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Future horizons: Planning for reform

How must the care sector adapt its approach to meet care needs of the future? Liz Jones, Policy Director of the National Care Forum (NCF), analyses some of the emerging trends and puts forward some of the questions care leaders should be considering.

In a previous edition of CMM, Knight Frank provided an interesting article about the future demand for care homes and the future challenges for providers.

An ageing population and the potential increase in older people who may need care presents both challenges and opportunities for providers. The current social care reform plans introduced by the Government raise questions about possible changes in behaviours of people looking for care and support, changes in commissioning approaches, changes in what care providers offer and changes in system leadership.

Demand for care

We have an ageing population; the DHSC’s ‘Evidence Review for Adult Social Care’ highlights that demand for social care has risen in both the older and working-age population. It describes a population in England that is ageing and an over-65 population that is becoming more diverse in terms of its care needs. Alongside this group, the review reports that key drivers of increased demand in the under-65 population include the increased proportion of people with a learning disability, following improvements in the diagnosis and reporting of disability and in the increased survival and longevity of babies born prematurely.

We also have a shrinking workforce – the ageing of the population will reduce the proportion of the population that is of working age (as currently defined), raising challenges for the staffing of care services; a proportionately smaller working-age population is likely to lead to labour market shortages across the wider economy as well as social care.

Adapting our approach

So, we are currently seeing more demand for care and a shrinking workforce to provide it. Considering the challenges to the care workforce and recruitment, Oona Goldsworthy, Chief Executive of Brunelcare, an NCF member organisation, said, ‘Many of our old assumptions about recruitment have been pushed aside. We’ve had to adopt a partnership approach that requires us to be much more proactive and closely linked to our local communities. In recent months, this has included: working closely with our local further education and higher education colleges to provide work placements for students; teaming up with youth and refugee charities to run taster sessions and redesign our application process; and sponsoring clinical apprenticeships in nursing and occupational therapy.

‘We know that there are more jobs than people to fill them, so we have to be flexible and work around what job seekers want. Sometimes this means more flexible hours and sometimes it’s about clear career routes, so we are investing in training and making use of the apprenticeships levy, which other employers have agreed to share with us. We are also re-designing some jobs and giving people the opportunity to move across the charity to gain more experience and support succession planning. Finally, it would be remiss not to mention pay.

‘On April 1st, we increased our entry-level pay to the Real Living Wage, with clear differentiation above this. It’s early days but, for the last three months, we have had more starters than leavers. We very much hope that is the start of a longer-term trend, as without dedicated and committed colleagues we will never be in a position to meet the needs of
our communities.’

The future of care

The exciting challenge for care providers now is, ‘What sort of care and support services can we envisage in 20 years?’ In a small piece of research run by the NCF, we found that only one in 10 people had thought about care and support options in later life. We also found that people generally had warm attitudes to the use of technology to support them in later life and that three in five would consider living in settings with mixed ages, while one in five wanted to be with people of a similar age.

Government policy is very focused on keeping people in their own homes; there is a huge focus on prevention, early intervention, social prescribing, a ‘home first’ approach from hospital and a discharge to assess approach that actively seeks to manage the perceived ‘over-prescription’ of residential care for older people. Given all this work to actively reduce the demand for accommodation-based social care (care homes especially), will we see an explosion of other options?

The white paper on social care reform quite rightly places a big emphasis on housing as part of care and support. The Centre for Ageing Better tells us that over two million over-55s are living in a home that endangers their health or wellbeing. A home first approach for them is unlikely to succeed without significant action to improve their housing environment. For those who do live in suitable housing and do want to stay there for as long as possible, perhaps care providers need to start to think about the innovation they might want?

NCF member, WCS Care, is a not-for-profit care home operator with 13 homes in Warwickshire. It opened its latest care home, Woodside Care Village, four months before the first lockdown in 2020. The home provides a village-style experience, with 12 family-sized households for between five and seven residents, each with their own front door which opens onto an outdoor plaza.

The home features cutting-edge circadian lighting and night-time acoustic monitoring technology, along with its own shop, launderette, café, cinema, hair salon, spa, gardens with a bike track, outdoor gym equipment and water features. Households are styled in one of three lifestyles – country, classic or town – helping residents to feel at home in their environment. Residents are encouraged to make the most of the village community, choosing meals from the shop to cook in their household kitchen, visiting the café to meet neighbours or joining one of the many clubs, depending on their interests and hobbies.

Ed Russell, Chief Executive of WCS Care, said, ‘Design and philosophy of care are fundamental to supporting us with our approach to care and we’ve challenged typical thinking about what a care home looks and feels like. The design principles we applied at Woodside Care Village have been put through the most rigorous testing over the last two years and have been proven to deliver in ways we hadn’t anticipated. ‘We’re delighted that Woodside Care Village has been recognised for its innovative design and construction nationally by winning LABC’s People & Place Award for New Housing – Best Purpose Built Accommodation.’

Complex needs

Knight Frank also talked about the importance of responding to the need for care and support for people with dementia and their families. This is definitely an area where need will grow and innovative services will be required to respond to this need. The predictions are that the number of people living with dementia will double to 1.4 million by 2040.

The Government’s reform plans bring very significant potential impact for residential care services for older people in England; the two interrelated aspects of the reforms are the extension of Section 18(3) of the Care Act 2014, so that any individual can ask a local authority to arrange their residential care at the rates available to the local authority, rather than having to pay at private rates; and the intention for local authorities to move towards paying a ‘fair cost of care’ to care providers.

It is already clear that progress towards the fair cost of care is hindered by the limited quantum of funding available from the Health and Care Levy to local authorities to achieve this. There is no end date for local authoritiess to achieve a fair price for care and so a slow progress to that with a fast progress to section 18(3) in October 2023 may have significant impacts. Ironically, the result of the Government’s dramatic National Insurance increase, combined with its reform approach, may well be that there is actually less money in the system to pay providers to deliver care and support, not more, resulting in less choice, not more.

Population trends

A future customer group that rarely gets a mention is those who are ageing without children. This is a growing demographic – there are already 1.2 million people over the age of 65 who have not become parents and, by 2030, this figure is expected to double to over two million.

Currently, the majority of support and care for older people is arranged and/or provided by family, principally adult children. However, many more older people are reaching the stage of needing care and support without having adult children to help. Formal care services, whether in the statutory, private or voluntary sectors, will need to both understand more about the issues affecting people ageing without children so they can design services to meet those needs (including access and communication systems that do not rely on family) and provide more of them to meet the increased demand.

Rethink the future

The care sector has the opportunity now to think about how it can respond to the changing demographics, an interesting policy environment, the futureproofing expectations (Knight Frank quite rightly mentions the urgency of ESG [environmental, social and governance] and sustainability), the potential of technology and the shrinking workforce.

Most importantly, it needs to listen to and understand the voice of the people it supports now and, in the future, create services for those who need them, where they need them, when they need them.


Liz Jones is Policy Director at the National Care Forum. Email: liz.jones@nationalcareforum.org.uk Twitter: @NCFCareForum @NCF_Liz

 

 

About Liz Jones

Liz Jones is the Policy Director of the National Care Forum and has a strong background in social policy, care and support and health and housing, with over 20 years’ experience across the civil service, local government and the charity sector.

Liz has strong research and analytical skills and is passionate for ensuring that the voices and views of the people and communities we serve are central to our policy development and implementation.

Related Content

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Training a new generation: Preparing apprentices for assessments

Darting through the decades: Future demand for older people’s care homes

Straight Talk: Covering the cost of reform

The future of care homes

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