Housing for an Ageing Population James Cawley Service Director: Strategy and Commissioning Nicola Gr

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Housing for an Ageing PopulationJames Cawley
Service Director Strategy and CommissioningNico
la Gregson Head of Commissioning Older People
and Adults with Physical ImpairmentDepartment
of Community Services
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Background

• LAA priority affordable homes
• Block contracts for provision of domiciliary care
  and care homes
• Little affordable Extra Care housing
• DToC very poor performance
• County Council did not understand housing
• Unitary Authority needed to make progress while
  establishing new Council
• CSCI / CQC lost star rating not viewed well
  by CQC or Regional Office

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Background

• Needed to engage key members and officers on
  benefits of improving choice for older people
• Linked to demographics and budget pressures
• Explained how other services could help deliver
  Corporate agenda
• Adult Care not a vote winner
• Orders of St John
• 20 year strategic partner
• not for profit
• contract not looked on favourably by Corporate
  procurement

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What proportion of the spend on Older people goes
into Residential Care?
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What we did

• Older Peoples Accommodation Strategy not just
  buildings
• Whole of the market
• All older people, not just people who receive a
  social care service 70 self funders
• Orders of St John 20 year strategic partner -
  not for profit
• Steering Group
• Land audit of 4 District Councils and County
  Council
• Office accommodation rationalisation surplus
  land to be considered for affordable housing

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Accommodation Strategy

• Phase One
• Data analysis to forecast demand for
  accommodation
• Assess appropriateness, demand for, and
  sustainability of, existing social housing
• Identify existing and planned provision of
  residential and nursing homes to assess their
  sustainability
• Quantify existing and planned provision of older
  peoples housing in the private sector
• Forecast future accommodation requirements of all
  types of older peoples housing

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Accommodation Strategy

• Phase Two
• Propose how future accommodation requirements can
  be met
• Provide a data model to forecast demand that can
  be adjusted as factors change
• Provide development and financial assessments of
  a number of potential sites

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Demographic Characteristics

• Population
• Number of older people within Wiltshire to
  increase by 55.7 by 2026
• 65-74 increase by 44.8
• 75-84 increase by 58.6
• 85 increase by 89.4
• Significant variations of population increases
  between community areas

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Demographics Characteristics
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Demographic Characteristics

• Tenure by Older People
• 71.8 own their own home
• 4.1 rent from the Council
• 15.8 rent from a social landlord
• 8.4 rent privately or live rent free
• Dementia
• Number of dementia cases within Wiltshire to
  increase by 59 by 2025
• Significant variations between community areas

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Demographic Characteristics
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Demographic Characteristics

• Migration not a significant issue within
  Wiltshire small net inflow for all age groups
• Ethnicity for older people predominantly White
  British no significant variations across areas
• None of Wiltshire is within top 10 deprived in
  England 3 areas among most 20 deprived
  nationally
• 15 of older people have limiting life-long
  illness lower than national average

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Care Home Sector

• 3,408 care home places for older people 59
  residential, 41 nursing
• EMI care 32.5 of overall provision
• Stable market
• Generally good spread throughout county
• Unrealistic to expect local supply in each
  community area due to larger home provision
• Investment required in preventative / diversion
  services to reduce demand in future

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Sheltered Housing

• 4,046 units of accommodation 69.8 rent, 30.2
  sale)
• Space standards, accessibility and level of
  preventative services are generally poor
• Tenure and level of supply varies across county
• Under supply of leasehold and shared ownership
• Growing demand for 2 bedroom accommodation and
  wider tenure choice representative of general
  needs housing

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Extra Care Housing

• 305 units of accommodation 35 affordable
  housing, 65 leasehold or market rent
• Very uneven supply across the county for all
  tenure types
• Significant under supply of extra care housing
  again all measures within Wiltshire
• Unless addressed it will impact upon Wiltshires
  ability to meet future demand and older peoples
  expectations

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Services

• Further investment in key preventative areas
• Additional investment in informal carers
• Improved information about options and services
• Further development of assistive technology
• Further development of step-down / intermediate
  care and hospital discharge services
• Better co-ordination of Supporting People
  resources
• Investment for independent brokerage service

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Key Messages

• Greater emphasis on nursing and specialist care
• Ensuring the new care home provision meets the
  aspirations of older people and is fit for
  purpose
• Reduction in the number of residential care home
  placements
• Development of extra care housing
• Supporting more people to remain in their own
  homes greater emphasis on preventative services

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Issues

• 1000 units of Extra Care over next 5 7 years
• Hub and Spoke Extra Care housing for rural
  communities
• New developments of Extra Care / Care Villages
• Remodel sheltered schemes for Extra Care and
  other user groups
• Decommissioning of care homes - political
  difficulties post Election
• Area Board profiles dispersed bungalows through
  to specialist nursing care
• Evidence based shift needed to
• decommission residential care, commission Extra
  Care and specialist nursing care
• can only work with more preventative services
  e.g. Telecare, Reablement, Intermediate Care

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Issues

• Efficiency model to deliver Extra Care
• Supply and Demand Model linking services to
  accommodation
• Private care home providers understand
  direction of travel either they will work with
  us to change or they will go out of business
  very positive response
• Need small and large provider mixed economy
  need all to manage the market
• Third sector providers to manage down self funder
  market extremes for care home fees

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Area profiles
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Governance Arrangements for Older Peoples
Accommodation report

• Partnership inclusive group, including NHS
  Wiltshire
• critical they understood the effects of
  increasing accommodation choice for them as well
  as Adult Care
• Steering Group RSLs
• harsh messages about quality of sheltered
• needed to have them on board to deliver new
  agenda
• Wiltshire and Swindon User Network leading a
  workshop on key priorities

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Delivery of our aspirations

• Successful Department of Health Extra Care scheme
• PFI bid to Homes and Communities agency
• Corporate support and track record of delivering
  on PFI schemes, capital projects and Unitary
  implementation plan
• Working with RSLs to identify other opportunities
• Joint approach Housing, Adult Care, Regeneration
  and Planning
• Identified sites
• PFI bid to Department of Health Dementia
  programme linked to Extra Care strategy, Orders
  of St John development strategy

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Delivery of our aspirations

• 24/7 health and social care response service
• Telecare infrastructure and services
• Review of domiciliary care contracts outcome
  focused
• Re-commissioning of Home Improvement Agencies

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Rutland House, Trowbridge

• DH funding obtained
• 40 units of extra care
• 20 social rent / 20 outright sale shared
  ownership
• Community facilities
• 2, 3 bedroom supported living bungalows
• Complete by December 2010

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North Wiltshire Schools PFI

• 140m project or 28m (indexed) per annum over 32
  years
• Originally to build 1 and refurbish 2 schools
• Built 3 new schools in 2 years as a result of
  design and material innovation by provider
• Project delivered on time and within budget

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Wiltshire and Swindon History Centre

• 11m project joint funded with Swindon
• 3 years to complete
• Extensive consultation conducted
• Specialist design and construction contractors
• Completed on-time and within budget
• Opened 31 October 2007

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Athelstan House, Malmesbury

• Care village campus
• Developed in partnership with NHS Wiltshire and
  Private Developer
• 80 bed care home with nursing re-ablement unit
• GP surgery
• Chemist

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Burnham House, Malmesbury

• Vacant care home site
• Surrounded by local community and other older
  peoples accommodation
• Short walk to town centre
• Consultation with local people undertaken
  preferred site for extra care housing

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Map of Potential Sites
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Demand Information / Analysis
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Some Issues

• Orders of St John managing the market, not for
  profit organisations
• Commissioning care model in partnership with
  RSLs key issue 24/7 support and efficiency
  agenda
• Personalisation and choice where is the choice
  in Extra Care and how does this balance with
  efficiency agenda
• Orders of St John development strategy
  decommission care homes and retain an affordable
  care contract
• Care home market management
• Extra Care housing hub and spoke models must be
  cost effective
• Private Developers economic situation

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Outcomes

• Users and user organisations
• understand direction of travel and how the
  Wiltshire model will offer choice and quality
• CQC / Regional Office
• very different view of Wiltshire
• helped in selling Wiltshire story
• Adult Care a priority and vote winner in
  Wiltshire
• Efficiency agenda
• Adult Care has shown other services the way
  forward

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Where next

• Await PFI decisions
• Continue with engagement strategy
• Proactive approach with RSLs, care providers
• Refine Extra Care model efficiency agenda
• Care pathway for older people - CSED

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QUESTIONS?