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Dudley Care Market and Market Analysis

The tables below show the spend from Dudley Council Adult Social Care budgets in 2022-23 and committed spend for 2023-24 and recurrent ICB spend and budget for the same period.

Dudley Council Adult Social Care Spend

2022-23 2023-24
Residential £24,229,237 £25,652,760
Nursing £12,869,758 £14,129,504
Domiciliary Care £16,555,623 £17,714,516
Supported Living £21,809,437 £23,211,413
Direct Payments £12,405,909 £13,196,015
Shared Lives £976,964 £1,018,697
Extra Care £709,575 £759,245
Voluntary Sector £2,833,731 £2,933,731
Total £92,390,234 £98,615,881

Costs Incurred by ICB Established Recurrent Budgets

2022-23 Actual Spend 2023-24 Budget
Continuing Healthcare £24,401,791 £27,464,991
Intermediate Care £7,154,571 £8,664,946
Total £31,556,362 £36,129,937

The graph below shows the Dudley Council spend according to care type, 60% of spend is used to support people in their own homes, we expect this percentage to grow year on year in line with our commissioning intentions to support a Home First approach.

Dudley Council Spending According to Type

Pie charting showing Dudley Council spend according to care type. The largest sector is Residential at 27%, followed by Supported Living 24%, Domiciliary Care 19%, Nursing 14%, Direct Payments 14%, Shared Lived 1%, Extra Care 1%

Care Type Number of Services/Contracts Number of People
Residential Care (18-64) 66 165
Nursing (18-64) 28 61
Residential Care (65+) 117 620
Nursing (65+) 68 327
Domiciliary Care 38 1557
Supported Living 39 39
Extra Care 4 107
Shared Lives 8 (7 out of area) 51
Direct Payments NA 866

37% of people supported are in care homes using 40% of the budget, versus 63% of people who are supported in their own homes using 60% of the available budget.

Quality Monitoring

Dudley Council undertakes monitoring against contracts it issues for all types of care and support or social care related activity. Our quality monitoring process employs a wide range of tools and may take the form of any one of the below or a combination and these:

  • data requests and data analysis
  • contract monitoring data forms
  • contract meetings
  • contract reports
  • feedback from people using services
  • feedback from agencies visiting the service
  • feedback from partner agencies
  • satisfaction surveys
  • safeguarding concerns
  • concerns
  • complaints
  • compliments
  • planned quality audits
  • unannounced quality monitoring visits

This list is not exhaustive.

Services that are rated inadequate by CQC are automatically suspended from new purchasing and will be subject to intensive monitoring by the council and partner agencies to ensure quality and safety is improved for the benefit of people accessing the service.

Decisions related to how and when quality monitoring is undertaken is by use of a risk-based quality assurance (RBQA) tool that assesses the risk from intelligence gathered and is issues based. The key domains of the risk tool are:

  • Safeguarding
    • includes complaints/ concerns, client outcomes
  • Regulatory rating
    • CQC ratings for registered provision
    • SE notices, etc
  • Finance
    • Viability
    • Sustainability
    • Service operating model
  • Workforce
    • Sufficiency of staffing
    • Staffing experience, suitability, and expertise

The current regulated CQC provision in Dudley comprises 91 care homes and 51 domiciliary care registered provision which includes supported living but does not reflect domiciliary care and supported living services that support Dudley residents but do not have offices registered in the Dudley Borough. The graph below shows the CQC ratings as at April 2023.

CQC Ratings

Bar chart showing CQC ratings for Dudley Council care provision as at April 2023. In Nursing, 4 are rated Good, 11 are rated Requires Improvement and 1 is not rated. In Residential, 56 are rated Good, 15 are rated Requires Improvement and 4 are not rated. In Domiciliary Care, 321 are rated Good, 5 are rated Requires Improvement and 15 are nor rated. In Shared Lives, 1 is rated Good

Non-regulated services that are contracted with the council are also monitored by the council and will be reflected in the new version of the risk-based tool that is being refreshed in 2023.

Non-commissioned and non-regulated services may also be supported by quality monitoring resource when issues arise due to safeguarding and or serious concerns.

Market Entry and Exit

In 2010 there were 110 care homes in Dudley 22 of which were nursing homes, in 2023 there are 91 care homes 16 are nursing.

During and since the pandemic Dudley has seen an increase in home closures for both Nursing homes and small homes supporting 6 people or less. Closures have mostly been as a result of financial sustainability issues where occupancy has been reduced to 50% or less though a few closures were as a result of quality and safety issues.

CQC Registered Care Home Beds in Dudley 2012-2023

Line graph showing the number of CQC registered care home beds in Dudley Borough 2012-2023. The line starts at 2,374 in 2012 and rises to a peak of 2,494 in 2015. The line declines to its lowest point of less than 2,264 in 2020 then rises again to 2,423 in 2022 and finishes as 2,321 in 2023

Despite the reduction in the number of care homes over the last decade, care home beds capacity has been relatively static over the last few years but population growth and increased demand, especially complex needs demand for social care means that the current care home provision will not meet future demand, this is especially the case for nursing care. Models of care that can support people with complex needs in their own homes will be a priority for development over the next few years. See housing with care section for more information.

Currently there are a high number of placements in out of area care homes, especially nursing homes for people aged 65+ is rapidly increasing.

Care Homes people 65+ by Spend %

In Borough Residential 79%
Out of Borough 21%
In Borough Nursing 24%
Out of Borough 76%

The situation for placements of people aged 18-64 with learning disabilities, autism or mental health needs is equally higher than we would want for out of area placements.

Care Homes people 18-64 by Spend %

In Borough Residential 53%
Out of Borough 47%
In Borough Nursing 46%
Out of Borough 54%

Number of CQC Registered Care Homes in Dudley

Line graph showing the number of CQC registered care homes in Dudley Borough 2012-2023. The line starts at 108 in 2012 and then declines to 103 in 2015, 94 in 2020 and finishes at 91 in 2023

Dudley Population Growth

Bar chart showing Dudley population growth from 2002 to 2020. The line rises steadily to a peak of 420,000 in 2020

To meet the changing demand and ensure there is a sustainable market, we will work to shape the market to be more outcome focused; Dudley will be introducing formally procured frameworks across the social care market for both older adults and people with disabilities and working with the market to consider how collectively we can drive up quality and outcomes.

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