As the news continues to fill with figures around delayed discharge, and the role of social care in relation to this, it is critical that we understand what is happening to care home beds across England, and importantly care home beds in the not for profit sector. Mike Short, from Care Sector Innovations, has produced an exclusive report for NCF
highlighting how the not for profit sector performed in 2015. I want to look in detail at his figures, to understand what they might mean for the future.
(Upon reading the title of Mike’s report – Say Hello, Wave Goodbye - those of you hoping for a Soft Cell tribute blog may be disappointed. However, as a teen of the 80’s, whilst I might have eschewed the big hair and shoulder pads, it is almost impossible for me to shake off the decade without some fondness for Marc Almond. So – I have decided to pick some of their back catalogue to walk you through this new report.)
Forever the Same
CSI findings suggest that overall, the not for profit sector has lost, rather than gained care home beds for older people during 2015. This is in line with the sector as a whole, which lost 3,000 beds in 2015 against a required growth of 9,000 beds needed to meet the extra demand from changing population needs. Having seen last week’s report Still Not Ready for Ageing
, highlighting the lack of readiness for ageing across the UK, this reduction in capacity within the sector can only serve to reinforce the lack of appropriate provision for the needs of the future population.
There is significant regional variation in relation to both opening and closures in the not for profit sector across the UK. The South West and London demonstrate the largest net closures, whereas the largest net gain is in the North West. The South East and Yorkshire and Humber show small amounts of growth, but there is limited activity elsewhere in the country. We know from demographic trends, that this does not reflect population change and growth.
Where the heart is
The majority of growth in care home beds across England is in dementia specialism, with a national figure of 90%, and a not for profit comparator of 85%. This is not surprising in the context of commissioning priorities, and the raising of social care thresholds. However, what is interesting is the proportional growth in residential provision in the not for profit sector, in comparison to the wider UK sector. Two thirds of growth in the not for profit sector was in residential provision, and one third in nursing – in contrast to the growth patterns across the sector as a whole which have favoured the development of nursing provision over residential. This was mirrored in the closure patterns in the not for profit sector, where more care home beds were lost from nursing homes than residential settings.
We know that recruitment of nurses to the sector is a key issue for NCF members, and earlier this year NCF produced, in partnership with Skills for Care, a powerful document
outlining the contribution of nurses to social care. In addition, the long awaited increase in NHS funded nursing care rates
may encourage more not for profit care providers to think more positively about growth in nursing.
Insecure – Me?
It seems from CSI’s report that size matters. Whilst the figures have not be broken down for the not for profit sector, the overall report on performance in 2015 shows that the average size of home opening in 2015 was 50% larger than those that closed, and 20% bigger than the market average. The analysis of this leads to some conclusions around the real challenges facing smaller residential care homes. The picture seemed less challenging for small nursing homes, where there was some growth of smaller units. Interesting debates to be had going forward over economies of scale, and consumer choice.
It is impossible to read the overall analysis of CSI’s report without asking some significant questions about how localities will meet future needs. We know that where bed numbers are shrinking in areas already under supplied, the further reduction will only limit the potential for people to exercise choice and control at the point when they need to enter a care home, as well as serve to exacerbate unnecessary delays from hospital. For commissioners, providers, families and residents thinking about the future – this report makes that Soft Cell refrain come to life – meaning we toss and turn and can’t sleep at night!