Agenda item

15.1     The Assistant Director - Strategy, Commissioning and Supply Management introduced the report, making the following observations:

·         Many of the issues outlined in the report are not unique to East Sussex but are part of general national and international trends.

·         The direction of travel in response to these trends is to use services differently and develop new forms of care.

·         There are ongoing programmes of work in East Sussex to mitigate the issues through East Sussex Better Together (ESBT) and Connecting 4 You (C4You).

·         Supplier relationship work has resulted in identifying a number of nursing home beds which can potentially be block contracted as and when needed.

·         The homecare supplier development programme has had a real impact on the sector and on care workers pay and conditions.

·         A bedded care strategy is being developed in order to obtain a more coherent view and subsequently recalibrate capacity.

·         Changes to the structure of ESCC’s contacting and supply team should have a real impact.

15.2     The following additional points were made in response to the committee’s questions:

·         Providers coming forward for the Care Home Plus scheme are not getting sufficient business from self funders. suggesting they may not be of the quality needed. This suggests that the care homes may not be of the quality required to provide the scheme. Higher quality providers are being proactively sought to offer the Care Home Plus model.

·         Social care assessments have never been a significant cause of delayed transfers of care (DTOCs).

·         Although there are nursing home vacancies evident in the data, these are not necessarily in the right place – fewer in the west of the county than the east. There is a further issue related to choice – people sometimes want to wait for a preferred placement.

·         There are a number of specialised developments advertised across the south east and marketed to people with high levels of income. ESCC is not in a position to pay the rates charged by these developments, both in relation to the cost of individual placements and due to the risk of inflating fees across the market.

·         Demographic pressures are reviewed as part of the budget setting process, using the Joint Strategic Needs and Assets Assessment (JSNAA) to identify projected need in different cohorts and therefore the type of services needed. Key cohorts are residents aged 75+ and particularly 85+, where needs for health and social care increase considerably. A modelling tool is in development through ESBT which will use current demand as a baseline and demonstrate the effect of making changes to the numbers of people supported in different ways (e.g. via technology). This will increase the availability and reliability of data but ultimately there will always be judgements about what is required.

·         The bedded care strategy is important in identifying demand and need and will be linked to an estates strategy as there will be a need to build or develop new nursing homes. East Sussex has numerous small and medium sized providers rather than more robust larger providers.

·         Historic fee levels did present real challenges for the market but budget reductions limited the Council’s ability to increase these over the last eight years. There was a choice between increasing fees or meeting eligible need. The fee increases which have been possible this year have focused on areas of capacity concern and have been a direct result of the extra government funding provided over two years. This additional funding will end in 19/20 unless there is further Government action to address the funding gap.

·         The fee rise appears to have stabilised the market compared to last year and there have been fewer closures. However, it hasn’t increased the capacity to the levels needed and it doesn’t bring local authority fees close to the self funded rate. Initial modelling suggests around 50 vacancies a week are needed to make the system work and these levels are not currently available.

·         Local authority placements make up 40% of the market and offer providers stability of funding and a high level of certainty of occupancy for homes. For these reasons most homes have a mixed economy of local authority and self-funded clients.

15.3     RESOLVED to note the report.