Residential and nursing care home market

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