Future Demand in Care Homes for the Over 65S in Herefordshire

Future demand in care homes for the over 65s in

Herefordshire

Version 1.0 Herefordshire Council Intelligence Unit

April 2018

Herefordshire Council Intelligence Unit V1.0, April 2018 Page 1

Summary Projections of the future demand in care home beds for the over 65s were generated by applying prevalence rates by single year of age and gender to the projected future estimates of the resident population for each year, up to 20361. Prevalence rates are defined as the number of people in care homes as a proportion of the resident population. Prevalence rates for local authority (i.e. Herefordshire Council) funded and non-local authority funded beds were based on different assumptions –

Local authority (HC) funded prevalence rates were defined as the annual average of the monthly number of clients in care homes using snapshots extracted from Herefordshire Council’s adult social care database (i.e. Mosaic) from January to December 2016, as a proportion of the most up to date estimate of the resident population2, by single year of age.

In the absence of any administrative data for non-Herefordshire Council funded care home placements, prevalence rates were estimated by combining historical data from the 2011 Census3 with more recent data on the current number of beds from the Care Quality Commission (CQC) directory4. The number of non-HC beds were calculated by generating estimates for the combined number of HC and non-HC funded beds for five-year age bands and subtracting the number of HC- funded beds. Note that this group includes NHS funded and placements by other local authorities as well as self-funders.

Key figures -

 The total need for care home beds in Herefordshire is projected to increase from 1,550 in 2016 to 1,800 in 2021 (an increase of 250 and is equivalent to an average annual growth of around three per cent per year over this five-year period); and to 2,900 people by 2036 (an increase of 1,350 since 2016, equivalent to an average annual growth of around five per cent per year over this 20- year period).

 As of 2016, 40 per cent of all care home beds were HC-funded. In the absence of any future estimates of financial status by age, it is assumed that this proportion will remain unchanged over the projection period.

 As of 2016, 56 per cent of care home beds were residential and 44 per cent were nursing. These proportions are not expected to change drastically over the next 18 years, with a small (three per cent) decrease in the number of residential care home beds and a small increase (three per cent) in

1 2014-based Subnational population projections. Office for National Statistics © Crown copyright 2016 2 The Office for National Statistics’ Mid-2016 Population Estimates 3 2011 Census, Office for National Statistics © Crown Copyright Reserved. Table DC4210EWla - Communal establishment management and type by sex by age 4 CQC database at 1st July 2016.

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the number of nursing care home beds. There is an approximate 3:2 ratio of residential to nursing beds in HC-funded clients compared with an approximate 50-50 split in non-HC funded clients.

 Just over a third of all care homes (36 per cent) were located in the Hereford & surrounds area, just under a quarter (23 per cent) are located in each of the north and south Herefordshire areas and just under a fifth were located in the East Herefordshire area. The relative proportions of need across the county are expected to remain unchanged throughout the projection period. There is not expected to be an appreciable change in the relative proportions of HC and non-HC funded beds nor in the relative proportions of residential to nursing beds over the next 20 years.

 Around 77 per cent of people currently in a care home in Herefordshire are estimated to have some form of dementia.

County-level projections All projections must make certain assumptions based on the availability of data and the ability to predict what might happen on the future. These projections of the future requirement for care home beds assume that -  the number of beds available in 2017 were adequate to meet demand  all care home beds are at a hundred per cent occupancy of permanent residents (i.e. no short-stay clients are included)  there will be no changes to the eligibility criteria or other policies that would affect trends in residential and nursing home placements in the future  no new prevention schemes will be implemented over the projection period  there will be no meaningful changes to net migration of the population of interest over the projection period

Table 1 on the next page provides the projected number of beds required per year up to 2036 for all care homes; broken down by HC-funded, non-HC funded, residential and nursing. Also shown is the projected number of people in care homes who will have dementia. Projected trends are illustrated in Charts 1 to 3. Chart 1 also includes the expected number of care home beds based on proposed new development based on current planning approvals.

The current level of need for HC-funded beds was determined using data extracted from Herefordshire Council’s adult social care client database (Mosaic). Information about the current level of need for non-HC funded beds was determined from CQC records and historical data from the 2011 Census5.

Projections of the number of people in care homes who will have dementia were calculated by applying national age-specific dementia prevalence (Dementia UK: Update, 2014. Alzheimer’s Society) and the

5 2011 Census, Office for National Statistics © Crown Copyright Reserved. Table DC4210EWla - Communal establishment management and type by sex by age Herefordshire Council Intelligence Unit V1.0, April 2018 Page 3

proportion of people with dementia living in care homes (Dementia UK, 2007. Alzheimer’s Society) to the projected resident population of Herefordshire6.

Table 1. Future requirement for care home beds in Herefordshire and the estimated number of people in care homes with dementia. Note - these figures are rounded to the nearest 50 to avoid implying spurious accuracy.

Herefordshire council funded beds Other beds people in care homes with Year All beds total residential nursing total residential nursing dementia 2016 1,550 650 350 300 900 400 500 1,200 2017 1,600 650 350 300 950 400 500 1,250 2018 1,650 700 350 300 950 400 550 1,250 2019 1,700 700 400 300 1,000 450 550 1,300 2020 1,750 700 400 300 1,000 450 550 1,350 2021 1,800 750 400 350 1,050 450 600 1,350 2022 1,850 750 400 350 1,100 450 600 1,400 2023 1,900 800 450 350 1,150 500 650 1,450 2024 1,950 800 450 350 1,150 500 650 1,500 2025 2,050 850 450 400 1,200 500 700 1,550 2026 2,100 850 500 400 1,200 500 700 1,600 2027 2,150 900 500 400 1,250 550 700 1,700 2028 2,200 950 500 400 1,300 550 750 1,750 2029 2,300 950 550 450 1,350 600 750 1,800 2030 2,400 1,000 550 450 1,400 600 800 1,900 2031 2,500 1,050 550 450 1,450 600 800 1,950 2032 2,600 1,050 600 500 1,500 650 850 2,000 2033 2,700 1,100 600 500 1,600 700 900 2,100 2034 2,800 1,150 650 500 1,600 700 950 2,200 2035 2,850 1,200 650 550 1,650 700 950 2,250 2036 2,900 1,250 700 550 1,650 700 950 2,300

NB. Figures for each type of care home may not sum exactly to the total number of care homes due to rounding.

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Chart 1. Projected number of care home beds required. Note - these figures are rounded to the nearest 50 to avoid implying spurious accuracy.

Chart 2. Projected number of people in care homes with dementia. Note - these figures are rounded to the nearest 50 to avoid implying spurious accuracy.

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Sub county-level projections These indicative bed requirements were generated by applying countywide prevalence rates to the sub- county area populations.

Tables 3 to 8 provide the projected number of beds required for selected years up to 2036 for all care homes in each sub-county area; broken down by HC-funded, non-HC authority funded, residential and nursing. Also shown is the projected number of people in care homes who will have dementia.

In the absence of any population projections for sub-county areas it was necessary to assume a uniform migration rate across the county. Therefore, in order to limit the imprecision of this assumption, four broad localities were used.. Table 2 and Figure 1 illustrate the composition of each of these broader areas, which are built from corporate localities.

Table 2. Composition of sub-county areas.

Area Constituent corporate localities North Hfds Kington; Leominster; Mortimer; Weobley Hereford & surrounds Hereford East Hfds Bromyard; Ledbury South Hfds Golden Valley; Ross-on-Wye

Figure 1. Areas used for projections and their constituent corporate localities.

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Note – figures shown in tables 3 to 8 are rounded to the nearest 10, but cannot be assumed to be accurate to this level. These figures are indicative and should only be used to look at general trends and identify areas of particularly high or low demand.

Table 3. Future requirement for all care home beds in Herefordshire localities.

Area 2016 2018 2019 2020 2021 2026 2031 2036 North Hfds 350 370 390 400 410 480 570 660 Hereford & surrounds 550 590 600 620 640 750 890 1,040 East Hfds 280 300 310 320 330 380 450 540 South Hfds 350 370 390 400 410 480 570 670 total 1,540 1,630 1,680 1,730 1,780 2,080 2,480 2,910

Table 4. Future requirement for Herefordshire Council funded residential home beds in Herefordshire localities.

Area 2016 2018 2019 2020 2021 2026 2031 2036 North Hfds 80 90 90 90 90 110 130 160 Hereford & surrounds 120 130 140 140 140 170 200 250 East Hfds 60 70 70 70 80 90 110 130 South Hfds 80 90 90 90 90 110 130 160 total 350 370 380 400 400 470 570 690

Table 5. Future requirement for Herefordshire Council funded nursing home beds in Herefordshire localities.

Area 2016 2018 2019 2020 2021 2026 2031 2036 North Hfds 70 70 70 70 80 90 110 120 Hereford & surrounds 100 110 110 120 120 140 170 200 East Hfds 50 60 60 60 60 70 90 100 South Hfds 70 70 70 70 80 90 110 130 total 290 300 310 320 330 390 470 540

Table 6. Future requirement for non-Herefordshire Council funded residential home beds in Herefordshire localities.

Area 2016 2018 2019 2020 2021 2026 2031 2036 North Hfds 90 100 100 100 100 120 140 160 Hereford & surrounds 150 150 160 160 170 190 230 260 East Hfds 70 80 80 80 80 90 110 130 South Hfds 90 100 100 100 110 120 140 160 total 400 420 430 450 460 520 620 710

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Table 7. Future requirement for all non-Herefordshire Council funded nursing home beds in Herefordshire localities.

Area 2016 2018 2019 2020 2021 2026 2031 2036 North Hfds 120 120 130 130 140 160 190 220 Hereford & surrounds 180 190 200 210 210 250 290 340 East Hfds 90 100 100 100 110 130 150 180 South Hfds 120 120 130 130 140 160 190 220 total 500 540 550 570 590 690 820 960

Table 8. Estimated number of clients with dementia in all care homes.

Area 2016 2018 2019 2020 2021 2026 2031 2036 North Hfds 270 290 300 300 310 370 440 530 Hereford & surrounds 420 450 460 480 490 580 690 830 East Hfds 220 230 240 250 250 300 360 430 South Hfds 270 290 300 310 320 370 450 540 1,180 1,260 1,300 1,340 1,370 1,620 1,940 2,320

Appendix These projections of demand for care home beds are an update to unpublished provisional figures produced in September 2017; incorporating improvements to the methodology and updates to the underlying population estimates.

The current projections estimate a total increase in need for care home beds of approximately 250, from 1,550 in 2016 to 1,800 in 2021; compared with an increase of around 350 in the provisional projections. Looking further ahead to 2036, an increase of 1,350 to 2,900 beds from 2016 was projected; compared with an increase of 1,650 in the previous projections. The revised downward projection is a result of (i) applying more detailed age-sensitive prevalence rates for estimating the HC-funded component; (ii) incorporating historical information about the age distribution of the non-HC-funded component from the 2011 Census7. Note – the previous projections assumed an identical age distribution for both HC and non- HC funded components; however, application of the Census figures would imply a younger age profile for the non-HC funded component. Estimations of the non-HC component of the projections are, as such, not as robust as the HC funded component.

7 Table DC4210EWla - Communal establishment management and type by sex by age. Herefordshire Council Intelligence Unit V1.0, April 2018 Page 9