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Supporting health and social care providers in Devon

MPS: Replacement care

MPS: Replacement care

What do we want from this area in the future?

The aim of our approach to replacement care is to:

  • increase carer resilience, reduce stress and prevent family breakdown
  • increase the choice of service models that provide replacement care that best meets their needs and individual circumstances
  • support people to be as independent as possible and by so doing reduce stress on carers. This is particularly the case for younger adults and for children with disabilities moving into adult life
  • ensure that there are enough, locally accessible and affordable services
  • ensure that those people with more complex needs usually requiring overnight accommodation, and often arising from multiple health conditions or disabilities, have access to services that can manage the complexity of need
  • provide greater assurance of the quality of replacement care services
  • ensure that replacement care can be booked well in advance.


What is the assessment of need?

(For general assessment of carers needs see MPS – Adult carers commissioning statement

The estimated demand is for at least 2,095 carers to have their needs met through replacement care. For the 2018-19 financial year there were 753 people who received replacement care in a care home or as a Direct Payment. Overall this was a 5% reduction in the number of people recorded as receiving support in the 2017-18 financial year. However, total spend was £3.05m, an increase of 2% on the preceding year. The increased spend, is due to an increased number of people with a learning disability receiving replacement care compared with other groups, for example older people.

The gap between estimated number of carers requiring support and the actual number of carers supported with replacement care by Devon County Council (DCC) can be accounted for as

  • not all carers will be eligible for DCC funded support but may be purchasing replacement care privately. The volume of private purchasing of replacement care is not known to DCC but engagement with carers indicates a keen interest in replacement care for private purchase.
  • DCC is only able to capture replacement care activity in residential settings – we know that there is significant replacement care purchasing in other care markets such as care and support into the home, sitting services, day services etc but we are unable to quantify this activity at the moment (work is underway to improve our identification of replacement care activity).

This is not to negate the potential for a level of unmet need and this is something we are continuing to investigate.

Of the people receiving replacement care:

  • 43% have a client category of physical disability
  • 30% have a client category of older people with a mental health condition
  • 24% have a client category of learning disability
  • 3% have a client category of mental health.

The need for replacement care is likely to be most required for those carers of working age, those aged 85+, and carers looking after young children whilst also caring for older people or other people with disabilities.


What is the assessment of supply?

There is likely to be significant under reporting of replacement care activity and spend (as stated above).  Nonetheless, ‘known’ spend is approximately £3.05m per annum, of which includes:

  • £179k is through Direct Payments
  • £2.8m on adult residential care places
  • £100k on nursing places.

Spend per annum by client category and service type (care home and Direct Payment) is further illustrated:

Cost per annum by client category and service type: Green = Direct payment, Black = nursing care, Red = residential care. The majority of clients are in the learning disability category aged 18-64 and live in residential care
Cost per annum by client category and service type: Green = Direct payment, Black = nursing care, Red = residential care. The majority of clients are in the learning disability category aged 18-64 and live in residential care

Replacement care is often a marginal activity for bed-based providers, whose main area of activity is longer term placements. Bed-based services will be made available for replacement care often only because a vacancy is available at that moment in time and not if there is a reasonable prospect of an alternative longer stay placement. Consequently, it can prove difficult to make placements suitable for people’s needs particularly when they have intensive and/or complex needs and it makes advanced booking extremely difficult.


What changes are we looking for from this service in the future, including any market opportunities, and how can Devon County Council help to move towards these changes?

The challenges are:

  • to support the development of community and voluntary sector support to carers that enable them to take a break, particularly in more rural areas
  • increasing the availability of bookable-ahead replacement care that supports the advanced planning of replacement care
  • to increase the range of service models available for people and carers to choose from, including replacement care into the person’s own home, accommodation-based replacement care and replacement care in community-based services and other innovative models of provision
  • to develop a more transparent market for replacement care for the benefit of carers (both funded and private purchase)
  • to improve access to replacement care services available at short notice or at the point of crisis
  • to improve the awareness of vacancies, quality and cost that supports purchasing of placements
  • to improve understanding of needs to better describe demand and further stimulate market development.

We will do this by:

  • Introducing, in the autumn of 2019, a list of services that addresses the need for replacement care with the following features
    • that includes all service models including for example regulated and unregulated home-based services, care homes, other bed-based services, day services etc
    • qualification by virtue of being an existing contractor with Adult Social Care on a substantive contract (such as Living Well at Home, Care Homes Framework, Supporting Independence Framework)
    • placements subject to the terms and conditions of those ‘substantive’ contracts including quality assurance and Provider Quality Support Policy
    • pricing subject to arrangements within ‘substantive’ contracts
    • utilise existing call – off arrangements to generate a list of potential providers across service models for people needing replacement care
    • individuals and their carers can ‘choose’ the appropriate model within their agreed personal budget, and will be able to ‘top up’ to enhance the service experience. And service provider details will be held on a database of providers accessible to carers and care managers to enable choice.
  • Developing a web-based platform for replacement care, supportive of online booking and available to support carers to make private arrangements within 18 months.
  • Working with providers to innovate in response to particular areas of need, such as:
    • services that can address the needs of adults with complex mental health, learning disabilities and or Autistic Spectrum conditions who experience escalations or crises in needs, which occur without warning, frequently and at random intervals.
    • host family type provision which might be further developed for daytime or short stay services, so that families can develop longer term relationships and plan ahead.
    • potential for social care personal assistants to provide replacement care into the person’s home.
    • partnership approaches between care providers and accommodation providers such as hotels/B&Bs.
  • Working with the community and voluntary sectors to increase the availability of low-cost, non-regulated volunteer-provided sitting services.
Market opportunity - replacement care
  • To join the list of services providers will need to be willing to offer replacement care and replacement care bookable in advance.
  • To work with commissioners to develop services for people with complex needs.
  • Develop host family replacement care and the use of personal assistants.
  • Develop volunteer-provided sitting services.


(Return to the Market Position Statement)

Last updated: 30/01/2020

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