Ignoring Local Authority funding levels for a while, there is another massive challenge facing the care home sector over the coming years; that of providing enough beds for those who need them.
During 2015 and 2016 a total of around 13,300 new care home beds were created through openings in care homes catering for older people. That is around 1.6% increase per annum, which is less than the 2% increase each year just to keep up with growth in the older population.
But during the same period, nearly 19,000 beds were lost due to closures.
So, whilst we needed an extra 16,000 care home beds just to stand still, with all the openings and closures during that period, we have lost around 5,600. Fortunately, new registrations through extensions in existing locations, has reduced net losses over the 2 years to around 3,000 beds.
If this rate of loss continues, and if we assume that a generally reported average occupancy level was around 90% a couple of years ago – by 2019 there will be more people needing a care home bed than there will be beds themselves. (See table)
But this is just the tiny tip of an iceberg that could sink the Care Home sector.
Whilst care is a national concern, it is built on local need, and there are so many massive local variances in supply and demand levels across the country.
- On average in England there are around 87 beds for every thousand 75 plus population (who account for about 90% of care home beds) but at Local Authority level this varies between 148 beds per ‘000 in Middlesbrough, and just 39 per ‘000 in Bracknell Forest.
- Only 40 out of around 150 local authorities are within 5% either way of the average supply levels – only 56 are within 10% – so around two thirds of local authorities will have too many or too few beds available to them.
Where supply levels are too high, there will be a degree of local choice that should put the person at the centre of their care, but there will be pressures on both occupancy levels (that will obviously be lower than average) as well as the availability of RNs and care workers, who will be spread even more thinly across the homes.
And over supply does cause casualties. Around 62% of net bed losses in 2016 were in local authority areas that had a higher than average beds per thousand rate.
Conversely when supply levels are too low, local choice will be almost non-existent, and may well result in people being moved outside their local area in order to find the right type of care (or being housed locally in a less than suitable location?)
So how can technology help?
By using current and forecast population data, aligned to existing supply levels on a local basis, (as I have done here) we can identify areas where we need new care home beds to cope with increased local demand – and those where we do not.
These will not always be in the most “demographically ideal” locations, so we must:
- Secure government funding, subsidies and grants to encourage and incentivise, developers and investors to build new homes that fit with the local need and demand, rather than local demographics. The reduction or removal of the cost of debt will obviously assist operational performance especially within less affluent areas.
- Local demand should not just be about number of beds, and the CQC needs to broaden its categorisation of registered homes. For example, rather than specifying a single registration figure for a home, it should detail the number of beds allocated to specific areas (nursing, residential, dementia etc.) and levels of dependency – which will be especially useful to the NHS when trying to find care for someone who can leave hospital.
- Encourage local authority social services to work alongside their planning departments to fast track applications where real local needs exist.
- The Local Authority should also consider other planning applications where a new home will create an over-supply situation, that will affect the future of existing, experienced and quality care providers, and further dissipate the already limited numbers of registered managers, care workers and RNs.
Of course, we would not necessarily have to build all these new care homes, if we could get the Homecare marketplace sorted. Unfortunately, and again I put aside funding levels, it is very hard to quantify local supply and demand, as we can do with care homes.
A care home will have its number of registrations, which helps in quantifying the local supply and demand situation. Unfortunately, a homecare location is simply registered as an office – offering no idea of number of carers, or hours of care that it can provide.
I believe very much that if there was a way of measuring local supply and demand for homecare, it would show similar imbalances across the country.