Residential and nursing care home market

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.