Agenda item

This paper provides a briefing on the care homes market in Bath & North East Somerset (B&NES). It offers an overview of the quality and supply in current provision as well as introducing some key gaps and challenges in the sector.

The Commissioning Manager for Adult Social Care introduced this report to the Select Committee. He informed them that the Care Quality Commission (CQC) lists 60 care homes in B&NES. The ‘Older Persons’ portion of that market consists of 36 homes offering 1,375 beds in total. He added that roughly a quarter of this capacity supports dementia care.

He explained that the Council currently has 320 active placements in B&NES, including 34 Continuing Healthcare beds on behalf of the CCG. This is a market share of 23%. The remaining beds are either vacant or occupied by placements from other Local Authorities/CCGs or self-funders. The Council and CCG also make some out of area placements though this is a minority.

He said that as of 11th September 2017, there are 40 available vacancies across B&NES and 11 of these are for nursing beds.  However, the bed types do not always match the needs of people assessed and not all of them are affordable to the Council. Almost half of the 40 vacancies are in one particularly expensive home. This puts a lot of pressure on the Council when securing placements and can also cause delays in hospital discharge. 

He stated that the majority of care homes in B&NES are rated by CQC as ‘Good’ though a few do ‘Require Improvement’ in one respect or another.

He explained that between 2016 and 2017, 6 care homes in B&NES closed with the loss of almost 200 beds. This was due to a range of factors but again has reduced capacity significantly, pushed up fees and led to greater pressure on hospital discharges. The commissioning team has a successful track record in managing these closures and ensuring continuity of care for residents.

He informed the Select Committee of the ‘Discharge 2 Assess’ beds project. He said that this was a result of joint commissioning across the Council and CCG in partnership with the not-for-profit sector. He explained that commissioners are piloting a scheme to deliver 5 short-stay beds to assess people’s long term care needs. This alleviates pressure on hospital discharge and allows people’s long term needs to be more accurately assessed outside the acute hospital setting. It will also help the Council to place people in a more planned way and negotiate fees with providers with more time.

The Chair asked if there were any concerns over staffing levels within care homes.

The Commissioning Manager for Adult Social Care replied that B&NES is a member of the ‘Proud to Care-South West’ campaign. This seeks to make social care a more attractive career option and tackle the longstanding challenges of recruitment and retention in care homes. He added that there are enduring issues of staff turnover and shortage, with close attention on the possible impact of the UK leaving the European Union.

Councillor Bryan Organ asked if the Council had working connections with St. Monica’s Trust.

The Commissioning Manager for Adult Social Care replied that there is an established working relationship and that potential opportunities were being explored.

Councillor Lizzie Gladwyn asked if a figure could be given to the average waiting to be placed in a home.

The Commissioning Manager for Adult Social Care replied that the availability of appropriate supply is fluid. He said that every Friday a multi-agency discussion takes place to help find the right placement or care package for people. He added that delays can occur through either the patient’s needs changing while in hospital or changes in families preferred destination.

Councillor Geoff Ward asked if a local place within a local home can be guaranteed.

The Commissioning Manager for Adult Social Care replied that travel links were key in this decision making process. He said that affordability was a factor and considering how in some boundary areas, placements outside of the B&NES area may be required where there isn’t in-area supply.

Councillor Eleanor Jackson asked was there any evidence to support the planning decision for a dementia care home that the developer now says cannot be marketed.

The Commissioning Manager for Adult Social Care replied that the need has been identified and that commissioners were to become more involved with the planning department prior to future developments. He added that the challenge remains through affordability and geography and that it was a long piece of work that lied ahead.

Councillor Geoff Ward commented that an ageing population is obviously a factor alongside the work that takes place to keep older people at home for longer initially before care is required.

The Select Committee RESOLVED to note the report.