The key challenges for residential and nursing care in Staffordshire include the following.
Quality and person-centred care
We primarily judge the quality of care within care homes by their CQC ratings, although we recognise that in some cases there can be a considerable period of time between CQC inspections. Every care home should aim to be assessed by CQC as ‘Good’ or ‘Outstanding’, and every care home that is below this level should be enacting a clear plan to improve.
Some care homes have been unable to demonstrate capacity or capability to achieve a ‘Good’ or better rating from CQC, even where considerable support has been offered. There is a risk to the longer term future of those care homes.
As a County Council, working with the market, our processes for commissioning care home placements (e.g. our pen portraits) are not always as effective as we would like in supporting strength-based and outcomes-based commissioning, and so there is a need for a stronger focus on achieving personalised outcomes that maximise independence when delivering care and support for all individuals, particularly important in a group setting such as a care home.
Choice and accessibility
There is not always sufficient availability of good quality nursing care to meet complex needs. This includes dementia, complex communications needs, complex and challenging behavior, forensic mental health needs and complex physical and health needs.
In some areas of the county, there is a more limited choice of care homes that are available to people, and sometimes commissioners experience lengthy delays in being able to confirm placements in care homes, (which can be affected by the availability of decision makers within the care home setting): this can also affect the choice of placements available in practice.
Working in partnership with the NHS, there is an ever increasing expectation of being able to support hospital discharges 7 days a week. Swift decision making and support to discharges is particularly important for care homes specifically commissioned to provide Discharge to Assess or other services which support step down from acute hospital settings. It is also important for a reasonable pace to be achieved in sourcing care for people at the end of a Discharge to Assess episode, or for people living in their own homes who require an urgent placement due to a sudden escalation in needs or reduction in unpaid support.
Cost effectiveness
There is a wide variation in rates paid by the County Council for categories of care home in some areas of the county – a wider variation than would appear to be explicable by the nature of the care provided alone, and therefore appears to be unwarranted.
For all care homes, there are increasing cost pressure due to increases in national and living wage, national insurance, supplies, services and the impact of COVID-19.
The Council has recently completed and submitted to the Department of Health and Social Care (DHSC) the Fair Cost of Care exercise. The exercise was a condition of the Market Sustainability and Fair Cost of Care Fund.
The exercise was designed to identify median rates for older people care home services. At the present time there has been no confirmation of additional funding made available from central government to cover any cost changes from this exercise.
Workforce
The care home sector continues to be challenged in retaining and recruiting a sufficient and appropriately skilled workforce especially in leadership roles and clinical roles such as nursing, but also including other care workers. While there was a reduced turnover of staff during 2020/21, the overall trend in vacancy rates has been an increase over the past five years across the region. For many roles, the ability to retain and recruit can be significantly affected by the wider economy – i.e. the pay and conditions of roles in other sectors outside health and care. Many care homes are increasingly reliant on agency staff, which increases costs, and can adversely affect care if it adversely affects the continuity of relationships within the care home.
In January 2021 the Council commissioned Skills for Care to complete a district analysis on the County’s workforce, in order to understand the opportunities available in Staffordshire from the social care sector. The analysis concluded there are 10,900 jobs in care homes and of these 6,300 within a nursing home and 4,600 within a residential home. Of the 10,900 jobs, 7,300 of those roles are delivering direct care. The analysis highlighted the need to attract future generations into social care careers. In Staffordshire care staff aged 50 and over made up 39% of the workforce whereas only 2% of the workforce is aged under 20.
COVID-19
The pandemic has had a profound impact on care homes, and we recognise and appreciate the incredible role care staff have played in protecting those most vulnerable in our communities during this challenging time. We are grateful to local providers who have risen to the challenge, responded quickly and been prepared to deliver services differently, and we believe that providers who have been best able to do this are most likely to have the skills and capability to adapt to future challenges in social care.
During the pandemic there has been substantial short-term investment in the sector, often through specific government grants. This may, however, mean that for some care homes there are longer-term challenges to sustainability that may become evident during 2022 and beyond. We will continue to work collaboratively with the sector and share intelligence about the changing care market to inform commissioning activity and enable care providers to make informed decisions about their services.
Digital and technology enabled care
Digital and technology is advancing at pace in our sector and presenting opportunities to improve the delivery and quality of care. Care homes need the ability to increase the use of assisted and digital technology enabled care. The Council in partnership with care homes need to consider the use of technology to prioritise the time of the available workforce and support them to deliver quality care. In addition, technology has become key in proactively monitoring and managing health conditions. Care homes need to ensure their practices are technology enabled.
Estates and property
Some care homes have challenges in providing the best possible quality of care due to the nature of their physical estate, and this has sometimes made it particularly difficult to implement all the guidance relating to COVID-19 - for example, care homes without ensuite facilities in every room, a large number of shared rooms, or buildings that make it more difficult to cohort residents.
When considering a care home placement, the Council requires a supply of appropriate specialist and adapted accommodation to allow people with physical disabilities and/or support needs to remain independent. In addition, the ability to safely accommodate and meet the needs of bariatric residents.
There are a number of new builds in the county recently opened or still at the planning or build stage. As a Council we want to work with those property developers to ensure the build offers a service that meets the needs and expectations of our communities. The Council wants new builds to be designed for the people in our communities who can no longer manage to live independently with varying level of complexities of care needs and to provide cost models that are affordable to all.
Adult social care reform
The Governments white paper, People at the Heart of Care, sets out an ambitious 10-year vision for how the government intends to transform support and care. The intentions from the white paper will support to shape the Staffordshire care home market and as a Council we will ensure all practices and approaches embedded deliver the three key objectives of the reform for the people we support;
- How we will support people to have choice, control and independence
- How we will provide an outstanding quality of care
- How we will ensure that care is provided in a way that is fair and accessible to everyone who needs it.
To prepare for the social care reform like all other local authorities Staffordshire is undertaking the fair cost of care exercise with the aim for all Staffordshire care home residents to pay a fair and sustainable cost nondependent on how the placement is funded. To achieve this the Council believes a reduced variation in all care home weekly charges will be required.
The scope of the national cost of care exercise is for care home placements for those aged 65+. The spread of varying fees remains a challenge to the Council, and in order to achieve a fair and sustainable market for all client types we intend to look at a localised exercise for placement costings for those aged under 65.