There are several significant influences that are expected to continue impacting the delivery of care in the older people’s residential and nursing care market over the coming years. Whilst these may be considered structural, they have been accelerated and deepened by COVID19, resulting in significant challenges for service providers and commissioners.
Unprecedented demand for care
Prior to COVID19 there were pockets of reductions in referrals that services were highlighting, which coincided with our strategic approach of providing care at home for more people. From May 2021, the numbers of placements with the sector are over and above pre COVID levels and this trend is likely to continue.
Increasing prevalence of high frailty/dementia/complex comorbidity
The growth in demand has not been uniform. Demand has particularly accelerated for services that can support extremely vulnerable people with multiple conditions. This has been driven predominantly by hospital discharges, but also by what can be considered as ‘pent up’ demand from her community, where informal caring arrangements are coming to an end, for example.
Impact of COVID 19 on and our communities and individual care needs
As the wider economy rebounds from the economic shock of COVID, more and more people are making choices about their future. This may be due to the increasing logistical economy, furlough coming to an end, the re-opening of some offices and expectations on people to return to their workplaces. This may also lead to a contraction of the role families and communities played in supporting vulnerable people. These needs may manifest as increased complexity, possibly driven by a point or period of crisis.
Workforce, quality, and resilience challenges
Clap for carers was a welcome recognition for the care sector and the individuals who had, and are continuing to, put themselves on the line to care for our loved ones. However, the structural workforce issues remain; recruitment and retention, pay and reward, support, training and career progression, proposed increase in National Insurance. This has increased the risk to services to ongoing or further shocks that require micro and macro resilience planning to safeguard people in receipt of care.
Care reform impact on fees and self-funder arrangements
Recent announcements, ahead of a planned White Paper on this issue, will have an (as yet unquantified) impact on the sector. A removal of the ‘cross-subsidy’ of public and private fees has been proposed that will be worked through at all levels to fully understand the impact locally.
Financial pressure on providers and local government
Recent announcements to increase funding for the NHS are welcome and this will support the local care economy in Hertfordshire. The social care contribution remains proportionally less and the release of future monies are more closely linked or aligned with NHS priorities on discharges, to tackle the backlog on elective procedures. Combined with the care reforms, there is significant work to ensure sustainability of the sector to focus effort and services in the right places to achieve the right outcomes, for both people and systems.
Developments in the procurement environment
Councils and the residential and nursing sector have a limited procurement relationship; in Hertfordshire there is a heavy reliance on spot contracting arrangements. There is now an increasing desire to maximise social value within contracts and procurement and increase the emphasis on environmental sustainability.