Find out more about the capacity for adult social care in Torbay 2023 to 2024.
Please detail what measures were put in place during winter 2022 to 2023 to ensure sufficient capacity across your social care markets, and an assessment of how successful these measures were.
Torbay Council and Torbay & South Devon NHS Foundation Trust have operated a completely integrated health and social care system since 2004, from acute hospital all the way through to community health provision and adult social care. This level of integration has significant systemic benefits within areas such as hospital flow, Pathway 1,2 and 3 discharge management and associated social care market management.
Prior to winter 22/23, work had already been done to ensure that the temporary rate uplifts of the COVID pandemic and as part of winter measures 21/22 were made permanent. Alongside the end-to-end flow management supported through health and social care integration, the improved hourly rate ensured the contracted homecare providers were able to recruit staff and sustain services. This resulted in almost no delayed Pathway 1 discharges throughout the 22/23 winter period.
Torbay now has an adequate supply rather than an oversupply of residential care beds, having seen a reduction of approximately 200 65+ beds since 2018. Recruitment has been challenging at times but support with this issue has been ongoing before and during winter 22/23, including very early work to support overseas recruitment where appropriate.
Again, the high level of health and social care integration, including intermediate care and reablement, has a significant positive impact on both Pathway 2 and 3 hospital flow. Where discharges were delayed, it was primarily due to waits for complex capable beds. Short-term block purchasing of beds in homes with complex capability supported the system throughout periods of higher demand, including through winter 22/23.
Torbay has a longstanding and effective supported living framework, jointly commissioned by the council and its partner NHS Foundation Trust. Improvements to overall market management prior to winter 22/23 has supported more effective management of vacancies within contracted supported living services, reducing waiting times for placements and ensuring successful diversion from higher cost service models with less effective outcomes. However, due to ongoing housing issues within Torbay and continued issues with construction inflation, the overall supply of both supported living and extra care housing remains significantly below the level of demand by the health and social care system locally.
Please provide an assessment of any current capacity gaps within your markets for a) long term nursing care, b) long term residential and c) long term community care (split into Homecare, Extra Care and Supported Living). Please include details on what the required capacity is, the available capacity in the market, and the level of capacity that is currently affordable.
Given the dynamic multi-agency nature of this segment of the market, with all having dual 18-64 / 65+ registrations and high levels of usage by the neighbouring local authority, projected annual demand is estimated to be 129 placements and projected annual capacity is estimated to be 161 clients, meaning we have market capacity for 2023/24. The system is seeing a gradual decrease in demand for 65+ care home beds with nursing.
Projected demand is for specialist nursing placements for working age adults is estimated to be 17 placements and projected annual capacity is currently estimated to be 17 clients. Commissioners expect demand to rise slightly beyond 2024 but the flexible registrations of Torbay’s wider nursing sector means that there is capacity to meet this demand.
Within existing supply, Torbay commissioners have identified a shortfall in capacity for all age nursing care provision for people with the most complex dementia presentations, although this is likely to the commissioned exclusively through Continuing Health Care.
Projected annual demand is estimated to be 626 placements and projected annual capacity is estimated to be 769 clients. Given work being undertaken to redesign other areas of adult social care at the front end, whilst data indicated a short-term increase in demand during 2021 to 2022, demand is now decreasing, and commissioners expect that overall demand to continue to decrease during 2023/24. This means that we have capacity to meet demand in this market sector, with only one care home (44 beds) deemed to be unaffordable.
Projected annual demand is estimated to be 96 placements and projected annual capacity is estimated to be 121. Given work being undertaken to redesign other areas of adult social care at the front end, demand is decreasing, and commissioners expect that overall demand to continue to decrease during 2023/24. This means that we have capacity to meet demand in this market sector. All homes within this market segment are deemed to be affordable.
The Torbay integrated system maintains a high level of market intervention within home care, through a fairly funded reactive framework, meaning that supply is able to flex effectively to meet local demand. Waiting lists for home care remain low in Torbay.
Projected annual demand is estimated to be 1,300 clients and projected annual capacity is estimated to be 1,370 clients. Data indicates an ongoing increase in demand, but commissioners expect that overall demand will begin to decrease beyond 2024 as wider service redesign begins to impact on transactional commissioning.
Projected annual demand is estimated to be 568 clients and projected annual capacity is estimated to be 598 clients. Whilst data indicated a short-term decrease in demand during 2021 to 2022, demand is now increasing, and commissioners expect that overall demand to continue to increase during 2023/24. Commissioners then expect that overall demand will begin to decrease beyond 2024 as wider service redesign begins to impact on transactional commissioning.
All commissioned framework and non-framework domiciliary care for both age groups is deemed to be affordable and there is capacity to meet demand.
There are currently 109 multigenerational commissioned extra care units in Torbay.
Projected annual demand is estimated to be 64 placements and projected annual capacity is estimated to be 64 clients. Capacity is limited due to current capital development constraints, so whilst commissioners expect that overall demand to increase during 2023/24, Torbay lacks capacity to meet demand in this market sector. All commissioned support services within this market segment are deemed to be affordable.
Projected annual demand is estimated to be 59 placements and projected annual capacity is estimated to be 59 clients. Capacity is limited due to current capital development constraints, so whilst commissioners expect that the increasing (at faster rate) overall demand from this age group to increase during 2023/24, Torbay currently lacks capacity to meet demand in this market sector. All commissioned support services within this market segment are deemed to be affordable.
Projected annual demand is estimated to be 154 placements and projected annual capacity is estimated to be 154 clients. Capacity is limited due to current capital development constraints and housing supply, so whilst commissioners expect that overall demand to increase during 2023/24, Torbay lacks capacity to meet demand in this market sector. All on-framework support commissioned services within this market segment are deemed to be affordable. Market shaping work is ongoing to ensure high-cost sport purchasing is reduced.
Please provide an assessment of any future capacity gaps within your markets for a) long term nursing care, b) long term residential and c) long term community care with a focus on winter 2023 to 2024, as well as a detailed plan on how these capacity gaps will be addressed.
When meeting the health and care needs of older people, the Torbay health and social care system has long been more dependent on the use of bed-based care than its comparator and neighbouring local authorities. While commissioners can do little about the impact of spending caps on the cost of bed-based care for self-funders, there are several mitigating measures that are in progress to reduce the use of non-complex residential care without nursing and better control of the cost of complex / nursing bed-based care.
Even outstanding residential care is a less enabling model than supporting someone to have choice and control in their own home, therefore commissioners believe that bed-based care should be regarded as an end-of-life model of care for most older users. This approach is set out in the 10-year joint local authority and local NHS ‘Blueprint for Market Transformation in Torbay’, utilising data set out in the 2021-22 Torbay Market Position Statement and the current Joint Strategic Needs Assessment for Torbay.
In the case of non-complex residential care without nursing, it is essential to continue with measures to divert people of all ages away from bed-based care wherever possible, meeting their assessed care needs using community and housing-based models of care and support. This is achieved through several measures covering short, medium and long-term trajectories.
Short-term diversion and ongoing improvement in hospital flow, particularly during winter 23/24, is managed through:
Medium term diversion will be achieved through:
Long-term diversion beyond 24/25 is supported through:
In the case of complex bed-based care, the Torbay health and care system faces a well understood demographic pressure. This is causing increased demand for complex-capable beds due to a large aging population and an increasing incidence of dementia and other long-term health conditions. The more complex end of the bed-based care market has few self-funders and is commissioned by the local authority and NHS. Service inputs are intensive, and the costs are increasing due to the economic and social pressures set out earlier in this paper. Data indicates a declining demand for 65+ nursing care specifically and a slightly increasing demand for 18-54 nursing care, albeit with a very small cohort.
However, some level of mitigating activity is possible to better manage costs of complex and nursing provision, in addition to the activity set out for mainstream complex bed-based care:
In 2022-23, the Torbay integrated care system used the Fair Cost of Care funding to move towards closing the gap between the current average local authority fee and the average cost of 65+ bed-based care, targeting key services supplying essential capacity, as shown through the Fair Cost of Care exercise. Maintaining an effective supply of complex care beds, whilst continuing to reduce the supply of low capability beds, is the most pressing market issue for health and social care commissioners at the current time.
In 2023-24 and 2024-25, it is Torbay’s intention to use the Market Sustainability and Improvement Fund to continue this work within the care home sector, through targeted spending activity in two key areas:
The council will follow the same annual fee uplift methodology through to April 2025 and this will be actioned within the budget provided.
The continued delivery of effective and affordable services to enable vulnerable adults to remain living independently at home is critical to the transformation of adult social care in Torbay. As with bed-based care, the market approach for domiciliary care is set out in the 10-year joint local authority and local NHS ‘Blueprint for Market Transformation in Torbay’, utilising data set out in the 2021-24 Torbay Market Position Statement and the current Joint Strategic Needs Assessment for Torbay.
During the 2023 to 2025 period, commissioners will review the composition of the current domiciliary care market and accelerate the strength-based approach that successfully diverts people away from needing state-funded care.
The indicative Fair Cost rate (adjusted for the most recent uplift of 8.3%) nearest to both the current Torbay 23/24 rate of £24.36 and the suggested UK Home Care Association (UKHCA) equalised 23/24 rate of £25.95, is from a national provider able to deliver sustainable services at a cost close to the UKHCA rate.
There have been significant changes in the economics and mobilisation of domiciliary care over the last 2-3 years, which combine to undermine the relative effectiveness of Torbay’s current provider ecology and have contributed to inflated costs. Torbay has successfully managed to match adult domiciliary care supply with demand, despite the dual risks of short-term increases in that demand and market sustainability.
Commissioners from the local authority and local NHS now expect to conduct a redesign of the commissioned Torbay domiciliary care market over the next 2-years, adjusting the market ecology to mitigate cost / risk more successfully. Finally, commissioners will look to make best use of any opportunities for greater efficiency that might be offered through the integration with the Local Care Partnership across Torbay, Plymouth and Devon.
In 2023-24 and 2024-25, it is the council’s intention to use Market Sustainability and Improvement Fund within the domiciliary care sector in Torbay to continue to move toward an improved hourly rate, reflective of national rates. This will maintain providers’ ability to recruit and retain staff, and therefore to meet demand from the Torbay system.