Our approach to market shaping and commissioning is informed by a combination of local insight, national policy, provider engagement and population health evidence. Together, these influences help us understand what people need now, what will change in the future, and how the care market must adapt.

What people are telling us

People who draw on care and support in Herefordshire consistently tell us that they want to live the life they choose, with support that fits around them rather than the system.

Across engagement activity, people emphasise that they want:

• Personalised support that reflects what matters most to them
• Flexible services that adapt as needs change
• Support that enables independence, not dependency
• Opportunities to stay connected to family, friends and community
• High‑quality care delivered with dignity and respect
• Choice and control, including the ability to use Direct Payments and Individual Service Funds

Older people in particular value continuity, trusted relationships and clear communication, especially when needs become more complex or when navigating transitions such as hospital discharge or changes in living arrangements.

This feedback reinforces the importance of home‑first, prevention‑focused and community‑based approaches, alongside planned, high‑quality care when living at home is no longer the right option.

What our providers say

Providers across all sectors have been open about the pressures they face and the changes they believe are needed to create a more resilient and sustainable care market.

Key themes raised by providers include:

Workforce pressures

• Recruitment and retention remain the most significant challenge across home care, supported living, residential care and community services
• Increasing complexity of need requires more skilled staff, greater supervision and stronger professional support
• Staffing costs now represent the majority of service costs, particularly in supported living and care homes

Rising operational costs

Providers report sustained increases in:

• Wages and employment costs
• Travel time and mileage, particularly in rural areas
• Energy, insurance and regulatory compliance
• Training, digital systems and safeguarding requirements

Many providers report that there is little scope for further efficiencies without impacting quality or workforce stability.

Limited scope for further efficiencies

Many providers have already:

• Consolidated management structures
• Adopted digital systems
• Renegotiated supplier contracts

Further cuts risk undermining quality, safety, and workforce stability.

Market fragility and financial uncertainty

Providers highlight:

• Cashflow pressures linked to delays or reassessments
• Reduced margins and limited ability to invest
• Difficulty planning for the future without clearer commissioning signals

Providers consistently ask for:

• Greater clarity about future commissioning direction
• More consistent communication and shared understanding of priorities
• Longer‑term, partnership‑based approaches that support stability and innovation

This feedback reinforces the need for commissioning that supports workforce stability, continuity of care and planned pathways, rather than reliance on short‑term or crisis‑driven arrangements.

What providers want

Across all sectors, providers consistently ask for:

• Greater transparency in commissioning intentions
• Clearer expectations about future market direction
• More consistent communication
• A shared approach to risk
• Better data flows
• Long‑term commissioning partnerships that support stability and innovation

Providers are clear: a resilient future market requires joint commitment, open dialogue and commissioning that enables confident planning.

National policy and legislative frameworks

Our approach is shaped by a range of national legislation and policy, including:

• The Care Act 2014 and associated statutory guidance on market shaping and prevention
• National priorities on independence, personalisation and safeguarding
• Increasing emphasis on prevention, reablement and neighbourhood‑based integrated care
• National workforce policy, including professionalisation, stability and career pathways

National policy is explicit that local commissioning practice plays a critical role in shaping workforce outcomes, service quality and system sustainability. This reinforces the importance of using commissioning deliberately to support prevention, integration and continuity.

Local population health data and JSNA insights

The Joint Strategic Needs Assessment (JSNA) provides a clear picture of current and emerging need in Herefordshire. It highlights:

• Rising levels of complex need among older people
• Increasing long‑term health conditions and dementia prevalence
• Inequalities linked to rurality, deprivation and digital exclusion
• Pressure on unpaid carers
• Areas where early intervention can have the greatest impact

These insights underline the need for services that:

• Intervene earlier
• Support independence for longer
• Work across organisational boundaries
• Reduce avoidable escalation into long‑term or institutional care

Financial constraints and cost drivers

Herefordshire, like many areas, faces significant financial pressures driven by:

• Rising demand and complexity
• Workforce costs increasing faster than funding
• Inflation across all parts of the care sector
• Increasing reliance on unsustainable traditional models

These pressures make clear that commissioning must focus on prevention, reablement and outcomes, rather than volume alone, to ensure value for money and long‑term sustainability for both the council and providers.

Demand: understanding today and planning for tomorrow

Taken together, these influences point clearly towards the need to:

• Prioritise prevention and early help
• Support people to live well at home for as long as possible
• Use commissioning to support workforce stability and quality
• Develop planned, partnership‑based pathways for people with higher levels of need

These themes directly inform the Working Age Adults, Services in Your Home and Care Home Partnership approaches set out in the following sections.