Approach 1: Place-based wellbeing

June 2025 teaching template, slide 35

Approach 1 Place-based wellbeing

Design and creation of a place-based wellbeing system.

June 2025 teaching template, slide 36

Approach 1: Place-based Wellbeing

Introduction: Focuses on upstream investment in wellbeing and community resilience to reduce demand on care services.

How to move toward: Start by mapping strengths and needs, and build a shared long-term vision with partners.

What to do: Promote co-produced prevention strategies and enable community-led responses.

What not to do: Don’t neglect statutory duties or assume full system redesign is required before progress.

Risks and issues: Vulnerable to short-termism, leadership changes, and funding volatility.

Commissioning skills and structure: Requires communicators who can influence widely, build alliances, and hold the strategic view.

June 2023 adult social care pre-reading, approach 1

Strategic Commissioning Approach 1. Place-based wellbeing

Design and creation of a place-based wellbeing system.

Introduction to this approach

This commissioning approach fits most closely with the ‘whole system design’ commissioning aspect. It represents the shift from thinking about care needs first, to thinking about wellbeing first, and begins with a view that the best way to deliver outcomes for the community is to start early and ‘upstream’ to the individual, families, neighbours, the community and other support wherever and as much as possible. Ideally, this is well before what is called ‘prevention and early intervention’ and is about creating the conditions for people to be healthy, resilient, and connected in their communities. It is more than just keeping people out of care; it is about establishing the environment, so people are able to have healthy lives.

It has to be recognised that a large part of this is a demand management approach which needs to be monitored and evaluated for impact on cost and outcomes, otherwise the risk is of wider service provision while the most vulnerable continue to miss out, and services continue to struggle.

Here, the council's role is to plan and commission interventions and services that are resolutely focused on building community well-being and individual health through carefully planned public health and joined up strategies with key agencies and providers. Commissioning is therefore focused on understanding need – the needs of the whole place, not only individual services – and on ensuring that suitable approaches are set up or enabled to reduce the demand arising from that need. Indeed, it would be even better to focus first on strengths and capabilities in the place, and how they could be enabled and strengthened such that the needs do not arise.

This approach means that this work is necessarily co-produced – it is about creating the conditions for people to be in charge of or co-produce their own care and wellbeing – and is more complex and emergent because the council cannot dictate terms or set out and then implement a programme. Such an approach works best where there is a robust professional practice and commitment to prevention, political leadership is resolutely focused on the long term. Levels of deprivation and need are significant but need long-term action, and all parties from providers to community bodies work well together and are willing and able to invest for long-term benefits.

How to move towards this approach

This is a long-term approach which needs consistency of purpose, leadership, capacity, and capability. A good first step is to keep a focus on overall strengths and needs in the local place (even if they cannot be worked with immediately). Share this with partners and public as a ‘convening call’, be clear about where the potential lies to begin to ‘get upstream’ to reduce needs for care and support wherever possible, demonstrate some of this through judicious experimentation, try to create more flexibility for providers, community groups and partners to experiment and work hard on building mutually supportive relationships across the system. If local commissioning is reasonably strong in the other aspects, your commissioning development plan could consider how to focus all parties on a vision of a place that helps people to maximise their wellbeing and minimise their care needs and where needs are dealt with in a way that focuses on supporting and increasing self-efficacy.

What to do, and what not to do, when you are pursuing this approach

The goal here is to make health, wellbeing, and minimal care needs the default, easy option, so it is important not to neglect statutory requirements and crisis intervention services, and to find a way to progress incrementally, building on and reinforcing (and, if necessary, defending) moves in the right direction.

You will need to build a strong understanding of your place and its possibilities, and widely embed the concept that it is better to create the conditions where people can have their needs met by the community, meet their own needs, or not fall into need in the first place, than to provide services. Remember that it is not necessary to have control over and redesign the whole system to make a difference, if you have a good overview and can identify the most effective things you can do to support a system of wellbeing.

Specific risks and issues

The challenges with this approach, apart from its scale and optimism, are clear. Apart from all the many demands on commissioners’ time and attention, large-scale issues around funding, crises, policy changes, changes of leadership and of structure will all impact success in this space. Sustainability of even small steps will be in question given current funding challenges and the push to unit-based provision.

Few councils are able to consistently work using this approach. It is also noteworthy that some examples are not easy to scale up or sustain, and do not fit into the paradigm of ‘services’ or comfortably into adult social care commissioning. In other strategic commissioning approaches, you will also see examples that seek to move towards place-based wellbeing, which may in some ways be more practical – to really move fully to place-based wellbeing, a lot of rethinking may be required.

Considerations for commissioning skills and structure

The need referred to above to communicate and enthuse people about the possibility of working very differently suggests that commissioners in this approach will need to be skilful communicators, and also to demonstrate examples at a small scale. It will also be important to have a grip on service delivery and costs while building a large-scale systemic picture of your whole place, influencing senior leaders, strategies, and plans, and building joined-up governance. Rather than attempting to recruit super-heroes, it is important to consider how social care commissioning can build alliances and appeal to the motivations of relevant people and organisations – acting as a catalyst and shaper, rather than taking on all the responsibility.

Examples of this approach in practice

• As part of Leicester City Council’s Supported Living and Extra Care Housing Strategy, the council aims to provide up to 396 new units over ten years, including provision for supported living and other housing to delay entry into statutory care, replacement of sub-standard existing statutory care provision, and provision for care leavers aged 18-25. Two new developments contain a mix of working-age adults with care and support needs and older adults, and are connected. Tenants report that the mix has a positive impact, supports diversity, and that “some younger residents help the older ones with shopping etc, and some of the older ones support the younger ones who may not have family. This makes for a nice community of people who can balance each other’s strengths and needs.”
• With over 2,000 people living with dementia in the borough, Dementia Inclusive Greenwich is an initiative to help businesses adapt their services to be more inclusive. It offers local organisations free training and practical support to make changes that can help people with Dementia – to both the built, physical environment and also the social environment. The scheme has been very successful and now requires funding and power to take it forward.
• The Small Supports Programme, delivered by NDTi, supports people with learning disabilities, mental health issues and autism and who are identified as having complex support needs because of their behaviour, forensic or offending history. The programme has a vision of people getting support that is right for them and having a choice about where they live and what they do. It supports organisations and ‘partners’ (including all the people who are helping the person), to plan and deliver support in a truly person-centred way. In a programme with the LGA and NHS England, they looked at how to spread this approach to more areas, identifying a number of strengths and opportunities, and a number of barriers, including a commissioning ‘myth’ that those who engage small providers might be sued by large providers, and a challenge that while this type of support is necessarily small, person-centred, and adaptive, this makes it hard to offer a concrete ‘thing’ for commissioners to grasp and understand.

One thing to read

Transforming care and Support, SCIE, https://www.scie.org.uk/transforming-care