Bed Based Care – Supported Living

Where are we now

Supported Living services for adults are an essential part of the Health and Social Care landscape, providing care and support for some of the most vulnerable people in society. 

Supported Living services (including Managed Living Environments) are typically defined as housing where support and/or care services are provided to help people to live as independently as possible. People living in Supported Living services have individual tenancies. This means that people have a home of their own. Supported Living arrangements aim to increase an individual’s independence and skills by reducing dependency over a period of time and reduce the amount of paid and unpaid support that they need. This enables people to try new things, allows the provision of care and support in their own homes and may support people to move-on to more independent forms of accommodation. Supported living provision within Sutton supports adults with differing needs including those with a learning disability, autism, physical disabilities and mental health conditions.

Within Sutton there are currently 46 Supported Living services (including 1 Managed Living Environment scheme) providing care and support to adults aged 18+ (including adults aged 65+). Not all of these services are registered with the Care Quality Commission (CQC), as not all provide personal care to the individuals living in the services.

Despite a broad range of Sutton based provision, some Sutton residents are placed out of the area. This can be due to the current market being unable to meet the needs of our more complex residents and ensuring that individuals are appropriately matched into existing services.

Diagram 1 : Location of Supported Living Placements For Adults Aged 18+

Data Source : Adult Social Care Sutton

Sutton’s preference is always to place residents who require care and support within the Borough, wherever possible. Just under three quarters (70.6%) of the placements made by Sutton into Supported Living for all adults, are within the Borough.

There is currently a total capacity of 254 Supported Living beds in Sutton for adults aged 18+. Of this total, Sutton commissions 71 beds (28% comprised in 9 schemes) through a block contracting arrangement with 3 suppliers. The remaining 183 units (72%) are provided by 19 suppliers, including 1 supplier who also provides 36 of the units contained in the block contracting arrangements. All other placements into Supported Living services made by Sutton are done through a spot purchase arrangement. 

Diagram 2 : Breakdown of Supported Living Placements by Purchasing Method

Data Source : Adult Social Care Sutton

The pie chart above shows the breakdown of placements into Supported Living provision made by Sutton by the purchasing method used. Of all placements purchased, 61.8% are spot purchased (32.4% in Borough and 29.4% out of Borough) and 38.2% purchased through a block contract arrangement.

Diagram 3 : Number of Supported Living Beds in Sutton by Market Sector

Data Source : Adult Social Care Sutton

The majority of Supported Living beds in Sutton (191 beds or 75.2%) are provided by private sector commercial organisations with the remaining 63 beds (24.8%) provided by the voluntary / not for profit sector.

Diagram 4 : Number of Supported Living Suppliers in Sutton by Market Sector

Data Source : Adult Social Care Sutton

 

Diagram 5 : Number of Supported Living Services in Sutton by Market Sector

Data Source : Adult Social Care Sutton

 

Diagram 6 : Number of Supported Living Services in Sutton by Supplier Size

Data Source : Adult Social Care Sutton

Of the 21 suppliers of Supported Living services in Sutton, 6 (28.6%) are voluntary organisations, with over two thirds (15 or 71.4%) being private commercial organisations. Of the 46 Supported Living services, the highest number (17 services or 36%) are provided by locally based suppliers. National and regional suppliers equally make up the remaining 64% of the Supported Living provision in Sutton. Of these services, the majority (36 or 78.3%) are provided by private sector commercial organisations with the remaining 10 services (21.7%) being provided by the voluntary sector.

The quality of Supported Living provision for our residents remains a key focus for Sutton.

Supported Living services are not subject to mandatory regulation, however Supported Living services which offer support with personal care are regulated by the CQC. Supported Living providers that do not provide the regulated activity ‘Personal Care’ are not required by law to register with CQC. Sutton only commissions Supported Living services from suppliers who are registered with CQC regardless of whether personal care is required.

Diagram 7 : Number of Regulated/Non Regulated Supported Living Services in Sutton

Data Source : Adult Social Care Sutton/CQC

 

Diagram 8 : Number of Regulated/Non Regulated Supported Living Beds in Sutton

Data Source : Adult Social Care Sutton/CQC

Of the 46 Supported Living services provided by 21 suppliers within Sutton, 38 (82.6%) are regulated by the CQC and 8 (17.4%) are non regulated. The impact of this means that the majority of Supported Living beds (89% or 226 beds) are regulated by CQC with a small minority of 28 beds (11%) being non-regulated.

Diagram 9 :  CQC Ratings for Supported Living Services in Sutton

Data Source : Adult Social Care Sutton/CQC

 

Diagram 10 : CQC Ratings for Supported Living Beds in Sutton

Data Source : Adult Social Care Sutton/CQC

Each regulated service or provider is rated across 5 domains (safe, effective, caring, responsive and well-led) by the Care Quality Commission (CQC) with a rating of either outstanding, good, requires improvement or inadequate.

Of the Supported Living services within Sutton 27 (58.7%) are rated as ‘good’ with 11 (23..9%) rated by CQC as ‘requiring improvement’. There is currently 1 service (2.2%) awaiting inspection with the remaining 7 (15.2%) services being non-regulated. There is currently no Supported Living provision within Sutton that is rated as either ‘excellent’ or ‘inadequate’. In relation to Supported Living beds within Sutton, this translates to 164 beds (64.6%) being rated as ‘good’ with 53 beds (20.9%) being rated as ‘requiring improvement’. There are currently 9 beds (3.5%) awaiting inspection with the remaining 28 beds (11%) being non-regulated.

Diagram 11 : Average Weekly Cost of a Supported Living Placement by Age Group

Data Source : Adult Social Care Sutton

The graph above shows that the average weekly cost of a Supported Living placement varies between £688 and £1528 dependent on age group. The highest average weekly cost is for the younger adult age group of 18-25, with an average cost of £1528. The lowest weekly cost is for the 76+ age group, at an average of £688.

Diagram 12 : Total Weekly Cost of Supported Living Placement by Age Group

Data Source : Adult Social Care Sutton

The total weekly cost of Supported Living placements averages at around £23,000 with significant variation across age groups. The most expensive age group is the 56-65 year olds at a total cost of £38,000 per week, with the least expensive being the 76+ age groups.

Diagram 13 : Distribution of Weekly Gross Cost of Placements in Supported Living

Data Source : Adult Social Care Sutton

The graph above shows the distribution of weekly gross costs of placements in Supported Living. The range covers placements of a weekly gross cost from those costing up to £300 at the lowest end, to those placements of a weekly gross cost in excess of £1800.

The overall financial picture of Supported Living placements in Sutton is a balance between a small group of expensive placements for 18-25 year olds and a larger but relatively inexpensive group of placements for 56-65 year olds. There is a general trend (when disregarding the 18-25 year old age group) that Supported Living placements become more expensive as a client gets older. 

Our Supported Living Market – Adults Aged 18+

Of the 46 Supported Living services in Sutton, 4 services (8%) identify as supporting adults under the age of 65, with 21 services (45.7%) identifying as supporting adults both under and over the age of 65. The remaining 21 (45.7%) do not specify the age of the clients they support.

Diagram 14 : Age Profile of Supported Living Clients

Data Source : Adult Social Care Sutton

The pie chart above identifies the age profile of adults aged 18+ in Supported Living placements made by Sutton. The significant majority (81.7%) fall within the 18-65 year old category, with the remaining 18.3% being over 65 years old. Of the full age profile of individuals, almost a quarter (24.1%) are aged 56-65 years old. Just over one tenth (11.2%)  fall within the younger adult group of 18-25 years old.

Diagram 15 : Primary Support Reason for all adults in Supported Living

Data Source : Adult Social Care Sutton

As part of the adult social care assessment process, individuals who are identified as having an eligible need for ongoing care and support, have their ‘Primary Support Reason’ identified and recorded. Individuals may have a number of identified needs, however a primary reason for support will always be identified.

Of the total number of adults aged 18+ being placed in a Supported Living provision, the graph above identifies that for the significant majority (78.8%), the primary reason they have been placed within this type of care setting is due to their requirement for support for a learning disability. For the remaining quarter of adults aged 18+, the primary support reasons for requiring care and support have been identified as mental health support (9.7%), physical disability (11.8%), other vulnerability (1.2%), substance misuse (0.6%) and social isolation (2.1%) respectively.

Diagram 16 : Primary Support Reason for those aged 18-30 in Supported Living

Data Source : Adult Social Care Sutton

Of the 36 adults aged 18 to 30 years old currently placed in a Supported Living setting, for the majority (61.1%), the primary reason they have been placed within this type of care setting is due to their requirement for support for a learning disability. For the remaining 14 adults, the primary support reasons for requiring care and support have been identified as mental health support (25%), physical disability (11.1%) and social isolation (2.8%).

Diagram 17 : Primary Support Reason for those aged 31-64 in Supported Living

Data Source : Adult Social Care Sutton

Within the age group of 31 to 64 years old currently placed in a Supported Living setting, for the majority (77%), the primary reason they have been placed within this type of care setting is due to their requirement for support for a learning disability. For the remaining 20 adults, the primary support reasons for requiring care and support have been identified as mental health support (10.3%), physical disability (9.2%), other vulnerabilities (3.2%) and substance misuse (1.1%).

Diagram 18 : Primary Support Reason for those aged 65 -75 in Supported Living

Data Source : Adult Social Care Sutton

 

Diagram 19 : Primary Support Reason for those aged 75+ in Supported Living

Data Source : Adult Social Care Sutton

Within the older adults age group of 65+, 93.8% of individuals in a Supported Living setting have a primary reason for requiring support for a learning disability, with the remaining 6.2% of individuals requiring support for a mental health condition.

The decreasing numbers of placements in Supported Living of individuals aged 65 and over would indicate that they have been in these placements for a considerable period of time.       

Sutton makes 70.6% of its Supported Living placements for adults aged 18+ within the Borough, with the remaining 29.4% requiring placement out of Borough. This may be for reasons of complexity of need but also to be placed nearer to family members.  

 Diagram 20 : Location of Supported Living Placements by Age of Clients

Data Source : Adult Social Care Sutton

The graph above shows the breakdown of Supported Living placements made in and out of Borough by age group. For the majority of age groups, placements in Borough exceed those out of Borough. However for the younger adult age group of 18-25, 65.5% of Supported Living placements are made outside of Sutton. This would indicate a need to develop further appropriate Supported Living Services to meet the needs of this age group.         

Where we want to be – Our Vision

Over the next 5 years (2023-2028) our vision is to develop in partnership, innovative and sustainable Supported Living options and a market that is responsive to the needs of our residents, remains safe, supports excellence and provides value for money. Our partnership approach to commissioning a sustainable range of high quality Supported Living provision will include:

  • Manage the Supported Living market as part of an integrated health, social care and housing system
  • Support quality in Supported Living provision through robust contract monitoring, performance management, quality assurance and data collection
  • Develop opportunities for the commissioning of new models of care over a five year period
  • Inform the planning of Supported Living provision for future years beyond 2028
  • A direct alternative to residential care for adults with a learning disability, autism, physical disability or mental health condition with increasing and/or complex needs who want to be as independent as possible

We want to improve outcomes for people living in Supported Living provision by enabling choice and control, delivering person centred care, managing risk and promoting independence and wellbeing. We will achieve this by ensuring:

  • The commissioning of Supported Living providers that improve the wellbeing of tenants and consistently achieve positive feedback from tenants, friends and family and other external stakeholders
  • Supported Living provision is safe and effective and delivered in ways that improve the tenant experience
  • Protecting the most vulnerable and ensuring tenants are supported to live the lives they want that may involve moving to more independent living options
  • The market is responsive to national and local policies and trends

We will know we have achieved our vision when we see:

  • Supported Living in Sutton recognised as a market leader
  • Integrated commissioning is developed and implemented
  • More use of digital and care technology to keep tenants safe
  • Partnerships deliver innovative, integrated care and support options
  • People are supported to live in their own homes as long as possible
  • High standards of quality of care evidenced by high satisfaction ratings from tenants and our Quality Assurance Team
  • More options in house and in the community to improve the wellbeing of tenants
  • New service models that continue to deliver better Sutton based Supported Living provision
  • Improved workforce recruitment and retention

To support our vision, our commissioning intentions are:

  • The retendering of Supported Living provision in Sutton, which may require remodelling existing provision (service redesign) and/or commissioning new services to meet gaps in local provision or to improve access to existing provision
  • Innovative Supported Living options supported by outstanding quality of care and support
  • Commissioning methodology that is aligned across health, social care and housing
  • Evidence of improved outcomes for tenants living in Supported Living provision
  • A workforce that is sustainable, career focused and is rewarded for excellence
  • Co-production forums to influence planning and service development.

Challenges and Market Influencers

Sutton continues to face significant financial challenges alongside pressures managing capacity and demand as well as having the resources to effectively quality assure the market. Promoting partnership and collaborative working across the whole Sutton system will assist to identify and where possible address these and other system challenges. 

The local health and social care system involves a variety of partners and care pathways. Supported Living provision is a key element of the system, which also includes primary care, community services, adult social care, learning disability services, end of life care, acute care, mental health services and safeguarding adults. The system is complex and there are many challenges that require integrated commissioning solutions. 

Existing Supported Living services need to be reviewed and options developed to minimise or eliminate voids in block contract provision, including making better use of in and out of borough spot purchased options.

There is a lack of move-on options from Supported Living services for an aging population of tenants, which means there are fewer accommodation options for younger people. 

There are barriers to the implementation of new digital care technologies to improve tenants’ quality of life due to the availability of suitable infrastructure within Supported Living services and the associated costs.

As with all provision, Supported Living services costs are escalating year on year due to:

  • The erosion of care costs because prices are not increased to fund cost pressures such as inflation, minimum wage and pensions
  • Low unemployment in Sutton, which affects recruitment and retention generally and specifically pushes up payroll costs
  • Much higher dependency levels of people entering Supported Living services today, requiring higher levels of staff numbers and staffing expertise
  • The perceived greater regulation of the industry by the Local Authority, creating more bureaucracy generally and specifically affecting staffing 

Need and Demand

Sutton, like many other places, has an increasing older population. The impact of dementia on our aging population requires further analysis and understanding to fully appreciate future need and demand both from a population and Adult Social Care perspective in regard to Supported Living services. Although numbers are currently small, this will be of significance in relation to those individuals who have grown older in long term Supported Living placements.

Diagram 21 : Comparison Between Sutton, London and National Rates of Dementia Per 100,000 (PHE Diagnosis)

Data Source : Public Health England Fingertips

The rate of diagnosis of dementia in Sutton for adults 65+ is 727 per 100,000 people. This is higher than the London average of 519, but lower than the England average of 755.

Diagram 22 : Dementia Prevalence Projections in Sutton and Neighbouring London Boroughs (POPPI Estimate)

Data Source : Projecting Older People Population information (POPPI)

Sutton’s estimated 60+ population with dementia is estimated to increase by 40% from 2300 to 3300 between 2020 and 2040. This is comparable to our London neighbours. It should be noted this rate is an estimate of all those who may have dementia, regardless of their need or the impact of Dementia on their lives, and as such this rate is higher than the diagnosis rates reported by Public Health England (PHE).

According to PHE data in 2020 there were 1491 people, or 4.66% of the 65+ population, living within Sutton who have been diagnosed with dementia. This is higher than the London average rate of 4.17%, and the England total rate of 3.97%, but is similar to geographical neighbours like Croydon (4.51%).

Diagram 23 : Moderate or Severe Learning Disability Projections to 2040 for 16-64s in Sutton and Neighbouring Boroughs

Data Source : Projecting Adults Needs and Service Information (PANSI)

PANSI (Projecting Adults Needs and Service Information) data predicts that there will be no significant change in the levels of learning disability in the 18-64 population over the foreseeable future.

Diagram 24 : Current Rates of Learning Disabilities and Autism (Per 1,000 of appropriate population) in Sutton with a comparison to London and England

Data Source : Public Health England Fingertips

According to PHE  data, Sutton has comparable rates of adults with a learning disability receiving long term support (4 per 100,000) to London and England averages. We have half the rate of children with Autism known to schools compared to London and lower levels of children with learning disabilities than London and England.

Within Adult Social Care the area we can expect to see the least growth in demand is in learning disabilities. The adult population aged 18-64 with learning disabilities is predicted to stay stable. There is a possibility that if our average learning disability and autism in children increases to match the London and national averages, we may see a significant growth in adults with learning disabilities and autism in the future. This would require the need to further develop Supported Living solutions for adults aged 18+ in Sutton.

How we need the market to develop for the future

Over a number of years we have identified options for service redesign or improved placements that will assist us to meet need and keep people within Sutton including:

  • Improved access to short breaks provision such as respite care and short term placements
  • Residential provision for young people (25+) leaving residential college for example
  • Placements for people with a learning disability who have forensic backgrounds
  • Appropriate residential or nursing provision for people with Down’s Syndrome and dementia
  • More residential provision for people requiring ground floor accommodation due to serious mobility issues
  • Residential provision for young people (35+) with ASD and exhibit behaviours that challenge
  • More residential provision for younger adults with severe physical disabilities
  • Nursing care provision for adults with a learning disability.