Our approach to commissioning is central to how we will deliver change.

National policy is clear that commissioning practice is one of the most powerful drivers of quality, workforce stability and system sustainability. In Herefordshire, we are therefore using commissioning deliberately as a tool to support prevention, independence, workforce sustainability and integration with health.

Our approach is focused on doing different things, not simply more of the same.

Our vision

We want services that help people build on their strengths, use community support, and live well at every stage of life.

Support should:

• Promote independence rather than dependency
• Be rooted in communities wherever possible
• Enable continuity of relationships and support
• Be delivered by a skilled, valued and supported workforce

This requires commissioning models that support stability, progression and quality, rather than fragmentation or short‑term activity.

What we are doing

1. Commissioning new models of care

We will work with providers and partners to develop modern models of care that support people to live independently at home and in their communities for longer.

These models will increasingly:

• Focus on outcomes rather than activity alone
• Enable reablement, recovery and progression
• Support continuity of care and relationships
• Align with neighbourhood‑based and integrated working with health

2. Making prevention part of every contact

Prevention will be embedded across commissioning, assessment, care planning, review and service development.

This reflects national expectations that councils consider, at every interaction, whether need can be reduced, delayed or prevented. Preventative commissioning will prioritise early help, community support and timely intervention to avoid escalation.

3. Improving information and advice

We will commission and support clearer, more accessible information and advice so people can make informed choices earlier.

This includes:

• Understanding support options sooner
• Knowing how to access prevention and community‑based services
• Supporting choice and control through Direct Payments and Individual Service Funds

4. Building a stronger, more flexible market

We will actively shape a more diverse and resilient market, recognising the challenges of rurality, workforce supply and rising complexity.

This includes:

• Encouraging a wider range of provision where gaps exist
• Supporting innovation and collaboration
• Using commissioning to support workforce stability and quality

5. Working more closely with the NHS

We will commission services that support stronger integration with health partners, reflecting national priorities for neighbourhood‑based, joined‑up care.

This includes:

• Supporting reablement and discharge pathways
• Aligning community‑based support with NHS services
• Enabling multidisciplinary working for people with complex needs

6. Partnering with more providers and organisations

We want to work with a broad range of providers and organisations, including new entrants, community groups, developers and social enterprises, where they can help deliver our ambitions.

Partnership working will increasingly focus on shared outcomes, shared responsibility and long‑term sustainability.

7. Co‑designing services with the people who use them

Co‑designing services means working in partnership with people who draw on care and support, their families and carers, and the wider community to shape how services are planned, delivered and improved. It goes beyond consultation on completed proposals and focuses on involving people early using lived experience to inform priorities, service models and outcomes. This ensures that services reflect what matters most to people, support independence and wellbeing, and respond to the strengths and needs of local communities rather than applying one‑size‑fits‑all solutions.

For Herefordshire, co‑design will be a core part of how we develop and improve the market. We will work with people who use services, carers and providers to test ideas, design pathways, and learn from experience. This includes using feedback, engagement events, pilots and service reviews to shape commissioning decisions and continuously improve quality. Providers are expected to demonstrate how they involve people meaningfully in service design and improvement, and how they use feedback and lived experience to adapt and innovate over time.

Our aim

Our aim is to create a commissioning system where providers, partners and commissioners work together to help people live well, independently and with dignity.

This approach is delivered through three interconnected partnership areas:

• Services in Your Home – strengthening prevention, reablement and outcomes‑based home care.
• Care Home Partnership – securing stable, high‑quality residential and nursing care for those who need it alongside expansion of Extra Care.
• Working Age Adults: Independence and Choice First – supporting adults to live connected lives in their communities, with less reliance on institutional care.

Together, these partnerships represent a planned and deliberate system shift, aligned with national policy expectations.

Working age adults

For adults of any age or ability, our ambition is that people can live well within their community, with support that reflects what matters most to them.

A growing proportion of future demand will come from young people transitioning from children's services into adulthood, many with complex needs that require earlier preparation and continuity of support. Over the next five years, commissioning will place greater emphasis on proactive transition planning, aligned pathways across children's and adults' services, and early engagement with providers to avoid crisis‑driven entry into adult systems and to support positive, independent adult lives.

This requires a balanced mix of universal, targeted and specialist services that promote independence, connection, safety and purpose.

Adults should be supported to:

• Take part in work, volunteering, learning and community life
• Shape their own support and make informed choices
• Live in accommodation that is safe, appropriate and promotes independence

Support must be flexible, person‑centred and capable of changing as needs change.

How we will achieve it

For working‑age adults, commissioning will increasingly focus on outcomes that support independence, participation and long‑term stability. This includes supporting people to access and sustain meaningful employment or training, live in safe and appropriate housing, build skills and confidence, and remain connected to their communities.

Services will be designed to enable progression over time, reducing reliance on institutional or crisis‑led models wherever needs can be met safely through personalised, community‑based support.

Older people

For people in later life, ageing well means being able to stay safe, active and connected, living at home for as long as possible and remaining close to familiar people, places and routines.

When more support is needed, it will begin with a conversation about what a good life looks like for the individual, recognising their strengths, preferences and aspirations. Support will be designed to provide just the right level of help, flexing as needs change and avoiding unnecessary dependency.

This will be achieved through a combination of home‑based care, housing options and community‑based services, ensuring that support remains proportionate, timely and focused on maintaining independence. Where living at home is no longer possible, older people should be able to access high‑quality, compassionate care in the right setting.

Ageing well is about dignity, respect and continuing to live the life people value, for as long as possible.

How we will achieve it

Focusing on experience and outcomes

Older people will receive support that builds independence, promotes faster recovery and protects dignity. This reflects the aims of the Services in Your Home partnership, ensuring reablement‑first approaches are embedded and that support focuses on outcomes that matter to people, rather than task‑based delivery alone.

Whole‑life thinking

We will work proactively with housing, health and care partners to ensure older people have the right options at the right time. This includes access to reablement, home care, assistive technology, extra care housing and high‑quality residential or nursing care when this is the most appropriate option.

Forward‑thinking partnerships

We will work with care providers, housing partners, developers and communities to grow sustainable models of housing and care. This will support stability in the market and long‑term planning, reflecting the Care Home Partnership approach to improving quality, resilience and continuity of care.

Strengths and assets

We will support older people to remain connected to family, friends and their communities, making best use of local networks, voluntary organisations and accessible neighbourhood assets to reduce isolation and promote wellbeing.

Co‑production

Older people and carers will be actively involved in shaping services and service models, ensuring that support reflects lived experience and what truly matters to individuals and families.

Outstanding quality

We will work with providers to deliver compassionate, respectful and high‑quality services both at home and in care homes. This includes supporting stable, skilled care teams that improve continuity, reduce avoidable hospital admissions and provide safe, reliable care when it is needed.