Current supply of long-term residential and nursing care for older people

There is an estimated capacity in West Sussex to provide approximately 8,450 beds within an estimated 228 care homes for older people: Approximately 42% are residential beds, 27% are nursing and 31% are dual purpose beds. These are the estimated number of care homes in each district / borough of the county currently:

The largest number of care homes are situated within Arun and Worthing, which are the two areas within West Sussex where the largest percentage of older people in receipt of bed-based adult social care currently reside. The areas with the lowest number in both these regards are Adur and Crawley.

West Sussex County Council pays for residents with eligible social care needs that have funds below the nationally set thresholds for social care eligibility. The Council commissions approximately 25% of all older people beds in West Sussex for this purpose, which constitutes around 30% of all current demand for older people bed-based care. Self-funders are estimated to purchase approximately 62% of beds, while the NHS and other local authorities commission the remainder.

60% of the people that the Council commissions services are residential customers and 40% are nursing customers.

32% of Local authority customers are estimated to be recipients of dementia-related services – 35% of residential and 21% of nursing customers.

The Council has a 30-year block contract with Shaw Healthcare Ltd, within Council owned buildings that meets around 20% of all demand for WSCC public funded bed-based care. Shaw Healthcare services currently provide 590 beds to the Council through this contract. Including 250 dementia residential beds, 160 nursing and 180 residential beds. There is no provision for dementia nursing care. The Council is working closely with Shaw Healthcare to review that the service continues to meet the needs of residents of West Sussex throughout the remaining 11 years of contract and indeed planning beyond the end of that period, and both Shaw Healthcare and the Council are committing to adapting and flexing the service accordingly to meet the need.

The Council also has a small number of nursing dementia beds in the wider market and is keen to work with the Shaw Healthcare and the wider residential and nursing care market to develop more of this provision as this reflects the more complex needs of people that is now more regularly being seen.

The Council has one older people in-house care home New Tyne that is under a review to ascertain future options. It is not currently full and the review is assessing the role of New Tyne in relation to provision in the wider market and the role it can play into the future looking particularly at complex bed-based care and options such as short-stay and emergency bed-based care.

To support people to return home from hospital after a hospital stay, it is sometimes necessary to enable people to have a short stay in a residential service whilst their long-term options are reviewed and considered. The Council currently commissions 28 beds in 4 services to meet this need. Around 60% of people can return home after a short stay in these beds. The Council alongside its system partners and as part of the ICS is reviewing the provision of intermediate care and hospital discharge services it provides to ensure that there are sufficient and appropriate intermediate care solutions for people leaving hospital.

Lastly, the Council commissions residential and nursing care as a respite offer, to support carers who are caring for people with complex needs in the community. The Council has some beds available for this purpose in the Shaw Healthcare contract and can also commission this care on a spot basis from the wider market. We plan to develop our understanding of demand and co-design services with providers in future.

West Sussex County Council has information on tendering opportunities on their website. 

This table sets out the current CQC rates of older people bed-based provision in West Sussex. It shows that the large proportion of beds and homes are rated as ‘Good.’

Arun and Worthing have the most beds rated as ‘Requires Improvement,’ but these are also the areas with the largest proportion of homes and beds.

One of the Council’s aims is to maintain good quality in this market and to ensure a focus on continuous improvement in quality.

Occupancy levels are currently high in West Sussex at 90% with an estimated overall vacancy rate of 10%. There are currently more vacancies in residential than in nursing care and most vacancies are in Western and Southern areas. We are working on occupancy levels through working closely with partners to improve pathways and we are interested in exploring other uses for void beds e.g., for respite.

At a district / borough level, overall occupancy levels for all bed types are as follows (source: April 2024 data WSCC provider ring around data and Capacity Tracker):

• Adur – 91.6%
• Arun – 86%
• Chichester – 89%
• Crawley – 87%
• Horsham – 94%
• Mid Sussex – 90 %
• Worthing – 92%

The Council is reviewing the occupancy of block contract provision to ensure that services continue to be well utilised and provide good value for money and liaises with providers as part of contract monitoring to understand occupancy in wider services and manage any impacts or issues around sustainability that may be seen as a result of low occupancy.

The length of stay of a customer in care homes has implications for council budgets and spend for customers and assists providers with strategic planning. Information on the length of stay for people commissioned by the Council shows that 62.7% of people are in residential care services for 2 years or less, and 70% of people are in nursing services for 2 years or less.

The average length of stay nationally in residential care is two-years and two-months, and for nursing care just under a year and hence this information broadly follows national trends and highlights that residential and nursing care services are most often focused on supporting people as their needs significantly increase and they can no longer be supported at home. For many people residential and nursing care services are their last home, and to avoid disruption late in life it will be important for many people that they can stay in that home until the end of their life where possible. The ICB has an End of Life Care Programme in which WSCC is a partner.

There are currently an estimated 2,250 older people in receipt of WSCC funded bed-based placements – 60% of these are residential, 40% nursing.

Across both residential and nursing provision older people are 69% female and 31% male. In residential provision customers are 70.5% female and 29.5% male. In nursing, customers are 66% female and 34% male.

The majority (98.5%) of all older people bed-based customers in West Sussex are white. This is slightly higher than the corresponding figure for customers in receipt of all adult social care services (97.5%) and higher than the overall percentage of the West Sussex population that is white (91%). This shows an under-representation of ethnic minority customers in bed-based care. It is estimated that currently only around 30 older people within current long-term bed-based services are from an ethnic minority. This needs to be explored further to understand why so few people from an ethnic minority are accessing residential care services and whether this is related to choice or there are accessibility and inclusion issues within our services which must be addressed to ensure that people with this protected characteristics are not disadvantaged.

75% of all older people bed-based customers are aged 80 years or over, 42% are aged 80-89 and 33% are aged 90+.

In terms of the primary needs of WSCC customers in residential and nursing care, 70% are recorded as Physical and Sensory Impairments (PSI) and 30% for Mental Health (MH). For residential customers, the split is 64.5% PSI and 35.5% MH. For nursing customers, it is 79% PSI and 21% MH.

In terms of the primary needs of WSCC customers in residential and nursing care, 70% are recorded as Physical and Sensory Impairments (PSI) and 30% involve for Mental Health (MH). For residential customers, the split is 64.5% PSI and 35.5% MH. For nursing customers, it is 79% PSI and 21% MH.

There are currently 583 customers with a learning disability (all ages) residing in residential and nursing care in West Sussex. 20% of these customers are aged 65+. Customers with a learning disability in residential and nursing care aged 65+ account for 5% of all older people in this type of care. The current number of customers with a learning disability in residential and nursing care across West Sussex (all ages) is currently 19% higher than projected previously by WSCC. There is an assumption that over 65s will continue to need residential and nursing care services that meet the needs of people with a learning disability and that Extra Care Housing will be a good alternative for adults with these needs.

There is limited information available about all other protected characteristics and the Council is keen to work with providers to understand how all people with protected characteristics are supported within these services and the accessibility of service provision across West Sussex.

Based on current information on purchasing within residential and nursing care service provider reported occupancy, the estimated current demand for services is highlighted in the table below:

This table shows current supply of older people bed-based care across the county and by district / borough against current estimated demand. This demand is split by WSCC demand, self-funder demand, and estimated demand from other commissioners such as the NHS and other local authorities. It also shows current occupancy rates.

This analysis of the current state is a key part our baseline for projecting need and future supply of bed-based care later in this statement.

• Each area of the county is unique with quite different demand and supply factors.
• There is a marked difference in the higher number of self-funders in some areas (e.g., Chichester compared to Crawley) which may impact the nature, choice, and price of provision available to both self-funders and public-funded customers.
• In some areas (such as Chichester and Worthing), there are indications of an oversupply of beds overall given current demand. In other areas (such as Adur and Crawley) there is a lack of specialist dementia bed-based care.
• Horsham has more nursing supply than other areas in West Sussex including a good supply of dual-purpose homes and specialist dementia care. Mid-Sussex also has sufficient supply of nursing and nursing dementia care.
• Crawley has a very low supply of nursing dementia but a higher prevalence of people with a primary need of mental health suggesting a need for dementia beds.
• Arun has good capacity for all forms of bed-based needs but possibly requires more dual-registered homes to bring flexibility to provision.