population health through data-driven planning and proactive care delivery. It employs analytical tools such as segmentation, risk stratification, and impactability modelling to identify local 'at risk' groups. Multi-disciplinary teams then use these insights to design targeted activities aimed at preventing ill-health, improving health outcomes, and promoting equity.

Coventry celebrates its diversity of communities as a significant strength and is dedicated to continually understanding and addressing the evolving needs of newer communities.

There is clear evidence of increasing demand due to factors such as an ageing population, health disparities by locality (including life expectancy and healthy life expectancy), and the growing numbers of individuals living longer with significant learning disabilities, autism/neurodiversity, and rising mental health issues. These elements drive the need for adult social care services that are tailored to meet specific requirements. Insights into these needs and demands are integrated into the Council’s Market Position Statement.

• Overall over-representation of the White group and underrepresentation of all other ethnic minorities in all ages
• 18-64 cohort sees a convergence with census figures
• However, for those ages 65+ the service user cohort is more closely aligned with the city as a whole

Currently uptake of Coventry City Council adult social care services from ethnically diverse groups broadly reflects our 65 + population as reported in the 2021 population census.

For the 18-64 age group representation is improving over time and we are proactively addressing this through various initiatives, including engaging with the Council’s Diversity and Inclusion Board, developing a more diverse market, and fostering stronger connections with a range of faith and community groups across the city, especially through the Member-led multi-Faith Forum. Adult Social Care regularly organises engagement events at venues accessible to local communities and continues to connect with individuals from diverse backgrounds to link them to appropriate support options. New contracts with voluntary sector organizations will require strong formal or informal links to groups representative of Coventry's diverse communities, promoting the use of services by everyone who can benefit.

Through our commissioning activities, we are actively taking steps to reduce disparities and work towards equitable service delivery that reflects our city's demographics.

For direct payments where there is an overrepresentation of minority ethnic service users. One hypothesis is that these citizens are not confident that mainstream services would cater for their cultural needs to an acceptable standard. The Council plans to test out this hypothesis through peer group sessions with minority ethnic service users with the aim of obtaining and applying learning going forward.      

Ethnicity of Direct Payments recipients

2. Co-production: involving service users and communities in the planning and decisions making processes to ensure services are designed with their input and meet their needs.

Adult Social Care has succeeded in developing a thorough approach to Coproduction , contributing significantly to the creation of the West Midlands ADASS Day Opportunities Coproduction Resource Pack. 

The Council’s Dementia Hub, launched in July 2023, stands as a shining example of co-produced support, crafted with invaluable input from individuals with lived experiences and their families. Their collaborative efforts have ensured improved, equitable access to this highly esteemed service.

Our Carers Plan and the subsequent recommissioning of carers support services have been shaped through dedicated engagement with family carers. Their valuable feedback has not only shaped the Plan but is actively informing the development of the contract specifications.

The recommissioning of long-term home support has been driven by comprehensive engagement with service users, families, and providers. This process has actively sought perspectives on how to best meet the needs of our diverse communities, including those with mental health issues, learning disabilities and/or autism, as well as individuals with physical disabilities.

Strengths and opportunities 

The Council has an array of channels for gathering stakeholder feedback to inform its commissioning processes, from real-time surveys to bespoke engagement activities and the analysis of compliments, complaints, and representations.

Though challenges exist in consistently engaging all community sections and ensuring the voices of lesser-heard stakeholders are heard and acted upon, staff capacity remains a crucial factor, these activities highlight the Council's dedication to inclusivity and comprehensive engagement.

3. Equality Impact Assessments: Evaluating the potential of commissioning decisions on diverse groups to identify and mitigate and negative impacts.

Coventry’s approach

All commissioning/recommissioning activity and quality assurance policy/procedure is accompanied by Equality Impact Assessments. Our Equality Impact Assessments consider three main themes:

• impact of implementation of decisions on people with protected characteristics,
• health inequality impacts,
• impact of digital exclusion.

Strengths and opportunities 

The Council's well-developed equalities team plays a pivotal role in supporting these activities, ensuring that training and development in equalities and EIAs are effectively delivered. Adult Social Care enhances corporate initiatives through various activities, including the widely available Social Graces training.

While data availability has seen significant improvements, there remains an opportunity to develop evidence in specific areas such as gender and sexual orientation. Additionally, there is potential to enhance data relating to intersectionality, such as ethnicity and disability.

4. Inclusive Procurement: Ensuring that the procurement process encourages a diverse range of providers, including smaller and community-based organisations.

Coventry’s approach

The Council has redesigned its procurement processes to better enable smaller organisations to bid for contracts. Subcontracting is considered which can enable smaller, more bespoke providers to be involved in delivery. Where feasible tenders are broken down into lots to enable smaller organisations to bid.

There are three key objectives in the Council’s Workforce Diversity and Inclusion Strategy:

1.  Provide support for Micro, Small and Medium Enterprises (SMEs) in your communities to navigate Council procurement processes.
2. Monitors spend/contracts with Micro, Small and Medium Enterprises (SMEs), targeting a year-on-year increase where possible.
3. Encourage suppliers to monitor their workforce diversity.

Strengths and opportunities 

The Council has numerous recommissioning activities that provide ample opportunities for smaller businesses to compete for contracts. SMEs and microenterprises often align with the Council's values of community presence and social value. Through the re-commissioning of Long-Term Home Support, we aim to foster relationships between main providers and smaller providers, for example through subcontracting or creation of consortia, to deliver services that cater to diverse needs more effectively.

Smaller providers can adeptly deliver services with smaller budgets due to lower overheads and greater local control, even in a financially challenging climate. We have levelled up the playing field by offering all organisations support from our Community Resilience team in applying for funding. This support grants smaller organisations access to local data, information, and bid writing expertise, which may be limited in some cases.

An exemplary initiative of commissioning diversity is the preventative support for people with mental ill health. The Council and ICB have commissioned the Wellbeing for Coventry Consortium, comprising Coventry and Warwickshire Mind, Sahil, and Tamarind. This includes support for people from Black and South Asian communities.

5. Contracts and service specifications

Coventry’s approach

Adult Social Care makes best endeavours to ensure that contractors are clear what expectations are in relation to equity of service delivery. This is evident in service specifications and tender evaluations.

Some examples of this:

Example one – Dementia Specialist Support Service

The Dementia Specialist Support Service specification includes the following:

Objective 11 – Equality, diversity, and inclusion in dementia care – the provider must be aware that dementia will affect people from all cultural and ethnic backgrounds. Issues of cultural and ethnic diversity may have an impact on how people experience dementia, including acceptance of the condition within their family or community. The Provider must also be aware that many of the characteristics covered in the Equality Act and wider health issues can have a significant bearing on experiences of dementia, including but not limited to a person’s sexuality, disabilities, gender, geographical location etc.

The Provider shall have in place an Equal Opportunities Policy for the recruitment, development, and care of the workforce (including volunteers).

The Provider will ensure they demonstrate a culture which values and respects all members of staff, enabling them to give a high standard of support to all service users.

Example two - Home support service

The service specification includes the following:

The Commissioner requires the Provider to build a local delivery capacity with the skills and experience necessary to respond to the wide diversity of specialist needs and preferences.

Coventry’s population is diverse in terms of ethnicity, faith, culture, and language. The Provider will demonstrate equality in all aspects of its practice and have clear policies and procedures in place. The Provider is required to develop a diverse workforce and to be part of networks that promote sensitive and appropriate service delivery and shall give due consideration to the service user’s gender, sexual orientation, religious persuasion, racial origin, cultural and linguistic background.

Example three – Communicator Guide

The tender included the following questions:

Please provide details of the experience your organisation has in delivering the services detailed in the specification, covering the following elements:

Your approach to improving outcomes and maximising independence for individuals, please provide one case study as an example/evidence of how you achieve this.

Through service delivery, how your organisation:

1. enables and ensures equal access to opportunities (as requested by the individual) and access to community services, promoting the person’s right to access services and support

2. reduces isolation, confusion and challenges within the community based on service users’ individual needs

3. enables people to have choice and control over their lives

4. please provide evidence of your organisation’s ability to work with a wide range of service user groups, cultures, and ethnicities, ensuring that approaches are tailored and respectful of the unique requirements of the individual service user. Please provide an example and/or case study

Example four – Learning Disabilities and/or Autism

As a response to a limited respite offer in the City, a new respite provision is under development with Lifepath Trust, comprising of nine beds. The scope is to be expanded to include those presenting with more challenging behaviours and physical disabilities:

•      en-suite facilities for each room, providing privacy and comfort for service users

•      dedicated parking, which the current facility at Ellys Road currently lacks, improving accessibility for families and staff

•      a sensory room within the garden to support the needs of those with sensory processing requirements and provide a calm space if needed

The unit rates will align to current respite provision, estimated time for completion at some point during 2025 (awaiting confirmation).

To improve access to day opportunities for people with learning disabilities, the Council have worked with Fitzroy, a charitable organisation to develop a scheme which the provider has promoted with operational teams, improving uptake offering people with disabilities meaningful daytime activities and enabling carers to continue caring, thereby avoiding situations slipping into crisis and breakdown.

Kings’ Hill nursery, run by Life Path Trust, another charitable organisation in the city, is developing their café enterprise such that they will reach a position to offer paid employment for people with a learning disability thus helping to reduce inequality in access to paid work in the city.

Example 5 – Carers' Identification Projects – (Carer's Wellbeing Services)

Throughout Coventry, we have commissioned a number of Carer Identification campaigns to help people with caring responsibilities recognise their caring status and gain support.  We have taken two approaches, one of targeting communities where there is underrepresentation and secondly working with areas like healthcare where we are likely to engage with people from all backgrounds and are more likely to receive support. This includes:

• 2 equality and diversity workers
• hospital liaison
• GP Carer Liaison Officer
• Mental Health Carer Liaison Officer
• working carer's worker

The Carers' Trust Heart of England has also targeted areas of Coventry where there is known deprivation and communities where there might be identifiable support needs such as social supermarkets, food hubs and community hubs.  In the last year, there has been a wider presence in family hubs.  The projects have targeted specific areas, such as supporting the LGBTQ+ communities, working with specific communities such as the Caribbean Centre and working in areas such as Foleshill, where we know there is a diverse population.     

Part of the approach has been filming videos from Carers in their own languages to support identification within the city. 

All of projects aim to aid identification of carers in places that they are more likely to access support.  Research and evidence tell us that many carers only access their GP surgery for support very often for the person they are caring for. The GP liaison worker has engaged with all 60 GP surgeries over the last year, with 50% engaged with improving carer identification and further work identified to work with those who are yet to sign up. 

Strengths and opportunities 

There are numerous opportunities resulting from periodic recommissioning activities, where we ensure that equity is integral to the requirements. These opportunities include various commissioning and procurement exercises:

• long-term home support: Recommissioning commencing Autumn 2025.
• Housing with Care: Recommissioning, including renegotiation of contracts in Spring 2025.
• Money Management Support Service: Appointeeships and cash collection, with the next commissioning exercise in March 2027.
• Direct Payment and Money Management Services: Next recommissioning exercise in March 2028.
• Supported Living and Day Opportunities Framework: Negotiation using the Care Fund Calculator for supported living and agreed rates for Day Opportunities, with the next tendering exercise scheduled for 2026.
• Coventry and Warwickshire Community Integrated Support Services: next tendering exercise scheduled for March 2027.
• Residential Care Contracts: Across Learning Disability, Autism, and Mental Health, with tendering exercise scheduled for 2026.

While these opportunities are promising, they come with challenges. Adding requirements must be balanced carefully to avoid placing undue resource burdens on providers, which could be reflected in their pricing.

6. Monitoring: Continually assessing the effectiveness of services in promoting equity and making necessary adjustments based on feedback and outcomes.

Coventry’s approach

Adult Social Care uses various mechanisms for assessing how equity is realised.

1. Service user feedback.

Coventry’s Adult Social Care Department actively engages in a variety of mechanisms to assess and promote equity. These efforts include gathering direct feedback from service users and their families through the Adult Social Care Experience survey, regular engagement events, specific surveys on safeguarding and Direct Payments, Stakeholder Reference Group and Partnership Board meetings, and various bespoke activities linked to commissioning exercises. Additionally, the department collects compliments, complaints, and representations routed through the Council, as well as information provided by service providers and made available to quality assurance staff.

Despite the absence of formal complaints indicating inequity in support over recent years, it is noteworthy that the uptake of Direct Payments is higher among non-white individuals. This suggests that there may be a perception, whether accurate in all cases or not, that minority ethnic service users feel that contracted or directly provided services may not fully meet their specific cultural needs.

Throughout the year we have hosted or attended targeted events within communities, attended faith forums and community partnerships to understand more about people’s experience of utilising adult social care and provider services.

2. Quality assurance

Our goal is to ensure that all providers undergo a comprehensive annual review of their service quality. This process includes evaluating evidence of policies and procedures that promote equity in practice and verifying that care is person-centered and addresses needs in a manner that upholds equity. Recently, our quality assurance processes have been refined to consistently capture evidence in a systematic way.

3. Structure of the workforce          

Adult Social Care aims to ensure that the workforce in the city reflects the diversity of the customer base. However, the latest data from Skills for Care (October 2024) indicates discrepancies in representation among Direct Care staff. Specifically, there is an overrepresentation of minority ethnic staff, particularly Black staff, in direct care roles (39%) compared to the percentage of service users (15.5%). Additionally, while 42% of our customer base is male, only 20% of direct care staff are male. Although this does not imply that gender and culturally specific needs are not met or not met in the optimum way, a more balanced representation may enhance experience of service delivery.

Demographics

Strengths and opportunities 

It is advantageous that we have access to comprehensive and annually updated data on workforce demographics through Skills for Care, allowing us to make informed comparisons with our customer base.

However, the disparity in certain staff characteristics highlights potential challenges in delivering personalized support. We lack detailed information on the full range of protected characteristics of staff, which would enable us to make necessary adjustments and promote inclusive service delivery, and this is an area we continue to focus on.

Summary/key actions

Coventry City Council is committed to embedding the principles of equity and responsiveness in adult social care services through its commissioning practices. While progress has been made, the following key actions are essential to further integrate equity into our commissioning and procurement processes.