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
| 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
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
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
Dudley Population Growth
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.