The number of older people with care and support needs will increase over the next 5 years.
This is due to:
- 10% increase in people over 65, to 40600
- 11% increase in people with dementia to 2800
- 10% increase in people who need help with at least one self-care activity – to 11500 people
- 11% increase in frailty to over 4300 people
- 15% increase in moderate to severe visual impairment, to over 5200 people
- 12% increase in stroke to just under 1000 people
The adult over-65 social care current forecast spend of just over £30M for year 2020/21. This includes costs for domiciliary care, nursing care, residential care, day services and direct payments. As demographic changes suggest above, levels of demand are likely to increase, and so the challenge will be to do more and better with the budget we have.
What we can do differently
We can do more to keep people living as independently as possible for as long as possible, to help them ‘age in place’ and remain part of their community and within their natural circles of support. To do this we need:
- More domiciliary and personal assistant services in the community, which also specialise in complex support, that people can buy directly, including with a personal budget or direct payment.
- A stronger focus on resilience, re-ablement, and access to aids and assistive technology
- More providers offering short breaks to support carers taking a break;
- An adult social care ‘front door’ with a more effective route to short-term and preventive help;
- Greater availability of supported housing including Extra-Care Housing and sheltered schemes
Additionally, Torbay has an oversupply of residential care, and although the majority of our homes are CQC rated ‘good’, compared to our CIPFA neighbours we have fewer rated as ‘good’, more CQC rated as ‘requiring improvement’ and fewer rated as ‘outstanding’.
Torbay has 550 nursing home beds – some of which are in residential care homes, but this is insufficient. We need about 200 more nursing beds of greater quality to meet the growing demand for complex care and nursing needs.
Delaying entry into residential placements would benefit individuals and communities, and also reduce spend and generate some savings. On average residential care costs over £700pp/pw and includes an element for housing costs, compared to supported living which costs under £300 pp/pw.
- The Torbay JSNA, PANSI & POPPI DATA shows a predicted increase in older people with disabilities, co-morbidity and long-term health conditions in the next 5 years.
- This presents a demand for longer-term support that is closer to home, promotes independence and self-care, and requires social care, NHS and CVS resources to be better integrated around the individual.
- Currently, Torbay’s Residential care capacity significantly exceeds local demand, whereas local demand exceeds our nursing care capacity
- Without development, there will be insufficient domiciliary care, Personal assistants and Extra Care to meet the potential demand, especially for people with dementia
Inputs and resources
Significant capital investment for:
- ‘Extra-care’ units
- Complex and nursing care capacity development
- Commissioner time plus procure support from external data modeller (e.g. PENchord) to help with dynamic modelling of demographic demand.
- QAIT, ICO finance & commissioner time to agree cost model & contracts for residential care.
Engagement with providers and service users:
- Cost of venues, facilitators, refreshments.
- Commissioner time to carry out analysis of data.
Activities - what we will do
- Complete Torre Marine and Crossways - 164 Extra Care units
- Dynamic modelling analysis to understand demand flow for enhanced domiciliary care/PA and to develop the responding capacity
- Engagement with residential care providers on market development & reduction
- Expand Living Well at Home and domiciliary care/PA Framework
- Provide dementia training to skill up and support providers and family carers.
- Increase Carers' assessments
Outputs - what is delivered
Market development:
- OP residential care beds reduced by 200
- Nursing and complex dementia care increased by 200 beds
- 164 new units of extra care
- A stronger, diverse care and support market with more flexible options for people to buy, including with a PB or DP
- 20% increased provision of specialist dementia PAs, and dementia domiciliary care.
- Advanced dementia and cognitive stimulation therapy training for family and paid carers
Outcomes - what needs to change
- More people over 65 with long-term health conditions and/or dementia are supported to live independently for as long as possible.
- 20% of Carers feel more supported and more able to support family members with dementia, for longer.
- DTOC waiting times for nursing and complex dementia care are reduced by 20%.
- Over 80% of residential provision is rated outstanding or good.
- The average length of stay in residential care is halved.
- Reduction in oversupply of residential beds for OP.
- Sufficient capacity to meet increased demand for complex dementia and nursing care.
- Significant improvement in quality and ability to provide dementia care in Residential Care
Process benefits and system change
- Improved coordination of services.
- Increased efficiency and financial savings
- Increased skills, capacity and knowledge to better support people with dementia.
- Availability of wider range of service provision
- Increased evidence base for what works and policy change.