Herefordshire's care and support system is changing because people's needs, expectations and circumstances are changing, and because national policy now places greater emphasis on prevention, independence, workforce sustainability and joined‑up care.

The number of older people living in Herefordshire continues to grow, and many people are living longer with multiple long‑term health conditions, frailty or dementia. This increases demand not just for care, but for skilled, flexible and well‑coordinated support that can respond as needs change over time.

At the same time:

• More people wish to remain living at home for as long as possible
• Families and unpaid carers are supporting people for longer, often with limited support
• The social care workforce is under pressure from recruitment, retention and rising costs
• Traditional models of care are proving less sustainable, particularly in rural areas

National policy is also clear that prevention, reablement and community‑based support must be prioritised, and that commissioning decisions play a central role in shaping quality, workforce stability and system sustainability.

Together, these factors mean that continuing with business as usual is not an option.

Understanding demand and demographic change

Herefordshire has a significantly older population than the national average, and growth is fastest among those aged 75 and over, and 85 and over. People in these age groups are more likely to live with complex needs, require support over longer periods, and need services that are responsive, skilled and reliable.

We are seeing:

• Increasing numbers of older people with more than one long‑term condition
• Growing demand for home‑based care, often involving higher hours and complexity
• Greater need for dementia‑capable support across all settings
• Ongoing pressure on carers and family networks

These trends reinforce the need for earlier intervention, continuity of care and stronger community‑based models that can support people to remain independent for longer and reduce avoidable escalation.

Financial pressures and sustainability

Care providers are facing sustained cost pressures driven by:

• Workforce costs rising faster than historic fee uplifts
• Increased skill requirements linked to greater complexity
• Travel time and workforce availability in rural areas
• Regulatory and quality expectations

National policy increasingly recognises that unsustainable commissioning models undermine workforce stability, service quality and system flow, including delayed hospital discharge.

To respond effectively, commissioning must support:

• Stability and continuity of care teams
• Prevention and reablement as core functions, not add‑ons
• Planned pathways rather than crisis‑led responses
• A workforce that is skilled, supported and able to work across organisational boundaries

Strategic priorities for transformation

Looking ahead to 2031, demand is expected to continue to grow, driven by increasing complexity, workforce pressures and demographic change, particularly among working‑age adults with complex needs and older people living with multiple long‑term conditions. This reinforces the need for a deliberate shift towards prevention, reablement, community‑based support and planned pathways, as set out in this Market Position Statement.

To respond to the changing needs of our population and the pressures facing the care system, we are reshaping the local care market so that people are supported to live well at home and in their communities for as long as possible.

Our strategic priorities are to:

• Prevent, reduce and delay the need for long‑term care by providing support earlier, closer to home and in ways that maintain independence
• Embed strengths‑based, community‑led practice across all services, ensuring people's abilities, relationships and local networks are central to support
• Grow supported accommodation and housing‑based options, bringing together housing, care and independence in a more integrated way
• Encourage innovation and collaboration to build a more resilient, responsive and sustainable provider market
• Reduce reliance on traditional or out‑of‑county services by developing more flexible, local and community‑based alternatives

Together, these priorities support our vision of a care and support system that is preventative, personalised and financially sustainable, while improving outcomes for people and greater stability for the market and workforce.

Opportunities for innovation and collaboration

We want to work with providers and partners who share our ambition and are keen to develop modern, future‑focused models of care.

There are opportunities to:

• Design services that focus on people's outcomes and lived experience, rather than task delivery alone
• Expand preventative and reablement‑focused approaches that help people stay independent for longer and reduce escalation of need
• Develop flexible housing and care solutions, including supported living, step‑down provision and community‑based support
• Work alongside community, voluntary and faith organisations to build on local strengths and provide support closer to home
• Use digital tools and assistive technology to improve access, quality and efficiency, particularly in rural areas

This is a time to be creative, collaborative and bold, working together to shape a care market that is fit for the future.

Commitment to fairness and transparency

Fairness underpins how we commission and work with providers. We expect all services commissioned by the council to:

• Reduce inequalities and promote fairness for people across Herefordshire
• Use clear, transparent eligibility and access arrangements, so people understand their rights and choices
• Pay at least the Local Living Wage, recognising the value, skill and responsibility of the care workforce
• Apply trauma‑informed approaches, ensuring people are treated with dignity, respect and compassion
• Support inclusion and accessibility, particularly in rural and underserved communities

Fairness, transparency and respect guide every commissioning decision we make and every partnership we build.