Market sustainability
The current adult social care market in Norfolk is unstable, with higher than usual providers identified as being at risk of failure or no longer wanting to supply services in Norfolk.
We are particularly concerned about learning disability residential and older people nursing home services as these are seen as the two most at risk sectors. In addition, older people day services have struggled to recover from Covid-19 with low levels of new referrals.
Care homes
Norfolk has a lot of care homes that are old, converted or purpose-built properties that were built pre 1980 and not all of these are considered suitable to meet the higher acuity of needs now presenting. For example, some of the purpose-built homes that were built before 1980 have small room sizes which are not large enough to house the equipment, such as hoists, needed to manage higher acuity of needs.
Despite this, Norfolk does still appear to be a place where providers, particularly providers of older adult care home services, want to invest. Analysis of the net change in care quality commission (CQC) registered services during the 12 months from March 2022 to the end of February 2023 highlights the following:
- A net increase of three care homes delivering care to older people with a net increase of 237 registered beds
- A net reduction of five care homes delivering care to working age adults (people with mental ill-health, learning disabilities and physical disabilities) resulting in a net reduction of 138 registered beds
- A net increase of five home care services registered to deliver care to older people
- A net decrease of one service registered to deliver care to working age adults
Residential services
Residential services for working age adults appears to be very unstable. As can be seen above, there was a net decrease of five working age adult care homes between March 2022 and February 2023 which accounted for 138 beds closing.
Although there are new residential and supported living services in the pipeline, the new capacity is insufficient to meet the current identified demand. The life expectancy of people with a learning disability is increasing and people are experiencing more of the health conditions associated with old age.
We would like to explore opportunities to work with older adult residential providers to build their skills and expertise to support older people with a learning disability in older adult care homes.
Impact of Covid-19
Covid-19 has had a massive impact on the sustainability of the market particularly in relation to the older adult care home and day service sectors, both of which are experiencing lower levels of demand, with the resultant negative impact on individual providers and the market overall.
The shift in people choosing to be supported at home means that people accessing care homes will have more complex needs. For residential providers, the physical limitations, such as small rooms unable to accommodate equipment and premises with limited access to upper floors will be challenges to meeting complex needs. There are similar challenges for providers of day services.
We recognise the need to work with providers to shape the market; providing clear commissioning intentions to enable providers to develop their business plans.
Land and property prices
Disproportionately high-cost housing and land values in some areas of the county also have an impact on service development and service delivery, and make it difficult to recruit and retain staff as they cannot afford to buy or rent in these areas. This affects staffing availability for all types of care and operational costs for residential based care.
The office for national statistics housing affordability data from March 2022 shows the affordability ratio for national and local areas:
- England: 9.05
- Norfolk: 8.85
- Breckland: 9.04
- Broadland: 9.08
- Great Yarmouth: 6.74
- King's Lynn and West Norfolk: 8.90
- North Norfolk: 11.40
- Norwich: 7.12
- South Norfolk: 9.05
The higher the ratio the less affordable land and property within the area is.
Around 30% of households in Norfolk rent their homes. Of these households, 53% rent from a private landlord and 47% from social housing providers or the local authority.
The Norfolk office of data and analytics (NODA) briefing note on housing market projections published June 2022 highlighted the following key findings:
- The average house price in Norfolk (all property types) is £280,000
- Since April 2021 house prices in the East of England are reported to have increased by 11.9%
- Over the next five years, house prices are expected to increase by between 3.2% and 4% per year
- Rents are anticipated to rise over 5% a year over the next 5 years
Therefore, it is difficult to deliver social care in some areas of Norfolk to meet needs. The location of services in more rural areas are difficult for staff to get to especially if they rely on public transport. This has resulted in some providers buying properties in the most rural areas to rent to staff or to make specific arrangements for transport of staff.