In October 2023, our Chief Executive, Neil Blanchard, met with CEOs of five other local VCSE (Voluntary, Community and Social Enterprise) not-for-profit organisations that provide learning disability services across Sussex to discuss issues of common challenge and concern. Following the meeting, the group developed a ‘market position statement’ that has been shared with commissioners of services across Sussex outlining the current operating context and a set of recommendations to work towards resolving issues.

Market Position Statement 2024 for Learning Disability Services Across Sussex

About the Sussex Learning Disability VCSE CEO Group

In October 2023, CEOs of six local VCSE not-for-profit organisations that provide Learning Disability services across Sussex came together to discuss and campaign on issues of common challenge and concern. This was prompted by an appreciation that as we are all facing similar business risks, there is benefit in using peer support and learning to consider how we develop individual response strategies, but also the role that we can play to use our combined voice and expertise to highlight issues and lobby for the future sustainability and protection of local Learning Disability services.

Members have agreed to meet on a quarterly basis to develop strategic leadership representation and voice. The first agreed action is to develop this market position statement to share with
commissioners and stakeholders ahead of budget setting for 2024/25.

Current operating context

It will come as no surprise that the Sussex Learning Disability provider market is facing an increasingly challenging operating environment. This places significant risks on the sustainability of existing services, but equally, at a time of increasing system pressures, placement breakdowns and delayed discharges from hospitals, the local VCSE provider sector feels unable to respond to new opportunities with such current workforce and financial instability.

The Sussex Learning Disability VCSE Group identify the following issues of most concern:

1. Workforce costs – National Living Wage will increase from £10.42 to £11.44 (9.8%) from April 24. This follows a 9.68% increase from April 2023, hourly rates increasing by £1.94 over two years and a 26% increase over three years. Real Living Wage, often a better determinate of required salaries (and a requirement of BHCC supply chain) rose to £12 per hour from September 2023. Although increases are positive for frontline staff, fees will need to continue to rise to fully cover the increased costs. For 2023/24 this was achieved in West Sussex and East Sussex with average increases of 10%, but Brighton and Hove average fee increase was only 5%, creating many providers services to move into a marginal or deficit operating position.
2. Staff recruitment and retention – turnover rates for Sussex Learning Disability providers are currently c23% with this increasing to c35% in first year of service. To address this all providers have comprehensive workforce strategies in place with actions including increasing base salaries for 2023/24 up to £11.50, recruitment campaigns that promote care as a skilled and rewarding career, skill training and professional qualification programmes. Despite all efforts, workforce challenges remain the top risk for all providers. To cover vacancies, providers are forced to use agency staff at hourly costs of > £20.
3. Delays to referrals – the CEO group identified lengthy timescales to identifying, processing, and agreeing individual funding packages for new placements having a negative impact on financial sustainability through lost income to cover core operating costs. In addition, it is noted that there is an increase in complexity of need of referrals not always being able to be appropriately accommodated within existing service models or accepted by providers due to insufficient staffing resources.
4. Utility and Insurance cost inflation – many Sussex Learning Disability providers have been required to renew their utility tariffs over the past year, at a time of market instability and inflation. Southdown saw a 160% increase on their tariffs, and Guild Care a 100% increase in insurance.
5. Digital costs – as a new requirement of CQC for electronic care support and medication capabilities, providers are having to invest in new digital technologies and systems, which are increasingly central support costs.

Sussex providers are not alone in facing these challenges. As highlighted in the annual ‘Sector Pulse Check 2023’ report by Hft and Care England, the sector is in a perilous position:

• 84% of Learning Disability providers were either in deficit or experienced a decrease in their surplus.
• 92% of providers highlighted the annual increase in NLW as the most significant workforce-related cost pressure.
• 81% of providers report that fee increases did not cover the increasing cost of workforce pay.
• 60% reported utility cost inflation as a significant cost pressure, increasing by 500% for some providers (Southdown saw a 160% increase in 2022).
• A third of providers considered exiting the market in 2022, with 42% closing some services.
• Average vacancy rates of 21% requiring providers to increasingly rely on expensive agency staff.

Working constructively and collaboratively with partners to resolve issues.

As summarised, the Sussex Learning Disability VCSE sector is facing an ever complex and risky operating environment. All CEOs of local providers are very experienced business leaders with
decades of knowledge and personal relationships across the local sector and with statutory partners. We are all passionate and proud of the achievements of our respective organisations and the wider sector, committed to remain active and trusted Strategic Partners, helping to protect the future of Learning Disability services and continue to invest in meeting new priorities.

As peers, the CEO Group have agreed to expand our joint working and learning opportunities, looking to help shape and support ways of working that deliver improved value for money efficiencies and quality outcomes for the people we support. Initiatives that we are looking to progress include shared corporate services and systems, training, leadership coaching and procurement; as well as closer benchmarking of hourly rates and terms and conditions so we can better lobby for the longer-term protection of the sector.

Alongside our peer collaboration, we are also seeking to work constructively with Statutory Partners to openly discuss and resolve system issues that will help stabilise and grow the Learning Disability provider market offer. To initiate this new way of working, we request:

1. ‘Fair Fees for Fair Pay’ – Fee increases for 2024/23 to fully take account of the increase in operating costs and include an Equalities Impact Assessment, with a requirement of >10%.
2. For commissioners and stakeholders to use the Sussex Learning Disability VCSE CEO Group as a point of contact and engagement, using Systems Leadership approaches to work collaboratively to explore and develop plans to address system ‘wicked issues’.
3. For consideration of more sustainable and flexible commissioning models that are based on outcomes and look to appropriately share risks.
4. For the sustainability of the VCSE provider market to be considered as part of the research/recommendations from the ICS MHLDA Deep Dive currently underway and due to report in March 2024.
5. Clarity on transitional pathways between children and adult services.

Sussex Learning Disability VCSE CEO Group

• Sue Livett, CEO of Aldingbourne Trust
• Neil Blanchard, CEO of Southdown
• Alex Brooks-Johnson, CEO of GuildCare
• Eva Eriksson, CEO of Grace Eyre
• Sally Polanski, CEO of Amaze
• Maria Mills, CEO of Active Prospects