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12.1 Market Analysis

South Gloucestershire has been one of the fastest growing areas in the country and at the same time it supports an increasing older population. The likelihood of being disabled and receiving care increases with age. This is particularly the case with people the aged 80 years or over with a projection that by 2037 15,200 more residents will be over 80 and that the projected dependency ratio will rise from 57% to 74%. Notwithstanding the range of both statutory and non-statutory community based services, at some time in their lives an increasing number of people will require a stay in hospital or respite, reablement or permanent care in residential and nursing accommodation. Although people may be living longer, without corresponding improvements in health and wellbeing into old age and extreme old age, inevitably higher levels of care and support will be required for longer. Although every effort is being made to keep people independent for as long as possible, demand for care home beds, particularly affordable care home beds, continues to outstrip supply across South Gloucestershire, its neighbouring areas and across the country itself. Care home bed placements are the highest proportion at nearly half of our Department’s overall budget for adult services, running at £35.5 million for the year 2015-16. With higher demand and increased costs for providers, for the foreseeable time being costs to local authorities and their partners in the health service are set to continue to rise. It is therefore essential that commissioners and care home providers alike must work together to provide affordable, cost effective services that meet the needs of those citizens for whom there is no alternative but at the same time work with the overall care market and communities to focus on prevention, recovery, reablement and rehabilitation services that will enable people to live well and live independently, as well as live longer.

Availability of Care Homes & Beds in South Gloucestershire

There are 83 Care Homes in South Gloucestershire of which 50 are for older people and providing circa 1500 beds. However, there is a significant shortage of specialist capacity in both Bristol and South Gloucestershire, including for people with dementia with behaviour that challenges. These are made up as follows

  • 21 Care Homes with Nursing for Older People
  • 27 Care Homes for Older People
  • 2 Care Homes owned by South Gloucestershire are being decommissioned

Residential Care Homes Placements

  • 274 placements are purchased in care homes by South Gloucestershire Council but only 203 placements are in South Gloucestershire.
  • 77 people receive care in South Gloucestershire owned care homes
  • 500 beds are purchased by individuals funding themselves or purchased by other Local Authorities

Nursing Homes Placements

  • There are 796 beds in total in care homes with nursing for older people in South Gloucestershire
  • 346 placements are purchased in nursing homes by South Gloucestershire Council but only 241 placements are in South Gloucestershire.
  • 550 beds are purchased by a combination of South Gloucestershire Clinical Commissioning Group, individuals funding themselves and other Local Authorities

CCG Beds Purchased

  • 120 nursing beds for CHC clients
  • 20 specialist LD and MH beds (within S Gloucestershire and neighbouring areas)

Community Rehabilitation, Reablement and Recovery Services (Bed Provision)

We have begun to implement a new model for rehabilitation, reablement and recovery services in South Gloucestershire which ensures people are supported in the community and if they do require acute hospital care they are discharged back to community services as soon as they are medically well enough.  Whilst the focus is on ensuring people are supported to return home where this is possible, the 35 rehabilitation/reablement beds are currently jointly commissioned by South Gloucestershire Council and South Gloucestershire CCG in 6 independent nursing and care homes. This service is due to be retendered during 2016-17.

Estimated Future Supply Required

2015 2020 2025 2030
Demographics 1500 1845 2190 2535
Closures -70 -70 -70
Care Home Reablement -100 -100 -100
ECH -45 -80 -120
NET 1500 1770 2080 2385

These estimates project a 59% increase in beds required over 15 years. Housing LIN projections show a 58% increase in needs for care home beds over 15 years. These other variables that cannot be accurately predicted are not included in our estimates but will undoubtedly have an influence on the market:

  • pressures from neighbouring areas
  • current vacancy rates/shortfall
  • other new supply
  • other closures
  • increased affluence etc

Care Homes Vacancy Rate 3.8% at April 2015

Care homes Vacancy No of homes North South
Up to £600 18 23 6 17
£601 – £700 9 3 2 1
£701 – £800 0 3 3 0
27 29 11 18

Care Home with Nursing Vacancy rate 2.4% at April 2015

Care with nursing Vacancy No of homes North South
£450 – £600 7 7 4 3
£601 – £800 4 6 3 3
£801 – £1000 8 7 4 3
£1001 – £1200 0 1 0 1
19 21 11 10

The residential and nursing care market within South Gloucestershire is diverse with 63 residential homes with capacity to support 957 individuals and capacity for a further 797 people across 20 nursing homes. Care home capacity has markedly increased in recent years with an additional five care homes having opened since 2010 providing 244 beds whilst in the same period the Council has decommissioned 170 beds across 6 homes (a net increase of 74 beds).

The Council maintains a weekly vacancy list which details vacant beds in all nursing and residential care homes in South Gloucestershire. Although occupancy rates change on a daily basis, this shows that overall demand for residential care is currently being adequately met by private provision and there are beds available, although there is often a mismatch between the availability of beds and individual choice.

The phased decommissioning of the local authority’s eight care homes over the last 6 years is now coming to an end and has been managed in a way so as to minimise impact upon the sector.

South Gloucestershire is committed to a diverse and sustainable market and wishes to work with SME’s, larger scale providers and not for profit organisations to help ensure that the market is sufficiently balanced in order to promote customer choice, quality, mitigate risk and deliver value for money.

The geographic spread of care homes across South Gloucestershire varies considerably with significantly less choice in the more rural and north eastern areas of South Gloucestershire.

Fee rates are set individually with homes depending on a range of factors including locality, physical environment, quality and wider market conditions and under the Care Act, the needs of the individual and their health and wellbeing are taken into consideration.

The Council is continuing to work in partnership with providers to assess market and cost pressures, safeguard and develop quality of services and monitor sustainability and viability within the sector.

South Gloucestershire’s approach is to continue building on the progress made by working closely with the care home sector to promote quality, customer choice and value. This is in the context of the challenging financial climate and the continued emphasis on reducing traditional Residential Care services in favour of supporting people in the community and within ExtraCare settings. The Council intends to introduce some form of a Dynamic Purchasing System for care home placements during 2016-17 in support of this.

The focus of this partnership approach is through the s256 Care Homes project overseen by a partnership board with membership from the care home sector, CCG and local authority. Through this partnership we are seeking to invest in collaborative initiatives designed to improve quality, skills and outcomes across all care homes.

Care Homes and Maintaining People’s Independence, Choice and Control

South Gloucestershire Council proactively promotes independent living, to support people to live in their own homes for as long as possible. However, it remains committed to residential and nursing care where this is the most suitable option and favours innovative, person centred design. At the same time we strive to build a culture which encourages community engagement to deliver services differently and to provide a range of options across all centres which enables people, even those in CHC for example, to remain living as independently as possible, for as long as possible.