Supporting people to live well in East Sussex – Market Position Statement

Document summary

Published April 2019


Introduction

This Market Position Statement (MPS) is designed to contain information and analysis of benefit to providers of health, care and support services for older people and working age adults in East Sussex. It is intended to help identify what the future demand for care might look like and to act as a starting point for discussions with those who provide services. Commissioners and supply development staff will seek to continue conversations regarding future service development through our network of provider forums and specific market engagement activity.

Key messages

If the current volumes of service provision and purchasing patterns are applied to the demographic data for East Sussex there would be an expectation that demand will continue to rise for:

  • personal assistants that can support more complex health and social care needs
  • home care provision in identified geographical locations of the county
  • dementia residential care in the west of the county
  • nursing and dementia nursing provision across the county

At the same time there is ongoing pressure on the overall funding envelope for health and care.

In order to manage this, health and social care partners continue to work together to develop an approach that:

  • reduces demand
  • is focussed on outcomes
  • promotes sustainable delivery models that can maximise external funding opportunities
  • supports people to avoid using residential care and acute bedded care services unless absolutely required
  • invests in preventative services

51% of people want to stay living in their current home for as long as possible. People tell us they value services that:

  • allow them to regain their strength and rebuild their confidence, allowing them to return home and/or maintain their independence
  • have friendly, engaging and supportive staff who are given the time to communicate with them and build a relationship
  • provide clarity regarding expectations of the service delivery and costs up front
    support positive thinking and the value of having hobbies and volunteering, support groups, and contact with their peers
  • treat them holistically as a whole person and don’t focus too much on their condition in isolation

This market position statement is for advisory purposes only. If you are considering developing services it is recommended that you speak with a member of the commissioning or supply management team in the first instance to get an up-to-date picture of requirements.

If you are unsure who to contact please email us and we will direct your enquiry to the most appropriate team.


National and local policy context

The Care Act 2014

The Care Act 2014 places general duties on local authorities to:

  • promote individual wellbeing
  • prevent needs for care and support
  • promote integration of care and support with health services
  • provide information and advice
  • promote diversity and quality in provision of services (market shaping)

Under the market shaping duties in the Act, local authorities are required to work with stakeholders to promote the efficient and effective operation of the local care and support market. This means ensuring there is sufficient supply of sustainable, good quality care and support services and other resources to meet the care and support needs of adults and carers and promote wellbeing. We aim to achieve this by maintaining information about current and future supply and demand and supporting the market and its workforce to improve quality and respond to the needs of the East Sussex population.

The Care Act 2014 also requires local authorities to: 

‘consider the person’s own strengths and capabilities, and what support might be available from their wider support network or within the community to help’ in considering ‘what else other than the provision of care and support might assist the person in meeting the
outcomes they want to achieve.’

“Strengths-based practice is a collaborative process between the person supported by services and those supporting them, allowing them to work together to determine an outcome that draws on the person’s strengths and assets.” (SCIE)

The approach is an important part of assessment but also part of a preventative agenda too. To support a strength-based approach in East Sussex we are looking at:

  • how we assess and provide support to adults and carers to focus on a preventative and strengths-based approach
  • ways to work more effectively with community and voluntary organisations to better respond to local needs

Green paper on social care

In the March 2017 budget, the government said that it would publish a green paper on social care, in order to allow a public consultation to be held. The green paper is intended to “ensure that the care and support system is sustainable in the long term”. It is also likely to include integration with health and other services, carers, workforce, and technological developments, among others. Reported comments from the government are that it will now be published “at the first opportunity in 2019”.

NHS Long Term Plan

The NHS Long Term Plan describes how the £20.5 billion budget settlement for the NHS nationally will be spent over the next five years. It focuses on building an NHS fit for the future by enabling everyone to get the best start in life; helping communities to live well; and helping people to age well. The plan sets out that within the current legal framework, the NHS and its partners will be moving to create Integrated Care Systems (ICSs) everywhere by April 2021. These ICSs will “bring together local organisations in a pragmatic and practical way to deliver the ‘triple integration’ of primary and specialist care, physical and mental health services, and health with social care.” They are expected to create expanded neighbourhood which will comprise a range of staff such as GPs, pharmacists, district nurses, community geriatricians, dementia workers and Allied Health Professionals (AHPs) such as physiotherapists and podiatrists / chiropodists, joined by social care and the voluntary sector.

Sussex and East Surrey Sustainability and Transformation Partnership (STP)

Local organisations have been asked to work together as part of health and care systems to develop their own plans which will set out how the national plan will work across local areas. To help develop this local plan, doctors, specialists and clinicians have come together across Sussex and East Surrey to give a population health check. The CCGs within the STP are seeking the views, experience and ideas of patients, public, staff, volunteers and carers, so that local plans are developed in a way that best reflects the needs of our population. For further information and to access STP plans and policies, visit Sussex Health and Care Partnership.

Early intervention and prevention

Locally, health and social care commissioners want to promote, maintain and enhance people’s wellbeing and independence in their communities so they are healthier, more resilient and less likely to need formal health and social care services. We call this our approach to early intervention and prevention.

We want to build a new sustainable model of service delivery by focussing on outcomes so we can continue to meet increased demand within our financial envelope.

The outcomes we are looking to achieve for our population are:

  • People remain independently in their own homes with less need for formal interventions or statutory support.
  • People report enhanced health, wellbeing and quality of life.
  • Population health is improved and health inequalities are reduced.

In order to do this, we will commission and support interventions and services that:

  • use community-centred and asset-based approaches that involve and empower individuals and local communities to actively participate and take action on improving community health and wellbeing and reducing health inequalities
  • encourage people to take a more active role in maintaining and improving their own health, to stay as healthy and independent as possible
  • support people reaching a point of crisis by providing short-term outcomes-based support that enables them to regain their independence and continue living independently without ongoing formal health and social care services
  • enable people with long-term conditions and support needs to maximise their independence through support from family and friends and community-based services, and reduce their reliance on formal health and social care services

What local people tell us is important

We have a bi-annual client and carer survey, carry out regular one-off surveys and consultations, and monitor complaints themes. Insights that are relevant to providers are that:

  • people value services that allow them to regain their strength and rebuild their confidence, allowing them to return home and / or maintain their independence
  • people value friendly, engaging and supportive staff who are given the time to communicate with them and build a relationship
  • people value clarity regarding expectations of the service delivery and costs up front
  • people talk about positive thinking and the value of having hobbies and volunteering, support groups, and contact with their peers
  • most people (51%) want to stay living in their current home for as long as possible
  • people don’t like too much focus on their condition in isolation, or disjointed services that don’t treat them holistically as a whole person

East Sussex health and social care economy

Against a background of ever diminishing resources and increasing demand, especially in social care, the county council has been working over the last eight years to ensure that the core set of services and infrastructure most needed from the council is available to residents and businesses.

Robust and innovative management and strong partnership means we have transformed the way the council works and made savings of £129m between 2010 and 2019. We have done everything possible to make the most of the money available.

Making savings on this scale has not, however, been easy or without impact on front-line services and residents. The council has had to reprioritise its investment and reduce the extent and breadth of its service offer. This has meant significant impacts in community-based Adult Social Care (ASC) services, and in assessment and care management staffing levels.

While the proposed budget across the council is balanced for 2019/20, this does include making proposed savings of £5.1m. There is an estimated deficit of a further £21.2m for the following two years, with only savings of £7.2m so far identified to meet the gap. The need for further lobbying for sufficient funding remains urgent and significant, particularly for 2020/21.

The unfunded growth in the needs of our elderly population is putting a strain on both local authority and health finances. The green paper which was anticipated to look at how services to older people could best be funded continues to be delayed. A permanent solution is unlikely to be available before the temporary funding the government has made available runs out.

Our NHS partners also continue to face challenging savings targets in order to meet nationally allocated control totals. East Sussex CCGs continue to seek corporate and non-acute savings where possible, aligning their approach across the Sustainability Transformation Partnership (STP).


Demand

Key messages in this section

  • Over 65s now represent a quarter of the county’s population and are projected to make up nearly a third of all people by 2031.
  • The number of very elderly people aged 85 and over expected to increase by 63%, from around 21,700 in 2016 to 35,300 in 2031.
  • The number and proportion of people living with dementia will increase more than elsewhere in the region.
  • Much of the demand for health and social care will be driven by the increasingly complex management of people with multiple long term conditions and those who are becoming progressively more frail.
  • Good mental health and wellbeing is key to living a full, healthy and happy life; 1 in 4 adults will experience low mental health with 1 in 10 of those requiring specialist help.
  • Good quality, secure housing is essential to supporting vulnerable adults to stay at home, living independently for longer.

Population demand

Demographic projections

The population of East Sussex is projected to increase by nearly 41,000 to 590,000 between 2016 and 2031. The number of households is expected to increase by 12.1%, while the population is projected to increase by 7.4%, as household size decreases from 2.25 people per household, to 2.15.

Population growth over the forecast period 2016-2031 is projected to be mostly among the over 60s as the population continues to age, especially those people born during the baby booms of the 1950s and 1960s. The over 65s now represent a quarter of the county’s population and are projected to make up nearly a third of all people by 2031.

All elderly age groups are expected to increase in size, with the number of very elderly people aged 85 and over expected to increase by 63%, from around 21,700 in 2016 to 35,300 in 2031. There is predicted to be a decline in the working age population (18-64) of over 4% to 295,000 people in 2031.

The workforce (economically active people aged 16-74) is expected to increase slightly by 1.7% to about 271,100 people in 2031, but although there is projected to be an 6% fall in younger working age people up to age 59, there is expected to be a 51% increase in workers aged 60-74, reflecting changes to pension ages and increasing female participation in the workforce as well as rising numbers of older people.

Over the period 2016-2031, the number of households in East Sussex is likely to increase by 12.1%. Single male households are expected to see a large increase of 24%, and the number of older households (aged 65 and over) is projected to increase by 34% by 2031. Over a quarter of these new older households are projected to be made up of a single person, more than 8,200 households, and 4,400 new households are expected to be headed by someone aged 85+.

The number and proportion of people living with dementia will increase more than elsewhere in the region. The situation will be complicated by the forecast increase in numbers living alone. An estimated 10,172 people in East Sussex currently have dementia (either diagnosed or undiagnosed). This is equivalent to 1.88% of the population, or 1 in every 53 people. The expected number living in East Sussex with dementia will have risen to 15,900 by 2030, with the greatest growth in people over 85 years old.

People living with long term conditions

Much of the demand for health and social care in the future will be driven by the increasingly complex management of people with multiple long term conditions (LTCs) and those who are becoming progressively frailer. Common LTCs include diabetes, chronic obstructive pulmonary disease, chronic heart failure, osteoporosis and dementia.

The numbers of over 65s with two or more LTCs is expected to rise from just over a half (54%) in 2015 to more than two thirds (68%) by 2035. In 2015, nearly 10% of all over 65s in England had four or more long term conditions. This is predicted to rise to 17% by 2035. One third of people with four or more conditions will have mental health problems as well (dementia, cognitive impairment but not dementia, and depression). In the over 85s the percentage with four or more long term conditions is expected to increase from 15% to 40% by 2035.

Learning disabilities

National modelling suggests sustained growth in the need for social care services for adults with learningdisabilities between 2011 and 2026, with estimated average annual increases varying from 1.2% to 5.1% (average 3.2%).

Mental health

1 in 4 adults will experience low mental health with 1 in 10 of those will require specialist help. This severe and enduring cohort often has very poor physical health with particular requirements around retaining accommodation, finding employment and lacking social and support networks. This includes groups of patients who are now becoming elderly, may have been discharged from long-stay institutions, or received treatment in the past which was sub-optimal and disabling.

The population of those with serious and enduring mental illness is estimated (annual) to be 1,863. Others, with less severe or enduring functional mental illnesses, such as anxiety and depression, may not need specialist secondary mental health care and can be treated by primary care or with psychological therapies. The population of common mental health problems is estimated (annual) to be 48,848.

Sensory impairment

Hearing loss is a long-term condition affecting over 10 million adults in the UK. Around 80% of people with moderate or severe hearing impairment are aged over 65 years. In East Sussex, approximately 120,000 people are reported to have some hearing loss. This figure is expected to rise to over 140,000 by 20259, with the growth in an aging population and increasing exposure to social and workplace noise. Services are being commissioned in 2019/20 to reflect this increase.

Carers

At the time of the 2011 Census, 14.2% of East Sussex household residents aged 65+ were providing some form of unpaid care, numbering around 16,200 older people. This compares with 11.5% household residents of all ages in the county providing unpaid care. Over a third of carers aged 65+ provided 50 or more hours of informal care each week. Nearly 12% provided 100 hours or more. Over 45% of carers are aged 65 and over. At the last Census in 2011 the estimated total number of carers of all ages in East Sussex was 59,164.

Domestic and sexual violence and abuse

Incidents of domestic violence and abuse, rape and sexual violence, stalking and harassment and harmful practices (such as forced marriage, honour based violence and female genital mutilation), as reflected nationally, continue to increase in East Sussex (9.6% increased in reported incidents and crimes relating to domestic abuse; 7.8% increase in reports of sexual offences; 375 reports of stalking and harassment incidents; 53% increase in the number of high risk cases referred in to MARAC). There is also a need to recognise hidden prevalence and to consider impact from an equalities and whole family perspective.

Demand for health and social care services

Primary care

Whilst the average number of GP consultations per person per year has increased across all age groups, this trend is particularly marked among older people.

Hospital attendances and admissions

The numbers of older people attending accident and emergency (A&E) departments have increased significantly over the last 5 years; locally people aged 65+ made up 31% of all A&E attendances in 2016/17.

Nationally, average lengths of stay for emergency admissions increase with age, from an average of 5.2 days for all admissions to 6.5 days for those aged 65-74, 8.3 days for those aged 75-84, to 10.1 days for those aged 85+. The proportion of people aged 65+ who were still at home 91 days after discharge from hospital into reablement services (90.7%) remains consistently higher (better) than in England (83.3%).

Social care

Demand for social care services is not just driven by underlying health and disability but also the availability and provision of informal care and housing. Use of services is also dependent on supply of available provision in an area. Health and Social Care Connect (HSCC) received 126,410 contacts in 2017/18, an increase of 6,922 (5.8%) compared to 2016/17. For the first 8 months of 2018/19 HSCC received 90,730 contacts, an increase of 2,810 (3.2%) compared to the same period in 2017/18.

People aged 65 and over (older people)

The total number of clients in East Sussex who went on to receive long term support aged 65 and over at any time between 1 February 2018 and 31 January 2019 was 6,475. The table below shows the number of clients aged 65 and over being supported by social care either in care homes or in the community (4,462). A greater proportion of older people are supported in the community at home (61%) than in care homes (39%), this has increased as a proportion compared to 56% at the same point as at March 2018.

Older people being supported by social care – Jan 2019
Location Number
Nursing home 659
Residential home 1073
Community – direct payment 482
Community – part direct payment 105
Community – LA managed personal budget 2143

Of the 4,462 clients aged 65 and over being supported by social care as at 31 January 2019:

  • 30.1% had a reported physical health condition (Chronic Obstructive Pulmonary Disease; Cancer; Acquired Physical injury; other physical health condition)
  • 19.9% had a reported health condition of dementia
  • 10.3% had a reported neurological health condition (Stroke; Parkinson’s; Motor Neurone Disease; Acquired Brain Injury; other neurological health condition)
  • 6.3% had a reported mental health condition (other than dementia)
  • 5.6% had a reported sensory impairment
  • 2.8% had a reported learning, development or intellectual disability (Autism; Asperger’s Syndrome / High Functioning Autism; learning disability, other disability)

People aged 18-64 (working age adults)

The total number of clients in East Sussex who received long term support aged 18 to 64 at any time between 1 February 2018 and 31 January 2019 was 3,126. A greater proportion of working age adults are supported in the community at home (2,169) than in care homes (633).

Working age adults being supported by social care – Jan 2019
Location Number
Nursing home 72
Residential home 561
Community – direct payment 769
Community – part direct payment 207
Community – LA managed personal budget 1193

Of the 2,802 clients aged 18 to 64 being supported by social care as at 31 January 2019:

  • 22.5% had a reported learning, development or intellectual disability
  • 13.4% had a reported physical health condition (Chronic Obstructive Pulmonary Disease; Cancer; Acquired Physical Injury; other physical health condition)
  • 8.8% had a reported neurological health condition (Stroke; Parkinson’s; Motor Neurone Disease; Acquired Brain Injury, other neurological health condition)
  • 6.1% had a reported mental health condition (other than dementia)
  • 2.6% had a reported sensory impairment
  • 0.9% had a reported health condition of dementia