Extra Care Housing in Wales: Investing on our Futures Practitioner Workshop Ian Laight Director, Housing Research Ltd ‘Meeting rural needs’

Session content – Meeting rural needs 1. Rural extra care in Wales - Cylch Caron 2.Rural extra care precedents – North Yorkshire, Devon, Lincolnshire & Nottinghamshire 3. Rural extra care - challenges 4. Cylch Caron – partnership & reprovision objectives 5. Cylch Caron – funding, delivery & operation 6. Evolution of extra care – a greater involvement of health commissioners 7.Evolution of extra care – a greater variety of built forms 8.General needs housing - Lifetime Homes

1. Rural extra care in Wales - Cylch Caron A 40 minute bus journey to health services and amenities in Aberystwyth Tregaron is ‘deeply rural’ - a small traditional market town located at the head of the Teifi Valley and the foot of the Cambrian Mountains in the easternmost part of Ceredigion 3 ward catchment of 4,881 people, including 1,313 aged 65 and over All 3 of these wards are in the most deprived 10% of LSOAs in the Access to Services domain of the Welsh Index of Multiple Deprivation and 2 are in the most deprived 20% of LSOAs in the Housing domain

2. Rural precedents – North Yorkshire, Devon, Lincolnshire & Nottinghamshire A multiple bus journey to health & other services Bainbridge, North Yorkshire – completed 42 unit extra care scheme in a village of 480 people, most residents of an LA owned residential care home were settled successfully in this extra care scheme Next round of commissioning: Bentham – 3,606 pop, including 984 people aged 65 and over Gargrave – 3,604 pop, including 895 people aged 65 and over Same issues in other ‘shire’ counties

3.Rural extra care – challenges & responses Challenges  Large geographical areas but small population sizes  Sustainability and cost of small schemes  Workforce recruitment  Long travel times to health services and amenities  Limited pool of providers and contractors able to deliver and operate schemes Responses Hybrid schemes that combine several commissioning requirements Hybrid schemes that meet multiple needs – dementia, ALD, physical disabilities Small scale ‘shared household’ schemes with 24 hour staffing Direct development by Local Authorities General Needs housing to Lifetime Homes standards

4. Cylch Caron – partnership & reprovision objectives A partnership between Ceredigion County Council and Hywel Dda University Health Board, formalised in a Collaboration Agreement Cylch Caron meets multiple strategy and reprovision objectives for the partners: Housing Cylch Caron will provide 34 extra care unit in area where there is no purpose built housing for older people Direct provision of residential acre The Council’s existing EPH is very small & has limited scope for further improvement. Cylch Caron will provide alternative accommodation for the EPH residents and day care services Community services and integration Cylch Caron will provide a new operational base for social care and health staff delivering services into the surrounding rural community Health services Cylch Caron will provide 6 Intermediate Care units that reduce reliance on existing health accommodation, plus a new GP surgery within the building

5. Cylch Caron – funding, delivery & operation Draws on both Supported Housing Grant and health capital funding Normal funding and procurement rules apply, so Cylch Caron must: Meet Welsh Government health funding requirements through submission and approval of the Business Case to demonstrate value for money & deliverability Meet Welsh Government housing funding requirements through reference back to SHG and Acceptable Cost Guidance benchmarks Delivery will involve 2 stages: Procurement of a Delivery Partner to develop the design, obtain planning permission and work up a costed scheme for submission to WG in an FBC Implementation and long term operation by the Delivery Partner as scheme manager and housing provider Care and health services will continue to be delivered by the Council & Hywel Dda

6. Evolution of extra care – an greater involvement of health commissioners Cylch Caron is one of a small, but increasingly significant, number of hybrid extra care schemes that combine several commissioning requirements Integration of health and social care is contributing towards the creation of hybrids that had previously been too difficult due to differences in the two services of commissioning, funding, procurement and operational practices The partnership that has carried Cylch Caron forward has been based on persistent joint strategy and project team working at a local level ahead of a formal Collaboration Agreement Cylch Caron has been the subject of extensive community consultation, consultation with the various occupiers and soft market testing of providers The partnership has secured indications of support from Welsh Government based on the demand, delivery, sustainability & value for money work in the Business Case process – a very useful discipline to prompt early discussion among partners of what the scheme is required to provide and how this will be achieved

7. Evolution of extra care – a greater variety of built forms We are seeing an increasing variety of built forms for extra care, such as lower density dispersed ‘estates’ with freestanding community hubs Brownlow Road, Mansfield Directly developed and managed by the Local Housing Authority with capital grant support from the DH Care & Support Specialised Housing Fund and the Adult Social Care Authority 54 units & a hub – 1 and 2 bed bungalows, houses & 2 storey flats 10 units arranged in a secure group for residents with dementia

8. General needs housing - Lifetime Homes The dilemma of specialist housing - there will never be enough, of the right type or tenure, in the place where it is most needed So ALL housing must make a contribution towards meeting the changing needs of our ageing population – ideally through full compliance with the Lifetime Homes standards, which inevitably means bigger internal floor areas & higher build costs There is now active development of open market Lifetime Homes compliant ‘care ready’ housing by a contractor who is experienced in extra care schemes Mainstream housebuilders will not comply with Lifetime Homes unless forced to do so through local planning policies Tenures are the next hurdle – older people should not have to move to change tenure