Current projections assume that demand for residential care will continue to fall as more alternative services in the community develop. However, the demand for good quality nursing home care is expected to rise, given increased dependency levels of service users and a shift from acute hospital beds to other community bed-based or community care and support options. Torbay Council, with the CCG is currently planning to encourage more good quality care home with nursing bed development in the area, whilst discouraging the development of more care home without nursing beds.

There are some areas where we could do better in preventing the need for long term care e.g. people with mental health issues needing long-term care. Whilst the rate of clients accessing long-term support for autism or Asperger’s is significantly lower than our comparator group average (figure 9) by contrast there are higher rates of clients accessing long-term mental health support across both the 18 to 64 and the over 65 year old age groups (figure 10figure 11 and figure 12).

We seem to be managing demand comparatively well at the moment but pressures are rising (figure 13). And we often provide some sort of service more so than other similar authorities (figure 14).

We can see in figure 14 that for people aged 18 to 64 years:

  • Torbay provides more long-term support in the community than other comparable areas of the South West or England as a whole;
  • That less people receive ‘no services’ than elsewhere; and
  • Low level and short-term support or signposting to other services is comparable or better than other areas.

This performance is in line with the vision to increase the options available for people in the community so that they can stay in their own home for as long as possible.

We can see in figure 15 that for people aged 65 and over:

  • Torbay provides more long-term support in residential care in particular than the South West or England, but less than family group comparator authorities. Use of nursing care is lower. These figures may reflect lower levels of supply of good quality nursing care in the Bay and the oversupply of residential care;
  • That less people receive ‘no services’ than elsewhere; and
  • That levels of on-going low level support could appear to increase but short-term support to maximise independence is higher than elsewhere (in line with the vision to invest in intermediate care).

This performance is in line with the goal to increase the options available for people in the community so that they can stay in their own home for as long as possible. However, the apparent over provision of residential care and under provision of nursing care is an issue. A key issue is that alternative offers of service, like direct payments and personal budgets, need to grow so that care homes placements are not used unnecessarily.

Over the last few years the following changes have taken place in the volume of adult social care services we deliver as commissioning shifts from bed-based care to community support to allow people to stay in their own homes:

  • Use of care home placements decreased from 873 clients in April 2012 to 744 clients in December 2016, a decrease of 15% in 4.75 years. See figure 16.
Table 2: Long term care placements
Year Under 65 Over 65
2014/15 5 people (6.7 per 100,000) lower than England or other unitaries 205 people (606.3 per 100,000) lower than England or other unitaries
2015/16 12 people (16.3 per 100,000) higher than England or other unitaries 174 people (513.0 per 100,000) lower than England or other unitaries

Source: Adult Social Care Outcomes Framework, England - 2014-15 and 2015-6 Final release

This table shows that between 2014/5 and 2015/6 the number of people being moved into long-term residential care from other settings decreased for older people, but increased for people under the age of 65 per 100,000 population. 

Trends in key alternatives to bed based care

10.7% of clients receiving homecare in Torbay receive less than two hours of domiciliary care each week. This is in line with the national average of 9.1%.

32% of clients receiving domiciliary care receive in excess of ten hours of domiciliary care each week. This is below the national average of 46%. This is surprising when taking account of the reduced reliance on care home placements and could suggest that the investment in intermediate care services in the Bay are effective in supporting and working closely with complex clients.

Demand for services from self-funders

The Local Government Information Unit (LGiU) report ‘Independent Ageing 2013’ estimated that on average, 41% of people entering residential care each year are self-funders, and of those, 25% will run out of money.

The self-funding segment is a significant part of the overall care market, with an estimated £4.9 billion being spent in care homes and a further 168,000 places being ‘topped’ up with individuals’ private funds. Estimates in 2011 suggested that the home care market alone was worth around £652 million nationally.