Residential and nursing care home market

Market analysis of the residential and nursing care home market

The following webpages provide a high-level summary of the residential and nursing care home market in Norfolk. This includes:

Quality ratings are based on care quality commission (CQC) ratings of the overall market and our view of sustainability in comparison to other East of England and comparator local authorities.

Adults with a learning disability and/or autism

Our vision

To work alongside the learning disability and autistic population to deliver services to meet their needs, at the right time and in the right place.

Challenges

The challenges we face in providing care for adults with learning disabilities and/or autism include:

It is becoming harder to source quality placements able to meet more complex needs
High level of provider failures and contract terminations and handbacks in the residential sector. We need to work with providers to co-produce the residential model and review our commissioning approaches.
There are a range of factors impacting home closures and contract handbacks such as on-going quality issues, homes that are not financially viable, and the inability to recruit or retain sufficient staff. Read more about quality challenges, financial challenges, and workforce challenges.
More people with learning disabilities are developing conditions associated with ageing, such as dementia. There is a lack of provision for working age adults with these needs
Access to independent living (including housing with careand enabling confidence at home) services for people with learning disabilities and/or autism who are over 55 years of age
The unintended consequences of the 'right support, right care, and right culture' regulations need to be considered. This will require us to use data more smartly to create specific services where someone's primary need is a learning disability and/or autism. An area that requires some immediate analysis is the cohort of the learning-disabled population who also have dementia.

Key data

The 2022-2023 spending by service type includes the number of people at the year-end accessing services for people with learning disabilities and/or autism, the number of accredited locations, the number of accredited places, and the percentage of services with a 'good' or 'outstanding' rating. This includes people accessing long-term, short-term, and respite services in 2022-2023:

Residential care home services for adults with learning disabilities and/or autism

Our spend on residential care home services for adults with learning disabilities and/or autism in 2022-2023: £53.5m
The number of people accessing residential care home services for adults with learning disabilities and/or autism funded by us in 2022-2023: 646
The number of Norfolk County Council (NCC) accredited locations (buildings) registered for adults with learning disabilities and/or autism by March 2023: 104
The number of NCC-accredited places (beds) registered for adults with learning disabilities and/or autism by March 2023: 966
The percentage of locations for adults with learning disabilities and/or autism registered and inspected by the care quality commission (CQC) with a 'good' or 'outstanding' rating from the CQC or provider assessment and market management solution (PAMMS) as of 1 March 2023: 51.5%

Nursing home services for adults with learning disabilities and/or autism

Our spend on nursing home services for adults with learning disabilities and/or autism in 2022-2023: £0.9m
The number of people accessing nursing home services for adults with learning disabilities and/or autism funded by us in 2022-2023: 14
The number of NCC-accredited locations (buildings) registered for adults with learning disabilities and/or autism by March 2023: 14
The number of NCC-accredited places (beds) registered for adults with learning disabilities and/or autism by March 2023: 364
The percentage of locations for adults with learning disabilities and/or autism registered and inspected by the CQC with a 'good' or 'outstanding' rating from the CQC or PAMMS as of 1 March 2023: 64.3%

Mental health and learning disability services can register to deliver services to people aged 65 years and older. Older people's services may also register for working age adult groups.

This can therefore cause some overcounting of locations and places and slightly distort the quality ratings. Services registering with CQC for multiples of learning disability, mental health and physical disability care provision can have a similar effect on the figures.

Supply and demand

Residential and nursing care

During the year ending in March 2023, there were 646 clients accessing long-term, short-term, and respite provision and 14 clients accessing nursing home services
During the previous two years (2020-2022), nine homes have closed, resulting in a loss of 94 beds
As of July 2023, there is a high demand for residential and nursing placements for people with complex needs, but our ambition is to increase the supply of supported living as an alternative to residential care for those who are more able
There are approximately 58 residential vacancies; however, 34 of these (59%) are in homes that are subject to quality assurance 'full restriction' meaning no new placements can be made
There are four new providers in the pipeline to develop five new services, which will provide an additional 28 residential beds
As of July 2023, there are around 83 people identified as requiring residential care. If the services with restrictions could improve their quality to have the restrictions lifted, and with the new beds identified as part of the pipeline developments, we would, on paper, have sufficient capacity to meet need. However, we need some of the services to be able to meet the needs of more complex and more specialist needs, people who are having to have their needs met outside of Norfolk.
Our ambition is to decrease the supply of residential services to be on par with other local authorities

Supported living services (learning disability, autism, mental health, and physical disability)

As of July 2023, there are 183 registered supported living schemes in Norfolk
68.2% of supported living services are rated 'good' or 'outstanding'
As of July 2023, there are eight voids and 100 people on the waiting list for a supported living service
During 2022-2023, 14 transforming care partnership properties were purchased and adapted, and a learning disability enablement scheme was opened
During 2023-2024, a further four supported living schemes are being commissioned, which will provide an additional 15/16 tenancies
Over the past two years, five supported living schemes have closed, and there are a further four services at risk of closure due to staffing issues
Five new supported living schemes came on stream during 2022-2023, providing 26 additional supported living tenancies. This still leaves a gap in supply of around 66 tenancies.
Our ambition is to significantly increase the supply of supported living services for people with a learning disability and/or autism

Key messages to providers

Our key messages to providers are that:

We have an ambitious target for the development of supported living services for people with learning disabilities and/or autism
The current supply of supported living is low, and it is mainly delivered in communal settings with people not having self-contained units. We want to decrease the supply of communally supported living schemes and work with registered social landlords (RSLs) and providers to develop more individual apartments.
To work with providers to co-produce the service models for good quality residential and supported living services and to review the fee rates required to deliver the quality of provision required
Although our strategy will promote more supported living, for those individuals who do require residential services, these need to be aligned with 'right care, right place, right culture,' providing more choice for individuals to access high quality care
We want to work with providers who support people within their care to maximise their skills for independence and to move to less intensive provision where this is appropriate to their needs and is safe

Market opportunities

We are going to commence a piece of work with providers of residential care for working age adults so we can work together to think about how the financial model for securing residential care for people of working age adult age can be sustainable and also procure good quality services for the people who live in these services.

People with mental ill-health conditions

Our vision

To develop a range of high-quality mental health social care provision that is joined up with other services based on good practice (psychologically and trauma informed), supports mental health recovery, and best enables people to live independent and fulfilling lives.

How we will achieve our vision

The integrated commissioning board is leading the development of the Norfolk and Waveney integrated care system. Provider collaboratives are being established, which will focus respectively on adults and children and young people.

In addition to the development of the provider collaboratives, mental health priority proposals for the following year in the joint forward plan to support mental health will be focussed on:

Developing more effective early intervention, including the prevention of suicide
Establishing an integrated front door for children and young people
Meeting the mental health needs of older people around dementia, delirium, and depression
Promoting recovery for people with multiple and complex needs, including dual diagnosis and complex emotional needs (personality disorders)

We will continue to work within the local integrated care system to support these priorities while also developing a clear strategic position about the priorities and offer for mental health social care within the partnership approach.

Challenges

The challenges we face in providing care for people with mental ill-health conditions include:

High level of contract terminations and handbacks in the residential sector. We need to work with providers to co-produce the residential model and review the current banded fee rates. Care providers report routinely struggling for timely community mental health interventions when someone's mental health is deteriorating. We need to continue to work with system partners to improve community mental health services.
The overall market quality of mental health residential provision is too variable
Availability of provision able to meet the complexity of presenting needs particularly in relation to working age dementia. There are a number of key areas in which we need to work with other commissioners (health and children's services) to develop more provision, including for people with early-onset dementia, young people at significant risk of self-harm who are coming into adult services, and people with multiple and complex needs.
The supply of supported living is low, and the programme to develop the additional capacity required will take several years to conclude

Key data

The 2022-2023 spend by service type, the number of people accessing services for people with mental ill-health needs snapshot at March 2023, the number of accredited locations, the number of accredited places, and the percentage of services with a 'good' or 'outstanding' rating. This includes people accessing long term services:

Residential care home services for people with mental ill-health conditions

Our spend on residential care home services for people with mental ill-health conditions in 2022-2023: £14.5m
The number of people accessing residential care home services for people with mental ill-health conditions funded by us in 2022-2023: 283
The number of Norfolk County Council (NCC) accredited locations (buildings) registered for people with mental ill-health conditions by March 2023: 70 (an accredited service is a service that we can make placements to, so it does not cover the entirety of the market, especially in home care)
The number of NCC-accredited places (beds) registered for people with mental ill-health conditions by March 2023: 1,401 (an accredited service is a service that we can make placements to, so it does not cover the entirety of the market, especially in home care)
The percentage of locations for people with mental ill-health conditions registered and inspected by the care quality commission (CQC) with a 'good' or 'outstanding' rating from the CQC or provider assessment and market management solution (PAMMS) as of 1 March 2023: 60.6% (excluding services that have not yet been inspected)

Nursing home services for people with mental ill-health conditions

Our spend on nursing home services for people with mental ill-health conditions in 2022-2023: £1.9m
The number of people accessing residential nursing home services for people with mental ill-health conditions funded by us in 2022-2023: 39
The number of NCC-accredited locations (buildings) registered for people with mental ill-health conditions by March 2023: 14 (an accredited service is a service that we can make placements to, so it does not cover the entirety of the market, especially in home care)
The number of NCC-accredited places (beds) registered for people with mental ill-health conditions by March 2023: 392 (an accredited service is a service that we can make placements to, so it does not cover the entirety of the market, especially in home care)
The percentage of locations for people with mental ill-health conditions registered and inspected by the CQC with a 'good' or 'outstanding' rating from the CQC or PAMMS as of 1 March 2023: 64.3% (excluding services that have not yet been inspected)

Mental health and learning disability services can register to deliver services to people aged 65 years and older. Older people's services may also register for working age adult groups.
This can therefore cause some overcounting of locations and places and slightly distort the quality ratings. Services registering with CQC for multiples of learning disability, mental health and physical disability car provision can have a similar effect on the figures.

Supply and demand

Since December 2021, access has been lost to around 70 mental health residential care beds
Our demand across residential and supported living services is stable; however, the loss of residential provision and the increasing difficulties in accessing social and other affordable housing mean that it is getting harder to support people to find care placements, particularly if their needs are complex
The ambition is to decrease the reliance on residential beds and increase the supply of supported living tenancies. Currently, the availability of supported living and independent living services is patchy.
There is a successful mental health outreach service, and this could support people if there were more social and private rented properties available for people who are ready to move on from supported living.
There is a gap in the provision of specialist mental health home care provision in West Norfolk, Great Yarmouth, and rural and coastal North Norfolk, which we want to work with providers to address
supported living scheme gaps in West and South Norfolk, Norwich, and Great Yarmouth

Key messages to providers

Our key messages to providers are that:

We need around 24 units of supported living, including long-term accommodation and support for people with severe and enduring needs, step-up and step-down schemes following crisis, and dedicated provision for young people with enablement support
We need around 20 units of supported housing or other move-on accommodation in which visiting support (such as key ring schemes) could be provided to enable effective pathways to independence
There are a number of people in existing supported living schemes whose support needs are settled and who could move on if there was access to housing to be able to do so. We would like to talk to landlords about provision for people who could move on from supported living provision.
We have collaborated successfully with Norfolk public health, the integrated care board (ICB), and providers to bring new income into Norfolk to trial housing, treatment, and support models for people who have poor mental health, substance dependence, and homelessness
With partners, we will establish the pilot services we have proposed and use the learning to consider further interventions to support people with multiple disadvantages
We would like to work with providers and the clinical commissioning groups (CCGs) to address gaps in meeting complex needs and step-down provision from in-patient beds

Adults with physical disabilities

Our vision

There are few alternatives in Norfolk to residential care for people with complex physical disabilities and long-term conditions. The independent living programme will provide supported living to enable more choice and control for some people.

Challenges

The challenges we face in providing care for adults with physical disabilities include:

Small sector, not much diversification
No strategy was developed for this sector, so there is no clear vision or commissioning intention for this sector
There are few options for people with more complex needs, resulting in the use of provisions at rates above what is affordable

Key data

The 2022-2023 spending by service type includes the number of people accessing services for people with a physical disability, the number of accredited locations, the number of accredited places, and the percentage of services with a 'good' or 'outstanding' rating. This includes people accessing both long- and short-term services:

Residential care home services for adults with physical disabilities

Our spend on residential care home services for adults with physical disabilities in 2022-2023: £7.1m
The number of people accessing residential care home services for adults with physical disabilities funded by us in 2022-2023: 109
The number of Norfolk County Council (NCC) accredited locations (buildings) registered for adults with psychical disabilities by March 2023: 69
The number of NCC-accredited places (beds) registered for adults with physical disabilities by March 2023: 1,568
The percentage of locations for adults with physical disabilities registered and inspected by the care quality commission (CQC) with a 'good' or 'outstanding' rating from the CQC or provider assessment and market management solution (PAMMS) as of 1 March 2023: 58.5% (excluding services that have not yet been inspected)

Nursing home services for adults with physical disabilities

Our spend on nursing home services for adults with physical disabilities in 2022-2023: £4.1m
The number of people accessing nursing home services for adults with physical disabilities funded by us in 2022-2023: 67
The number of NCC-accredited locations (buildings) registered for adults with psychical disabilities by March 2023: 41
The number of NCC-accredited places (beds) registered for adults with physical disabilities by March 2023: 1,731
The percentage of locations for adults with physical disabilities registered and inspected by the CQC with a 'good' or 'outstanding' rating from the CQC or PAMMS as of 1 March 2023: 58.5% (excluding services that have not yet been inspected)

Physical disability services can register to deliver services to people aged 65 years and older. Older people's services may also register for working age adult groups.

Supply and demand

Although there is an adequate supply of residential provision for people with physical disabilities, we are lacking provision for people with more complex needs at affordable fee rates.

The ambition is to increase the availability of independent living options for people with physical disabilities as an alternative to residential care.

The current supply and demand for nursing home care are seen as stable, and therefore the ambition is to continue as is.

Key messages to providers

Our key messages to providers are that:

We want to work with providers who are keen to develop capacity to meet the needs of people with more complex needs at more affordable fee rates
We will work with providers in 2023 to review our approach to commissioning these services and the way that we pay for care
As part of our supported housing programme, we want to develop specialist housing for people with complex physical disabilities to live in a home of their own with support to stay independent for longer

Older people accommodation based support

Our vision

Our vision for the next five years is to:

Develop an innovative and sustainable care market that is responsive to the needs of local people, delivers high quality care, and provides value for money
Improve outcomes for local people by supporting care providers to enable choice, deliver person-centred care, manage risk, and promote independence and well-being

Over the next 12 months, we will be working with NHS partners, care providers, and other stakeholders to develop a full strategic programme to deliver our vision.

Challenges

The challenges we face in providing accommodation-based support for older people include:

The complexity of the local health and care system makes it difficult for providers to get a clear picture of what we need and the confidence that this will be properly resourced
The fees that local health and social care commissioners can afford are regarded by many care homes as insufficient to meet costs, particularly in the current economic environment
Covid-19 has resulted in high vacancy rates across older adult care homes, and providers are reporting that they are not getting the level of private or council referrals to address. Some providers have limited capacity due to their inability to recruit and retain the staff needed to deliver safe care. Read more about workforce challenges.
The fair cost of care review highlighted a particular issue with nursing homes, with the majority of providers who participated in this review not securing sufficient referrals to attract the level of funded nursing care required to meet the costs of the nurse staff establishment. Some providers are therefore de-registering as nursing homes or are reducing the proportion of nursing beds and increasing the number of beds available for residential care. Read the fair cost of care review on the market sustainability and fair cost of care webpage.
Although the department of health and social care has given an indication of the funds that will be available to support market sustainability, the lack of certainty about the level of inflationary pressures makes it difficult to confirm how far Norfolk will be able to move towards the median rates calculated as part of the fair cost of care review over the next few years
Recruitment and retention of care staff across all sectors continues to be a significant challenge, particularly for registered nurses. Although recruitment and retention are challenges across the whole of Norfolk, there are areas within Norfolk where the problems are more acute. This means that it is easier for providers to set up services in the more urban areas, thereby limiting choice for people living in the more rural areas.
The level of acuity of need continues to rise, which will require an agreed-upon approach to health
The quality of provision for care homes and care at home remains low. Norfolk ranks lowest among comparators and other East of England local authorities for older adult care home provision. Read more about quality challenges.

Key data

The 2022-23 spending by service type includes the number of people accessing services for people with mental ill-health needs, the number of accredited locations, the number of accredited places, and the percentage of services with a 'good' or 'outstanding' rating. This includes people accessing both long- and short-term services:

Residential care home services for older people (aged 65 years old and over)

Our spend on residential care home services for older people (aged 65 years old and over) in 2022-2023: £128m
The number of people accessing residential care home services for older people (aged 65 years old and over) funded by us in 2022-2023: 2,508
The number of Norfolk County Council (NCC) accredited locations (buildings) registered for older people (aged 65 years old and over) by March 2023: 184 (an accredited service is a service that we can make placements to, so it does not cover the entirety of the market, especially in home care)
The number of NCC-accredited places (beds) registered for older people (aged 65 years old and over) by March 2023: 5,997 (an accredited service is a service that we can make placements to, so it does not cover the entirety of the market, especially in home care)
The percentage of locations for older people (aged 65 years old and over) registered and inspected by the care quality commission (CQC) with a 'good' or 'outstanding' rating from the CQC or provider assessment and market management solution (PAMMS) as of 1 March 2023: 70.6% (excluding services that have not yet been inspected)

Nursing home services for older people (aged 65 years old and over)

Our spend on nursing home services for older people (aged 65 years old and over) in 2022-2023: £19.2m
The number of people accessing residential nursing home services for older people (aged 65 years old and over) funded by us in 2022-2023: 331
The number of NCC-accredited locations (buildings) registered for older people (aged 65 years old and over) by March 2023: 54 (an accredited service is a service that we can make placements to, so it does not cover the entirety of the market, especially in home care)
The number of NCC-accredited places (beds) registered for older people (aged 65 years old and over) by March 2023: 2,587 (an accredited service is a service that we can make placements to, so it does not cover the entirety of the market, especially in home care)
The percentage of locations for older people (aged 65 years old and over) registered and inspected by the CQC with a 'good' or 'outstanding' rating from the CQC or PAMMS as of 1 March 2023: 61.1% (excluding services that have not yet been inspected)

Supply and demand

As of July 2023, there are 238 care homes delivering care and support to older adults.

Investment in new independent living continues, which will further increase the average acuity of need within residential care.

The older people's dashboard, developed before Covid-19, identified an oversupply of standard residential accommodation but an undersupply of enhanced residential and nursing provision. Since Covid-19, there have been high vacancy rates across all care home provisions. However, we are still struggling to source affordable, enhanced residential care for complex needs and good quality nursing provision.

During 2022-2023, work was undertaken to refresh the original pre-Covid-19 demand modelling for older adult residential and nursing care. The output from this work is:

Future needs in the older people's care home market

Two five-year scenarios for Norfolk older people's care home needs have been modelled:

Scenario one gives a higher prediction of future need as it has a strong link to the projected increase in the over 75 Norfolk population and anticipates higher demand for enhanced and complex residential alongside reduced demand for standard residential care
Scenario two gives a flatter prediction of future need that is more in line with the patterns of the last four years, with a more moderate increase in enhanced and complex residential alongside reduced demand for standard residential care

Both scenarios contain an increase in beds required by 2024 to rectify current shortage areas, plus allowances for various factors applying downward pressure on demand, including increasing independent living availability from 2025-2026.

Scenario one anticipates an increase in overall bed usage in the next five years (283), while scenario two anticipates a small reduction (154) in overall bed usage. This creates an upper and lower 'line' with the reality expected to be somewhere in between.

The anticipated increase and decrease in the number of care places required for each type of care for each of the two scenarios:

Market analysis older people accommodation based support

Scenario one

The number of occupied beds required in older people's care homes in Norfolk for the years 2023 to 2028 according to scenario one:

Residential care - Norfolk County Council (NCC) older people's enhanced/complex long-term care:

2023: 1,433
2024: 1,537
2025: 1,571
2026: 1,611
2027: 1,645
2028: 1,675
Five year change: increase of 242 occupied beds required

Residential care - NCC older people's standard care and non NCC rate long-term care:

2023: 1,057
2024: 982
2025: 919
2026: 846
2027: 783
2028: 727
Five year change: decrease of 330 occupied beds required

Nursing care - NCC older people's long-term care:

2023: 328
2024: 407
2025: 417
2026: 425
2027: 432
2028: 439
Five year change: increase of 111 occupied beds required

Residential, nursing and self/other funded care - All long-term and short-term care:

2023: 3,308
2024: 3,332
2025: 3,410
2026: 3,454
2027: 3,513
2028: 3,568
Five year change: increase of 260 occupied beds required

Scenario one total older people's care home occupancy:

2023: 6,126
2024: 6,258
2025: 6,317
2026: 6,335
2027: 6,372
2028: 6,409
Five year change: increase of 283 occupied beds required

Scenario two

The number of occupied beds required in older people's care homes in Norfolk for the years 2023 to 2028 according to scenario two:

Residential care - Norfolk County Council (NCC) older people's enhanced/complex long-term care:

2023: 1,433
2024: 1,524
2025: 1,547
2026: 1,573
2027: 1,596
2028: 1,616
Five year change: increase of 183 occupied beds required

Residential care - NCC older people's standard care and non NCC rate long-term care:

2023: 1,057
2024: 980
2025: 910
2026: 832
2027: 763
2028: 703
Five year change: decrease of 354 occupied beds required

Nursing care - NCC older people's long-term care:

2023: 328
2024: 404
2025: 404
2026: 404
2027: 404
2028: 404
Five year change: increase of 76 occupied beds required

Residential, nursing and self/other funded care - All long-term and short-term care:

2023: 3,308
2024: 3,308
2025: 3,308
2026: 3,288
2027: 3,268
2028: 3,249
Five year change: decrease of 59 occupied beds required

Scenario two total older people's care home occupancy:

2023: 6,126
2024: 6,215
2025: 6,169
2026: 6,097
2027: 6,032
2028: 5,972
Five year change: decrease of 154 occupied beds required

Shortages of older people's care home beds

Geographical areas in Norfolk each have a sufficiency rating for the provision of older people's enhanced or complex needs in residential care and nursing care. The ratings are:

Low sufficiency
Medium sufficiency
Sufficient provision

The sufficiency ratings show the difficulty in making placements and the shortages in the number of available beds in the care homes for older people in each area. For example, a low sufficiency rating shows that there are bed shortages and that it is difficult for us to make older people's care home placements in that area.

The geographical areas with identified shortages of beds for each type of care home are:

Older peoples care sufficiency ratings

Older people's enhanced/complex needs residential care

Sufficiency ratings for the provision of older people's enhanced/complex needs residential care in areas of Norfolk:

Gorleston: Medium sufficiency
Great Yarmouth and Northern villages: Sufficient provision
Fakenham, Holt and Sheringham: Medium sufficiency
Cromer and North Walsham: Medium sufficiency
Aylsham: Low sufficiency
Acle and Wroxham: Medium sufficiency
Norwich: Sufficient provision
Breckland (Thetford and Watton): Sufficient provision
Kett's Oak and Wymondham: Low sufficiency
Mid Norfolk (Dereham): Sufficient provision
Attleborough, Diss and Loddon: Sufficient provision
West Norfolk coastal and Northwest Norfolk rural area: Medium sufficiency
Fens and Brecks (villages around Downham): Medium sufficiency
King's Lynn, Dersingham and Hunstanton: Sufficient provision
Swaffham and Downham: Sufficient provision

Older people's nursing care

Sufficiency ratings for the provision of older people's nursing care in areas of Norfolk:

Gorleston: Low sufficiency
Great Yarmouth and Northern villages: Low sufficiency
Fakenham, Holt and Sheringham: Low sufficiency
Cromer and North Walsham: Low sufficiency
Aylsham: Low sufficiency
Acle and Wroxham: Low sufficiency
Norwich: Sufficient provision
Breckland (Thetford and Watton): Medium sufficiency
Kett's Oak and Wymondham: Low sufficiency
Mid Norfolk (Dereham): Medium sufficiency
Attleborough, Diss and Loddon: Low sufficiency
West Norfolk coastal and Northwest Norfolk rural area: Medium sufficiency
Fens and Brecks (villages around Downham): Low sufficiency
King's Lynn, Dersingham and Hunstanton: Sufficient provision
Swaffham and Downham: Medium sufficiency

Residential care homes

The supply and demand for residential care homes, especially those in geographical areas with shortages:

Demand plus council placement practices mean that there will continue to be a reduction in the number of new placements for people with standard needs and an increase in those with enhanced or more complex needs. These people will require larger rooms, more equipment (or space to accommodate), and a higher level of skilled staffing to support them.
For care homes in the shortage areas, if they have vacancies that they cannot fill or that arise, and where they are able, changing these beds to support an older person with more complex needs would result in a much better chance of the council making a placement there. This may require adaptations and staffing changes to enable it.
Care homes are encouraged to register with CQC for dementia and make the necessary staffing decisions to facilitate accepting more residents with dementia, especially those with enhanced level needs

Nursing homes

The supply and demand in nursing homes, especially those in geographical areas with shortages:

Generally, larger rooms, more equipment (or space to accommodate), and a higher level of skilled staffing to support people with more complex needs would result in a much better chance of the council making a placement
The complex situation for nursing homes around decreasing occupancies and difficulties finding appropriate placements has not yet been fully explained. Based on demographic data, we anticipate that we will require additional older people's nursing placements in the future. However, at the same time, we have experienced low numbers of nursing placements over the past few years. This is a complex situation that needs to be understood and addressed as part of our joint work with the integrated care board (ICB).

Our commissioning intentions

Residential and nursing

Our commissioning intentions for residential and nursing care are:

More enhanced, dementia and complex physical needs beds increasing in line with projected demand
Reduction in the low care need offer ('true' standard residential). There is a need for alternative or prevention provision, especially independent living or home care.
Accessible provision accepting NCC fees or charging a 'reasonable fee' in all areas of Norfolk, within a 'reasonable' distance of where people live
A high (and increasing) percentage of temporary care arrangements result in people returning to their usual place of residence
Good value and high quality, not cheaper and lower quality
Modern buildings or improved older buildings offering sufficient room size and home layout. This could ultimately mean fewer but more modern and larger homes.
Care homes rated at least 'good' by the most recent CQC or PAMMS inspection or on a 'provider quality journey' with our integrated quality service (IQS)
Care homes can cater to increased levels and complexity of need, both physical and mental
Skilled workforce paid a competitive wage, on a secure contract, supported to live in area where they work with less reliance on agency staff
Residents will be supported (on average) for a relatively short period of time

Nursing

Our commissioning intentions for nursing care are:

Continuing to work with the ICB to understand current and future nursing demand and to explore opportunities to align the commissioning and contracting of funded nursing care and continuing health care. This includes reviewing our current care definitions for residential and nursing care as well as consideration of a joint block contract for nursing care.
Fewer 'specialist' homes with nurses and skilled staff concentrated in fewer homes could be an option
Greater percentage of beds used or available for nursing rather than residential, ensuring that funded nursing care covers costs associated with operating a nursing home (for example, a greater percentage of the residents will receive this payment)

What was achieved during 2022-2023

We have drafted a five-year strategy for accommodation commissioning for people aged 65 years and above. We will be engaging with NHS partners, care providers, and other stakeholders to finalise this programme over the next 12 months.
We worked with providers to deliver the fair cost of care element of the social care reform. We also worked with providers to inform the development of the market sustainability plan, another key element of the social care reform. You can read the reports on the approach and outputs in the market sustainability and fair cost of care webpage.
We supported the ICB to introduce a new health-led intermediate care bed offer (pathway 2) from 1 July 2022. This replaced the short-term beds we previously commissioned during the Covid-19 pandemic.
We are working with the ICB to undertake a joint review of the commissioning and contracting of continuing health care and funded nursing care to identify opportunities for improvements. Working with care providers to implement the recommendations from this review is a key priority moving forward.
We have continued to develop our approach to identifying and supporting care providers who are at risk of failure

Key messages to providers

Our key messages to providers are that:

We want to work with registered social landlords and care providers to develop 1,135 units of independent living by 2028, increasing provision for people with lower care needs and helping them to remain independent for longer. The expected impact of this has been included within the residential demand modelling in the 'supply and demand' section.
We want to develop and enhance specialist provision for people with dementia, including working age dementia
Although we have an adequate supply of residential capacity, we have significant gaps in affordable provision for people with complex needs. We want to work with providers to develop the model and the affordable fee rates that would encourage providers into this sector.
We are working to identify ways to deliver a lower carbon sector