MEETING THE NEED

Meeting the growing demand for specialist care services

With the numbers of people living with complex disabilities and dual diagnoses rising, the pressure on care homes to deliver appropriate care is growing significantly.

To help meet this demand, and ensure people receive the specialist nursing care they need, Exemplar Health Care is embarking on a programme of expansion to bring significant new resource across England. NR Times learns more.

With significant and mounting pressure on NHS wards as the peak winter months arrive, many much-needed hospital beds are often taken up by people who have recovered from the reason they needed urgent medical intervention, but who continue to need ongoing care. For many people with complex needs, they are not able to be discharged to live independently - but neither do they need to occupy a hospital bed, a resource already at a huge premium in an underpressure health service. The lack of provision nationally in this area is a significant problem - and one which can see people remain in acute environments for far longer than they need to be, due to a shortage of places in specialist care homes which can meet their needs. And this huge demand on resources is set to grow in years ahead - statistics show that in 2020/21, there were more than 1.9million requests for adult social care, particularly among those of working age. Furthermore, Council for Disabled Children research shows there are growing numbers of children with complex needs, who will go on to need adult services in future years.

Meeting the need

This rocketing demand has been a key factor in the significant and ongoing growth of Exemplar Health Care. The specialist care provider, known for its capability in supporting those with high-acuity complex needs and behaviours of concern, is aiming to open ten care homes during 2023 across England, to help increase provision for those for whom resource is scarce. The ten planned for next year follow two recent openings - Cheshire Springs in Ellesmere Port and Edgewater in Wallasey - which are helping to bring additional provision in their local areas to ease pressure on NHS resource. All of the new homes will follow the format of Exemplar Health Care’s current portfolio of homes, which pride themselves on their person-centred approach to care and high staffing levels - with an average of one nurse for every six health care assistants on each small unit. The first new homes of 2023 are set to be unveiled in spring, with the openings of Roseside in Liverpool, Woolston House in Warrington and Tees Grange in Stockton. “Finding the right environment for someone after leaving a hospital setting is an ongoing problem, and particularly for someone with complex care and health needs,” says Rachel Calladine, business development director at Exemplar Health Care. “There is a lack of suitable care homes which have the expertise to provide this type of care, and within the care homes that do exist, there are very few beds available.

“This problem exists all year round, but particularly as we saw during the COVID-19 pandemic, and then the annual winter pressures, it is very much heightened at this time of year. “The pressure on the NHS and social care is very significant at present, and combined with the recruitment challenges and impending nurses’ strike, the pressures on the system show no signs of relenting. “Looking into the future, this is only going to increase - the number of people living with more complex health issues is increasing, and we have an ageing population and growing numbers of people with dual diagnoses. The need for complex care is only going to increase. “And that is why services like ours, which provide very specialist nursing care for people with complex needs, are so vital. Not only can we help to relieve some of the pressure on NHS frontline resources, but we can ensure that people are being discharged into the right environment for them, which is crucial in avoiding the distress of a failed placement.”

Overcoming the challenges in finding a placement

Increasingly often, in the desire to discharge those from NHS settings, people can be discharged into environments which are not entirely appropriate for the complexity of their needs - leading to problems further down the line and, in many instances, a failed placement. Cost pressures can be an issue for commissioners and can prove a barrier in some cases, says Rachel, but placing someone in the right placement, that meets their complex needs, the first time round, is critical to breaking the cycle of failed placements, that often leads to their needs being exacerbated. For Exemplar Health Care, their track record in supporting people who have experienced one or more previous failed placements is particularly strong. Over 60 per cent of their service users come to their homes following a failed placement. “It’s hugely important that people receive the right level of care and support for their needs. Where possible, we’re committed to ensuring that people receive this care close to home and their loved ones, in the communities they’ve always lived in,” says Rachel. “Understandably, at the times, this is difficult, which increases our commitment to providing specialist nursing care in more locations across England.”

New provision to help relieve mounting pressure

The new openings - a combination of purpose-built developments and extensive refurbishments of existing sites - see Exemplar Health Care strengthening presence in existing counties like Yorkshire and Merseyside, while establishing presence in new areas across the North including Sunderland, Leicester and Telford. “It’s very much demand-led, and in several of the areas, we are answering specific demand that we know exists in that area after speaking with local commissioners,” says Rachel. “We are building new homes in response to that, and our refurbishments are so extensive they are fully refurbishing the entire building to ensure they are totally fit-for-purpose, so we’ve remodelled the interiors to make sure that the bedrooms are big enough for people with ventilators or use large wheelchairs, or those who might need the rails on the ceiling for bariatric care. “We have specialist nursing capability which means we’re able to provide support for people living with very complex care and health needs. This includes those with conditions such as brain injuries, dementia, neurological conditions and spinal injuries. “Often, the care we provide would otherwise only take place in hospital, such as tracheostomy and respiratory care, and these are done in the homes by our in-house teams, it isn’t done by community resource. “In addition, we are creating more bespoke environments to care for people with complex behaviours of concern. “We are able to provide them with the appropriate environment and support that ensures wherever possible, there is not a revolving door scenario back into secure settings. “Our schedule for opening is continuing during 2023 and 2024, but we realise the level of demand and need for us to help meet this, and it’s very exciting that we can play our role in delivering the high quality, specialist care that is needed to help give people a better quality of life while also relieving pressure on the frontline.”