Challenge 2: Appropriate housing
What is the challenge?
For people to be able to stay in their own home whenever possible and when this is not possible that they can live in accommodation and with support that is appropriate to meet their needs.
Increase the use of extra care housing for older people
“The majority of people will be able to live independently during their lives … For some, an additional level of support will be required. For this group, housing with care may provide them with the right support to continue to live independently and thrive.”[1]
Our analysis in 2020 showed that Gloucestershire has more than the national average of provision of housing with care for older people. However, this provision is not evenly spread across the county, and it is not always used effectively. With the predicted increase in the number of older people with care needs, it is vital that we further develop and improve our Extra Care housing estate.
During our recent engagement with the market, providers identified the quality of available estate and engagement with housing associations as two areas for potentially improving residential, nursing and supported living placements for those with disabilities and mental health conditions.
Providers also highlighted the suitability of the current care home estate as a potential concern for the future, particularly when considering diversification of services to offer more complex support as it may be difficult to do so in older or modified (i.e. not purpose-built) settings.
Reduce the use of non-specialist residential care for older people
Our analysis shows that the bed-based provision required in future will increasingly be for nursing and dementia care. In a situation of increasing demand and limited capacity, it is vital that our care workforce is therefore utilised effectively by supporting the additional demand for nursing and dementia care rather than for non-specialist residential provision for which we have too much capacity.
We recognise that older people who need care are not all reliant on local authority funding. There is a risk that older people who fund their own care and cannot manage at home without support will be more inclined to enter residential care if they cannot easily find that support. However, this may be at a time of their lives when it’s not appropriate. The impact of this includes:
- Older people investing their resources in a residential placement when they could have remained at home for longer
- Gloucestershire County Council picking up the cost of avoidable placements once their capital reduces
- Workforce capacity is used to provide care which is not appropriate at that time
To support this, our data indicates that whilst nearly two thirds of people placed into residential care by Gloucestershire County Council have dementia, two thirds of people who fund their own residential care do not.
Review demand and provision for adults of working age
Gloucestershire is only expected to have a minor increase in its adults of working age population. A consistent drop in the birth rate since 1969 means that this age group has generally stopped growing naturally and increases are now largely driven by migration. The demand for care services for adults of working age is therefore expected to remain largely constant for the next 20 years.
There is a high proportion of adults of working age with care needs who are placed into residential and nursing services in Gloucestershire from other local authorities. Current data shows that this represents over 50% of capacity. This contributes to growth in this population, increasing demand for local health services and creating additional pressure on the care workforce.
We believe that at least 30% of the current supported living capacity in the county is being used by other local authorities, including former residential provision which has been de-registered to supported living to give people more choice and control over their life. The proportion may actually be higher, but we have limited data on the use of these placements.
If people move into supported living from other local authority areas, they may become ‘ordinary residents’, which could lead to responsibility for their care transferring to Gloucestershire. Whether this happens or not, demand increases placing additional pressure on existing capacity to meet it.
We currently have limited data around the demand for support for people with complex neurological conditions such as Acquired Brain Injury (ABI) and Huntington’s Disease. Providers have also highlighted to us that mental health provision needs to better reflect the diversity of need and conditions that vary, fluctuate, and co-exist.
Our data also shows that there has been an increase in the number of adults of working age above the age of 50 receiving support. This may be because of carer breakdown or the increase in life expectancy. We need to explore this further to understand the needs of this age group and how they might best be met as services for older people are not always appropriate.
How are we planning on addressing this challenge?
We will aim to strengthen our system-based approach with the closer alignment of services across adult social care, health and the voluntary sector. We need to better understand the needs of the whole individual and our population at large, to intervene appropriately and earlier to avoid an over-dependency on health and social care.
Several of the areas we need to address hinge on the development of a system wide approach to prevention of need for adult social care services and early intervention when people begin to require support, this includes:
Public Health led primary prevention:
- Promoting health and wellbeing to support people entering older age in good health, and then staying in good health for as long as possible
Gloucestershire County Council Adult Social Care-led primary and secondary prevention:
- Ensuring that all system partners information, advice, and guidance to allow residents to meet their needs appropriately whether from community, VCSE, or ASC/healthcare services
- Planning to ensure accommodation is appropriate to need in public as well as private provision
Integrated Care System-led primary, secondary and tertiary prevention:
- Thorough analysis of ASC and healthcare data, to support early identification of need and pro-active care to ensure early intervention and support
- Intervention to maintain supported independence using equipment and technology enabled care
- Intervention to help residents to plan for and be supported through crises to minimise their impacts
This work necessarily sits across the entire system, but strategic oversight will be led by our Adult Social Care transformation programme.
We will aim to strengthen our system-based approach with the closer alignment of services across adult social care, health and the voluntary sector. We need to better understand the needs of the whole individual and our population at large, to intervene appropriately and earlier to avoid an over-dependency on health and social care.
Several of the areas we need to address hinge on the development of a system wide approach to prevention of need for adult social care services and early intervention when people begin to require support, this includes:
Public Health led primary prevention:
- Promoting health and wellbeing to support people entering older age in good health, and then staying in good health for as long as possible
Gloucestershire County Council Adult Social Care-led primary and secondary prevention:
- Ensuring that all system partners information, advice, and guidance to allow residents to meet their needs appropriately whether from community, VCSE, or ASC/healthcare services
- Planning to ensure accommodation is appropriate to need in public as well as private provision
Integrated Care System-led primary, secondary and tertiary prevention:
- Thorough analysis of ASC and healthcare data, to support early identification of need and pro-active care to ensure early intervention and support
- Intervention to maintain supported independence using equipment and technology enabled care
- Intervention to help residents to plan for and be supported through crises to minimise their impacts
This work necessarily sits across the entire system, but strategic oversight will be led by our Adult Social Care transformation programme.
Our 2020 strategy highlighted that there was an increased need for affordable rental properties in Cheltenham, Cotswolds, Stroud and Tewkesbury and for properties for ownership in all districts except Tewkesbury and Cheltenham. There is a strong partnership in place between Gloucestershire County Council and the six district councils and together we are working to develop more Extra Care Housing (ECH) schemes where they are needed and can be sustained. Opportunities are currently being explored in the Tewkesbury and Stroud districts.
There are barriers to overcome, including a lack of enthusiasm from developers who consider ECH schemes to be high risk and the investment involved often leads to provision which is not affordable for the people whose needs might be met there. We are considering how developments of this type might be further encouraged and made more viable in the future.
In addition to new developments, there is also the need to make better use of those which are already in place. If ECH schemes are to be fully utilised, there needs to be sufficient capacity and there are some current challenges to this. As a result, we will work with care providers to understand and develop the current model including reviewing the fee structure, referral process, a universal wellbeing offer, falls prevention / response, enhancing the health offer, hospital discharge and a geographical (such as ‘hub and spoke’) model of provision.
There is also scope to make better use of sheltered housing. We have an opportunity to align our ‘hyper-localised’ commissioning model with sheltered housing schemes to ensure that care ii is available to both the residents and other people living nearby.
We will update our existing Housing with Care Strategy to recognise the importance of the right accommodation in the right place to meet need and this will include:
- An increase in sustainable ECH schemes
- Better use of current ECH and sheltered housing schemes
- Reviewing the referral process
- Reviewing care capacity
- Hub and spoke models of provision
- An enhanced universal wellbeing offer and falls prevention
- Ways to ensure offer is affordable
This work will be led by Integrated Commissioning working with other stakeholders including the Strategic Housing Partnership and we aim to publish the updated strategy in December 2024.
Our 2020 strategy highlighted that there was an increased need for affordable rental properties in Cheltenham, Cotswolds, Stroud and Tewkesbury and for properties for ownership in all districts except Tewkesbury and Cheltenham. There is a strong partnership in place between Gloucestershire County Council and the six district councils and together we are working to develop more Extra Care Housing (ECH) schemes where they are needed and can be sustained. Opportunities are currently being explored in the Tewkesbury and Stroud districts.
There are barriers to overcome, including a lack of enthusiasm from developers who consider ECH schemes to be high risk and the investment involved often leads to provision which is not affordable for the people whose needs might be met there. We are considering how developments of this type might be further encouraged and made more viable in the future.
In addition to new developments, there is also the need to make better use of those which are already in place. If ECH schemes are to be fully utilised, there needs to be sufficient capacity and there are some current challenges to this. As a result, we will work with care providers to understand and develop the current model including reviewing the fee structure, referral process, a universal wellbeing offer, falls prevention / response, enhancing the health offer, hospital discharge and a geographical (such as ‘hub and spoke’) model of provision.
There is also scope to make better use of sheltered housing. We have an opportunity to align our ‘hyper-localised’ commissioning model with sheltered housing schemes to ensure that care ii is available to both the residents and other people living nearby.
We will update our existing Housing with Care Strategy to recognise the importance of the right accommodation in the right place to meet need and this will include:
- An increase in sustainable ECH schemes
- Better use of current ECH and sheltered housing schemes
- Reviewing the referral process
- Reviewing care capacity
- Hub and spoke models of provision
- An enhanced universal wellbeing offer and falls prevention
- Ways to ensure offer is affordable
This work will be led by Integrated Commissioning working with other stakeholders including the Strategic Housing Partnership and we aim to publish the updated strategy in December 2024.
Many of the areas we need to address depend on how we respond to our increasing older population. For this reason, we will continue to develop an ‘ageing well’ system-wide approach which will include:
- Refreshing our ageing well programme (including Proactive Care, Enhanced Health in Care Homes (EHCH) and End of Life care)
- Developing a strategy for older people
We are also proposing that we work together as a system to develop and deliver a way of training care staff to undertake some delegated healthcare tasks. This would enhance and expand the wrap-around approach to health and care services for people in their own homes. This could be done by working with closely with community health services to ensure that all care providers are supported in the way which care homes are through the Network Contract Direct Enhanced Service (DES) for 2023-24 “Enhanced Health in Care Homes” Framework.[1]
This work will be led by Integrated Commissioning and we aim to publish the refreshed ageing well programme in February 2025.
Many of the areas we need to address depend on how we respond to our increasing older population. For this reason, we will continue to develop an ‘ageing well’ system-wide approach which will include:
- Refreshing our ageing well programme (including Proactive Care, Enhanced Health in Care Homes (EHCH) and End of Life care)
- Developing a strategy for older people
We are also proposing that we work together as a system to develop and deliver a way of training care staff to undertake some delegated healthcare tasks. This would enhance and expand the wrap-around approach to health and care services for people in their own homes. This could be done by working with closely with community health services to ensure that all care providers are supported in the way which care homes are through the Network Contract Direct Enhanced Service (DES) for 2023-24 “Enhanced Health in Care Homes” Framework.[1]
This work will be led by Integrated Commissioning and we aim to publish the refreshed ageing well programme in February 2025.
The provision of support services for adults of working age will benefit from further in-depth analysis, including transitions from children’s services to understand potential future demand from this age group.
In addition, there is work to be done with providers and other local authorities to manage the growth of demand from outside of Gloucestershire in this sector, especially considering our limited workforce capacity. The unpaid care workforce and voluntary sector organisations will also have key roles to play.
We will develop a living well strategy that will provide an in-depth analysis of the provision across all service types and to meet a full range of needs including costs, capacity and usage to help us develop a clear and coherent strategic approach for individuals with:
- Physical disabilities
- Learning disabilities
- Mental health conditions
- Specific complex conditions such as acquired brain injury or neurological illness
- Autism
This work will be led by Integrated Commissioning, and we aim to publish a 'living well strategy' in summer 2025.
The provision of support services for adults of working age will benefit from further in-depth analysis, including transitions from children’s services to understand potential future demand from this age group.
In addition, there is work to be done with providers and other local authorities to manage the growth of demand from outside of Gloucestershire in this sector, especially considering our limited workforce capacity. The unpaid care workforce and voluntary sector organisations will also have key roles to play.
We will develop a living well strategy that will provide an in-depth analysis of the provision across all service types and to meet a full range of needs including costs, capacity and usage to help us develop a clear and coherent strategic approach for individuals with:
- Physical disabilities
- Learning disabilities
- Mental health conditions
- Specific complex conditions such as acquired brain injury or neurological illness
- Autism
This work will be led by Integrated Commissioning, and we aim to publish a 'living well strategy' in summer 2025.
In order to achieve a personalised approach that encourages and enables independence, reduces care need and avoids people receiving community care earlier or for longer than they need, we recognise that we need to encourage the development of services that avoid or delay the need for statutory care.
We aim to increase opportunities for people to use direct payments which will involve increasing the choice of support offers available, including:
- Personal assistants (PAs)
- Micro-providers
- Voluntary sector community support
- Shared Lives
This work will be led by Integrated Commissioning working with Public Health, the voluntary sector, the social care market and the wider system.
In order to achieve a personalised approach that encourages and enables independence, reduces care need and avoids people receiving community care earlier or for longer than they need, we recognise that we need to encourage the development of services that avoid or delay the need for statutory care.
We aim to increase opportunities for people to use direct payments which will involve increasing the choice of support offers available, including:
- Personal assistants (PAs)
- Micro-providers
- Voluntary sector community support
- Shared Lives
This work will be led by Integrated Commissioning working with Public Health, the voluntary sector, the social care market and the wider system.
To support more people in their own homes we aim to further develop home care services and the staff working in them. We aim to increase the capacity of providers by commissioning in ways that enable them to use staff time efficiently and supporting them to train and develop their staff to meet the considerable variety of needs. We propose to do this by:
- Continuing with the development of hyper-localised commissioning wherever possible
- Developing links to community services to support maintaining and improving independence levels
- Working as a system to enhance training and development opportunities for staff
- Working with providers to find ways to incentivise staff
This work will be led by Integrated Commissioning working with home care providers and the wider system.
To support more people in their own homes we aim to further develop home care services and the staff working in them. We aim to increase the capacity of providers by commissioning in ways that enable them to use staff time efficiently and supporting them to train and develop their staff to meet the considerable variety of needs. We propose to do this by:
- Continuing with the development of hyper-localised commissioning wherever possible
- Developing links to community services to support maintaining and improving independence levels
- Working as a system to enhance training and development opportunities for staff
- Working with providers to find ways to incentivise staff
This work will be led by Integrated Commissioning working with home care providers and the wider system.
We will work on a regional basis with other local authorities to understand the demand for out of county placements into Gloucestershire to ensure that they are aware of the impacts on our resource and that any protocols agreed are mutually followed.
We will work with the providers that other local authorities commission with t better understand the drivers for accepting out of county placements and how that impacts on our resource and capacity, as well as compatibility within shared care settings.
This work will be led by Integrated Commissioning, working with Adult Social Care providers and neighbouring local authorities.
We will work on a regional basis with other local authorities to understand the demand for out of county placements into Gloucestershire to ensure that they are aware of the impacts on our resource and that any protocols agreed are mutually followed.
We will work with the providers that other local authorities commission with t better understand the drivers for accepting out of county placements and how that impacts on our resource and capacity, as well as compatibility within shared care settings.
This work will be led by Integrated Commissioning, working with Adult Social Care providers and neighbouring local authorities.
From 2024, we will host dedicated quarterly in-person provider forums for each of the home care, care home and disabilities/mental health sectors to be attended by colleagues from across the local health and social care system. The forums will aim to consider and focus on issues raised by providers as well as those raised by commissioners.
We will engage with providers to ascertain what they need and expect from their representative body going forward with a view to going out to competitive tender for a new contract during 2025-6.
We will improve our support offer to providers by improving accessibility to information and commissioners in relation to both strategic and day-to-day matters.
This work will be led by Integrated Commissioning working with Adult Social Care providers, their representatives, and the wider system.
From 2024, we will host dedicated quarterly in-person provider forums for each of the home care, care home and disabilities/mental health sectors to be attended by colleagues from across the local health and social care system. The forums will aim to consider and focus on issues raised by providers as well as those raised by commissioners.
We will engage with providers to ascertain what they need and expect from their representative body going forward with a view to going out to competitive tender for a new contract during 2025-6.
We will improve our support offer to providers by improving accessibility to information and commissioners in relation to both strategic and day-to-day matters.
This work will be led by Integrated Commissioning working with Adult Social Care providers, their representatives, and the wider system.
How can providers support us to meet this challenge?
- Continue to engage with us at provider forums and other opportunities so your views and ideas are heard as we develop our various strategies
- Involve us at the outset of any development or significant capital expenditure projects so that we can share our insights on demand and capacity for provision across our county
- Help us to better understand the picture of provision for Adults of Working Age, particularly in relation to placements by other Local Authorities
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