Our ambition for working‑age adults is that people are supported to live independent, safe and fulfilling lives within their communities, with choice and control over the support they receive.
Herefordshire is a predominantly rural county with strong communities, but also with growing complexity of need. Working‑age adults may require support related to learning disabilities, autism, mental health, physical disability, homelessness, domestic abuse or multiple vulnerabilities. Many people want to live ordinary lives – working, learning, volunteering and participating in their communities – but need the right support at the right time to do so.
Instead, services must be flexible, preventative and rooted in communities, enabling people to build skills, confidence and stability over time.
Context and vision
Our vision is that working‑age adults experience support that:
- Is easy to access, regardless of where they live
- Is shaped around what matters to them, not what the system expects
- Promotes independence, dignity and choice
- Strengthens community connection and reduces isolation
- Supports progression and positive life outcomes
- Recognises and supports the role of unpaid carers
- Provides safe, appropriate accommodation where needed
This vision aligns with national expectations on prevention, independence, housing‑led solutions and early transition planning, as well as local priorities for community wellbeing and inclusion.
How we will achieve it
Focusing on experience and outcomes
Support for working‑age adults will increasingly be commissioned around outcomes that matter to people, including independence, safety, stability, participation and wellbeing. Services will move away from models that create long‑term dependency and towards approaches that support progression and choice.
Whole‑life thinking
We will work across social care, health, housing, education, employment and community partners to support people throughout their adult lives. Early transition planning for young people moving into adulthood will be prioritised, ensuring continuity and reducing crisis at key life stages.
Forward‑thinking partnerships
We will work with providers, housing partners, employers, community organisations and the NHS to develop integrated pathways that support independence. This includes partnership approaches to supported living, mental health support, domestic abuse provision and community‑based services.
Strengths and assets
Support will build on people's strengths, skills, relationships and community assets. We will continue to expand the role of community‑based provision, voluntary organisations and peer support, alongside appropriate use of technology and assistive solutions.
Co‑production
People with lived experience, carers and communities will be actively involved in shaping services, pathways and commissioning decisions. Co‑production will remain central to designing support that reflects real lives and real aspirations.
Outstanding quality
We will work with providers to ensure support is delivered by skilled, stable and trauma‑informed staff, capable of responding to increasing complexity. Commissioning will support quality, continuity and safeguarding, recognising the strong link between workforce practice and outcomes.
Direction of travel
As demand and complexity continue to grow, the direction of travel for working‑age adults will be towards:
- Growth in supported accommodation and housing‑linked support, reducing reliance on residential or out‑of‑county placements
- Expansion of community‑based and preventative support, including mental health and domestic abuse services
- Reduced use of institutional and crisis‑driven models, wherever needs can be met safely in the community
- Greater choice and control, including through Direct Payments and Individual Service Funds
This approach supports independence for individuals, sustainability for the system, and confidence for providers to invest and adapt.
Evidence and insights
Insights from the JSNA, local data, and lived experience highlight several cross‑cutting pressures:
- Around 1 in 5 adults in Herefordshire may be unpaid carers
- Most unpaid carers (about 6 in 10) provide under 20 hours of care each week, while around 1 in 5 provide 35 hours or more
- 59% of working‑age carers have a paid job (compared with 67% of non‑carers). This drops to 35% for people caring 35+ hours a week
- About 17,000 adults in Herefordshire did not use the internet in 2020
- 41% of adults have no formal qualifications—this rises to 48% among housing association tenants
- Supported living for people with learning disabilities includes Red Coat Close, which has 10 one‑bed flats with long‑term care and support
- Adults who are homeless or at risk can access 24/7 supported accommodation through a Housing Solutions referral (age 18+)
- People usually stay in supported accommodation for up to two years before moving on
Rising demand and complexity
- More people with learning disabilities and autistic people requiring support
- Increasing numbers of young people transitioning into adulthood with complex needs
- Higher demand for supported accommodation and domestic abuse services
- Growing numbers of adults with multiple vulnerabilities
Health and social inequalities
- Higher rates of long‑term conditions
- Excess cold and fuel poverty
- Pockets of significant deprivation
- Reduced life expectancy for some groups
Carer pressures
- One in five adults provides unpaid care
- Many carers experience poorer health and reduced employment opportunities
- Carer breakdown is a key driver of crisis
Workforce challenges
- Recruitment and retention difficulties across all sectors
- Need for autism‑informed, trauma‑informed, and rights‑based practice
- Limited capacity in rural areas
Housing and accommodation gaps
- Shortage of supported living for people with complex needs
- Limited move‑on accommodation
- Pressure on emergency and refuge provision
Access barriers
- Rurality
- Transport
- Digital exclusion
- Limited community‑based options in some areas
Sources - Joint Strategic Needs Assessment (JSNA) - Understanding Herefordshire
These insights reinforce the need for a preventative, integrated, community‑led Living Well system.
Priority 1: Strengthen early help and preventative pathways
What
A system‑wide shift towards earlier intervention, prevention in every contact and timely support that helps people remain independent and avoids escalation into crisis or long‑term care.
This includes:
- Rapid, strengths‑based assessment at the point of first contact
- Community‑based prevention and enablement
- Reablement and recovery‑focused support following illness, crisis or hospital discharge
Why
People consistently tell us they want support that is easy to access, joined‑up and focused on helping them live well, rather than responding only once needs have escalated.
Early help and prevention:
- Improve outcomes and independence for individuals
- Reduce avoidable crisis responses and unplanned admissions
- Support carers and families to sustain caring roles
- Provide better value for the system by reducing long‑term dependency
Given increasing complexity, workforce pressure and financial constraints, prevention is essential to the sustainability of the care and support system.
How
We will strengthen early help and preventative pathways by:
- Embedding prevention in every contact, from information and advice through to assessment, care planning and review
- Strengthening the front door to adult social care to ensure timely, strengths‑based and proportionate responses
- Expanding community‑based prevention and enablement, including support that reduces isolation and promotes wellbeing
- Delivering reablement‑first approaches that focus on recovery, independence and confidence
- Using reviews as opportunities to reduce, delay or reshape ongoing support where this is safe and appropriate
- Targeting prevention at key life events, such as bereavement, diagnosis, hospital discharge or changes in housing
- Working with NHS, housing and voluntary sector partners to deliver joined‑up neighbourhood‑based pathways
- Improving information and advice so people understand options and can access help earlier
- Strengthening transition pathways for young people moving into adulthood to prevent crisis at points of change
- Ensuring preventative support is co‑produced, reflecting lived experience and what matters most to people
Priority 2: Grow community based, flexible support
What
The development and expansion of modern, community‑based support that enables people to live ordinary lives, remain independent and stay connected to their communities.
This includes:
- Flexible day opportunities and community support
- Floating support, Shared Lives and voluntary and community sector‑led provision
- Targeted support for carers and families
- Support that adapts over time as people's needs change
Why
People consistently tell us they want support that is local, flexible and rooted in their communities, rather than being reliant on institutional or building‑based services.
Community‑based support:
- Helps people maintain independence and wellbeing
- Reduces isolation and the risk of crisis
- Supports progression rather than long‑term dependency
- Provides carers with earlier, more sustainable support
As complexity increases, community‑based approaches are increasingly important to prevent avoidable escalation into higher‑cost or more restrictive forms of care.
How
We will strengthen community‑based and flexible support by:
- Redesigning and expanding day opportunities to focus on inclusion, skills, confidence and progression rather than attendance alone
- Growing floating support, Shared Lives and community‑based models that help people remain independent at home
- Expanding the use of Direct Payments and Individual Service Funds, giving people greater choice and control over how support is arranged
- Working with the voluntary and community sector to build on local strengths, reduce isolation and improve access to preventative support
- Strengthening carer support and respite offers, recognising the critical role carers play in sustaining independence
- Applying quality assurance frameworks to ensure community‑based support is safe, effective and outcomes‑focused
- Embedding co‑production so services reflect lived experience and what matters most to people
- Improving information and advice so people can access community support earlier and with confidence
Priority 3: Expand safe, high quality accommodation and support
What
The development of safe, high‑quality and appropriate accommodation and care settings that support independence, dignity and wellbeing for people with higher or more complex needs.
This includes:
- Modern, dementia‑ready residential and nursing care
- Supported accommodation for working‑age adults with learning disabilities, autism, mental health needs or multiple vulnerabilities
- Step‑down, move‑on and recovery accommodation linked to reablement and Discharge to Assess pathways
Why
Rising complexity of need, ageing trends and increasing pressure on hospitals mean that the system requires modern, flexible accommodation solutions that sit alongside strong home‑based support.
Safe and appropriate accommodation:
- Enables people to live with greater independence and dignity
- Reduces avoidable hospital admissions and delayed discharges
- Supports recovery, reablement and progression where possible
- Provides stability for individuals, families and the care workforce
Reliance on reactive placements, inappropriate settings or out‑of‑county provision does not support good outcomes and creates avoidable cost and instability for the system and providers.
How
We will expand safe and high‑quality accommodation and support by:
- Developing dementia‑ready accommodation and care models that respond to increasing complexity across the whole journey
- Strengthening residential and nursing care models through partnership‑based approaches that prioritise quality, workforce stability and continuity of care
- Expanding and aligning step‑down and recovery accommodation with reablement and Discharge to Assess pathways to support timely discharge and recovery at home
- Working with housing partners to grow supported housing and accommodation with care, including adaptations and accessible design
- Reducing reliance on out‑of‑county or institutional placements by building local capacity and flexible alternatives
- Embedding falls prevention, safety and prevention planning within accommodation and care pathways
- Strengthening quality assurance and oversight to ensure accommodation‑based services are safe, effective and outcomes‑focused
- Improving transitions between settings to avoid disruption and reduce risk at points of change
What this means for the market
We want to work with providers who:
- Deliver safe, high‑quality accommodation and care aligned to increasing complexity
- Can work in partnership to deliver planned pathways rather than crisis responses
- Invest in a stable, skilled workforce capable of supporting integrated models
- Are willing to innovate and adapt to changing demand