Market Position Statements (MPS)

Market Context 

We provide a range of nursing and residential care for people in Waltham Forest with mental health needs, learning disabilities, physical disabilities, and for older people. There are 45 residential and nursing homes in the borough. 

Placements are spot purchased both within the borough and out of the Waltham Forest area. This is driven by choice and availability. While the spot purchasing contractual arrangement offers the local authority and residents more flexibility and choice, it lacks an agreed pricing framework and does not comply with procurement rules.  

The nursing homes in the borough are based in Chingford and Leyton. They offer predominantly care to over 65s but some are registered for younger residents as well. 25% of placements in the borough are in the three nursing homes owned by the borough. 

There are 7 independent residential homes in the borough of various sizes, the smallest having 19 beds and the largest 43.  

Most homes are in Chingford, the most affluent part of the borough, and the area with a higher older population. This includes the largest nursing home and 6 residential homes. 

Current Market Status 

We are in the process of recommissioning all our residential care to support the Council in managing its budgets, achieve consistent cost packages, improve quality, and define placement specifications.  

A provider has recently purchased the old County Hotel in Old Oak Road, to develop a care home with 120 beds. This will offer both nursing and residential care. A provider will also be opening a new 60 bedded residential home focussing on dementia and challenging behaviour in March 2024 

Provider Dimension 

We currently have 3 local authority owned residential care homes for people aged over 65. We additionally have 3 nursing homes. All other older people homes are residential care for older people with or without dementia. We have 18 residential homes for people with a learning disability and 13 residential homes for people with mental health needs. 

In Waltham Forest our homes provide a total of 870 beds of which 326 are occupied (November 2023). Currently the contracted homes in Waltham Forest are 42% occupied by Waltham Forest residents. This provides 633 beds for those aged 65+, 133 for those with mental health needs, and 104 for people with learning disabilities.  

Our mental health and learning disability homes will usually be registered for those aged 18 to 64. However, some homes are registered for over 65 so residents do not have to leave when they get older. Equally, some people with mental health needs or a learning disability will be placed in older people homes due to their age when placed. Two of our three nursing homes are registered to take residents under 65. 

Market Data and Insight 

There are currently 633 residents placed in care homes and funded by the local authority. Approximately 51% of the placements are in care homes in Waltham Forest. 18% are in Redbridge, 3% in Havering and 3% in Barking and Dagenham (North East London boroughs). In Essex there are 12%. The remaining 13% are placed throughout the country. (November 2023). There are 252 care homes in North East London.  

(The above data set covers both Older People Residential and Nursing care. The market has been segmented based on the main specialism supported by the home.)  

(Note: this includes homes that are also registered as residential with Nursing.) 

The information shown in the table(s) above is correct as of 1st November 2023.  

Market Risks 

Workforce is a key factor, with continuous difficulties in recruiting and retaining staff in the face of competition from other market sectors over terms and conditions. Care homes reported that skilled recruitment was becoming more challenging post pandemic, and they couldn’t access overseas recruitment opportunities due to their size. By working with Care Providers Voice providers will be able to access appropriate staff across North East London who are willing to work in Waltham Forest. 

Availability of services to meet greater complexity is an issue. Difficulties are routinely reported by the LBWF brokerage team around the sourcing of the right home for higher levels of need and greater complexity, especially residents with specific needs of Delirium/Dementia/Under 65 with Challenging Behaviour. The March opening of 60 additional beds in Waltham Forest in a home specialising in dementia care will help to address this risk. 

Spot purchasing allows greater flexibility and allows choice in finding a residential placement.  A flexible framework with desirable pricing will help us to continue to provide choice, quality and maintain fair pricing. 

Current Areas of Focus  

We are working with colleagues across North East London to ensure consistency in commissioning services as far as possible in the region.  

We are developing standard service specifications. We will co-produce these with providers. We want to ensure quality and sustainability.  

We have recently funded Care Provider’s Voice who offer a job broker scheme for care providers as well as opportunities to share training opportunities and help us to engage with providers within and outside of the borough. 

Commissioning Intentions 

The Council is ambitious about quality care home provision with transparent package of care costs to meet the needs of residents who cannot remain in their own homes or in other accommodation-based services. Commissioners are keen to work with providers that offer excellent quality personalised care and support. Our goal is for care homes to be well-connected, at the heart of communities supporting respite and reducing emergency admissions. The aim is to support care homes to become active contributors to social care offering exciting employment opportunities. 

The current model of purchasing residential placements means it is difficult to control the price and quality of individual placements or to manage the market. We are therefore scoping options to move to a standard and enhanced model with a dynamic purchase vehicle (DPV) to address this.  

We are also working to continue to develop our discharge to assess and respite models to ensure that they are best value to achieve required outcomes.  

We will continue to work with colleagues across North East London to achieve best value and quality and to manage the local market across the sector. Commissioners will actively engage the market around any procurement opportunities. In addition to work undertaken at local level, commissioners are also working with North East London partners to develop joined up quality outcomes, specifications and package costs.