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12. Residential and Nursing Care

Following a gradual decline in demand for local authority commissioned residential care in recent years, we are now seeing a steady increase in demand for residential but more so for nursing care provision. As an indicator of the population’s ability to self-fund Residential Care, Housing statistics show that South Gloucestershire has an above average level of owner-occupancy of 77% against a national average of 68.6%. It is becoming increasingly clear that there will be an growing shortfall in provision based on demographics alone. Already we are in competition with neighbouring authorities and the prospect of the lifetime care fees cap in 2020 will mean more people who self-fund their care becoming local authority funded.

A great difficulty facing public sector commissioners is the cost of residential and nursing care and the difference in expectations and provision between what private funders can buy and the level of facilities and other provision that the market provides. Simply put, it is becoming increasingly difficult for the Council to buy an adequate service at a price that it can afford, when what is on offer is pitched at an altogether more affluent privately funded level of service. At the same time, it is difficult, even nigh on impossible, for providers to deliver two levels of cost and service in the same care home for Council funded and self-funding residents respectively.

What is clear is that the Council, as it continues to decommission its remaining care homes, must work with the market to develop in the first place affordable, quality residential and nursing care that can meet people’s needs. Secondly, but equally important, is the need for innovation and alternative provision, where people can live independently for longer in their own homes and a market that can readily accommodate rapid reablement and rehabilitation or respite where people, particularly dementia sufferers, do not become so deconditioned staying in hospital longer than they need to be in there, that the possibility of regaining independent living diminishes by the day. This increasing challenge faces the entire care sector and by working together in co-production with our communities and commissioning partners, the Council is committed to providing a sufficiently diverse range of quality services which can meet people’s needs and personal health and wellbeing goals, as well as being able to balance the books at the same time.

Another development in the residential and nursing care home sectors is Direct Payments (DPs). These have become a key mechanism for delivering social care support aiming to offer greater choice and control to people in need of social care. DPs have been used in community care for a number of years, but people living in residential care homes have not had access to DPs so far. The Government has decided to expand this approach to care homes from April 2016 and initiated a Trailblazer programme to test DPs and learn from the experience prior to DPs becoming national policy. Eighteen local authorities have volunteered to participate in the programme and its evaluation.

The evaluation to test DPs in care homes will include the following elements:

  • A process evaluation will aim to understand the different ways in which DPs are being offered to residents of care homes and how any challenges to implementation can be overcome.
  • An impact evaluation will assess the potential effects of DPs on care home residents and their families, care homes and the local care home market, and on Councils and their staff, such as care managers.
  • An economic evaluation will examine the costs and cost-effectiveness of different approaches to providing DPs for residents, their families and the local Councils.