1. December Network Meetings Older People Care Homes

4. Starts with Context – An ageing population (6.9% pop growth, >65 13%, >85 25.5%) - Increasing demand H&SC Services Continues with SCC Financial Position – Budget Pressures (£182m next 5 years)

6. Overall Approach: More positive view of growing older Ageing Well AgendaPM’s Challenge on Dementia Living & Ageing Well in Surrey Dementia Friendly Surrey Recommendations for the Sector to respond

8. Working Together with Health Joint Health & Wellbeing Strategy – Priorities for Surrey Residents Better Care Fund - In administering this fund, local authorities and health bodies will engage with local providers of care and support and develop a shared view of the future shape of services, an assessment of future capacity requirements and a description of what new patterns of provision are needed.

9. Recommendations

10. The Market for Older People’s Services and Support Guidance and Advice – development of universal guidance & advice vip in Surrey (self funders)

11. Community Based Services & Support Day care – whilst the capacity of day care purchased by Surrey County Council is for over 7,100 spaces per week, we have limited knowledge of the private market and of levels of best practice in the county. Having said this, it is clear that all day care establishments need to, where possible, be open at weekends and evenings as well as on weekdays, offer a range of stimulating activities and, where possible, support people to participate in group excursions. In doing so, they should keep their customers informed with regard to nutrition, hydration, safety and safeguarding issues and other health and wellbeing messages.

13. Direct Payments

14. Supported housing Our commissioning intentions For our funded extra care schemes, ensure that the model of care and support delivers person-centred care and which enables residents to exercise choice and control Build our market intelligence regarding supported housing in Surrey, especially with regard to facilities focused on self-funders, and recognise and share best practice in both care and support delivery and supported housing design Work together with Borough and District Councils in understanding the long term benefits of supported housing provision, and to maximise the utility of existing and future extra care schemes

16. Home Based Care With regard to older people’s services, Surrey County Council’s involvement with this wider market is minimal, and we therefore do not have a full understanding of: The number of home based care providers who deliver support in Surrey, but whose headquarters are based outside the county The market taken up by self-funders, their relative level of spend and their views on home based care services. Although it has been estimated that, nationally, local authorities purchase as much as 80% of private care providers’ care hours24, we believe that this would be an overstatement for Surrey The quality standards (beyond CQC reports) of home based care providers who have not been party to the Council’s framework agreements

18. Our recommendations to the market

19. Residential and Nursing Care

20. Challenges New provision – impact on current providers ? overprovision A shortage in qualified nursing staff. Although a national report anticipates a future shortage, anecdotal evidence suggests that shortages in Surrey are current and expected to worsen over time Ongoing difficulties in arranging training for staff – ensuring appropriate cover is in place and transport to training venues The average level of need of people accessing residential or nursing care is rising, as more people access a variety of care and support services to stay at home for longer. This reflects the national picture, with the CQC noting that the number of nursing home registrations has increased whilst the number for residential care has decreased Under the Government’s future funding proposals for social care, setting the appropriate “notional rate” for care will be crucial in managing the future demand for local authority funded residential and/or nursing care In some areas of Surrey, the Council is facing difficulties in ensuring a predictable supply, at an affordable rate, of residential and nursing care placements

22. Our recommendations to the market Develop care models which, as far as possible, can support people as their needs change through to end of life care. Attendance at local Clinical Commissioning Group care home forums (where and once they are established) will assist with this. Sign up to the Social Care Commitment (www.thesocialcarecommitment.org.uk), to publicly declare a commitment to improving the quality of care and support services and to treat all people receiving services with dignity and respect Review your care home environment(s) and establish whether it the design and decor supports people with dementia appropriately. Prepare for the social care funding changes proposed by the Government by splitting the elements of weekly charges into accommodation and care costs New care home developments, or changes to existing ones, should demonstrate how best practice design principles to support people with dementia are being followed Deliver high quality care and support which is person-centred. Encourage and enable care home residents, through linking care homes with outside groups and organisations, to connect with their local communities and participate in a range of stimulating, inter-generational activities.

23. Short Document Intentions as previously indicated

25. New beds required by 2024 In previous sections we have seen a wide variance in both population growth and the relative number of beds available between England, Surrey and across the 11 districts. This section looks at the number of new beds that would be required across all areas and service type to meet the current number of beds per ‘000 in England (see table below) by 2024 – therefore evening out the supply and demand levels in each area. As an example – to have 93 beds available for every 1,000 population aged 75 and over, England needs around 150,000 new beds, a 36.6% increase to match the population growth. To obtain supply and demand parity in 10 years, the situation in each district and across the different types of home varies greatly. Surrey needs around 13% more nursing beds, and 47% residential beds, a net required increase of around 27% Mole Valley, Guildford and Spelthorne need a much greater numbers of beds by 2024, Reigate & Banstead and Waverley appear to already have more beds than will be required. This shows that whilst there is a massive demand for new beds in England, locating them is key to maintain a sustainable marketplace for all care providers, and also ensure a sensible level of provision in all areas.

30. Top Up Fee’s

31. Sector Update December Network Meetings

33. Surrey Update

34. Outlines the HOW The process and procedure

35. Appendix A: Outlines what Inspectors Could look for as evidence Appendix B: Describes what a service in Each rating looks like Appendix C: Ratings Principles Training is referenced on pages: 6,7,9,11,12,13,19,20,34,36,37 ? Competency Vs Training

41. What we found “Overall we found more good care than poor in the care homes and hospitals we visited, but the quality of care for people with dementia varies greatly and it is likely that they will experience poor care at some point along their care pathway. Clear guidance has been available for years, but improvements in care are still needed and overdue.”

42. Action CQC will take Appoint a new national specialist adviser for dementia care. Train inspectors across all inspecting teams to understand what good dementia care looks like so that their judgements of the performance of providers are consistent and robust. Include a separate section in hospital inspection reports that shows how well the hospital cares for people living with dementia.

45. Care management and leadership

50. N.B. From Ireland Contacts at back not relevant