1. All roads lead to…..Warwickshire’s extra care housing The challenge of developing extra care at a large scale Tim Willis, Extra Care Housing Programme Lead, Warwickshire County Council, Sarah Vallelly, Intelligence Manager, Housing 21 & Julia Godwin, Development Programme Manager, Housing 21

2. Overview Introduction: Warwickshire & extra care (Tim) –Local profile –The extra care programme Challenges and critical success factors (Tim / Sarah) –From ‘niche market’ to mainstream The development challenges (Julia) –Engaging local communities –Overcoming the “bumps in the road” –Partnership working and contractors Service models and harnessing innovation (Sarah) Conclusion and discussion –so what is ‘special’ about Warwickshire?

3. About Warwickshire (Tim) 5 Boroughs and Districts - North Warwickshire - Nuneaton and Bedworth - Rugby - Warwick - Stratford-on-Avon 12 major towns Home to 550,000 people 104,300 65+ in 2012 Expected to rise to 126,700 by 2020

4. Warwickshire Extra Care programme Programme launched July 2007 Initial focus on all 22 care homes owned by County Council Now a ‘whole market’ approach 25% ‘rental’ to meet needs of WCC customers Providing ‘hub and spoke’ services to meet local needs Enabling people to remain in their own homes Single tenders Independent sector opportunities Retirement Villages Maximising opportunities, e.g. via S106 Framework Partnership – inc. Housing 21

5. Warwickshire Extra Care programme – Phase 1 (2007 – present) Overall need for approx. 4,500 units, inc. 25% rental 550 (50%) as a direct alternative to residential care Summary of current position (mixed tenures): - Operating schemes (4 inc. 1 x LD): Total units = 161 - Under Construction (7 inc. 2 x LD): Total units = 437 - Planning Consent in place (4 inc. 1 x LD) : Total units = 298 - Pipeline schemes (potential/actual) (11 inc. 9 x LD/PD/MH) Total units = 352 Overall Total = 1248 Phase 2: 2014 – 2020 –increased level of need to 6,000

6. The challenges Tenure and dependency mix –Is a balanced community possible to maintain? –What works financially? Workforce challenges – care staff recruitment and retention Care commissioning pressures Removal of Supporting People Two tier authority –Nominations from districts Mixed messages and marketing –Clarity of offer: who is extra care housing for? –Engaging local community Funding pressures on use of space –Smarter use of communal space

7. The Development Challenges 6- sites spread out across the County in 4 Districts 370 units over 3-5 years Partnering contractor- Willmott Dixon Legal framework and tender submission £43 million, mixed for tenures- high degree of sales HCA grant and delivery timescales Commissioning of associated services Rohan Gardens, Warwick

8. The Development Challenges Engaging local communities and local politicians –‘What is extra care?- seeing is believing Trust with partners- nominations process Organisational changes Technical site issues- Highways, archaeology, legal covenants, flooding and environmental issues and demolition, asbestos

9. Development challenges Partnering contractor- elongated programme, continuity of staff team- increasing costs and value engineering Risk sharing with all partners! Innovative solutions and funding options Effective communication and spirit to find the way forward.

10. Critical success factors in Warwickshire Genuine partnership and will to make it work –Open and transparent communication at all stages –Risk sharing with all partners involved Commitment to overcome problems together Integrated care and housing Balanced communities –Tenure mix –Dependency mix –Homes for people with local connection

11. Critical Success Factors Early identification of potential residents Focusing on local people – not looking to add to the cost of care Transparent and accurate information on ‘what's on offer’ Clear about costs - who contributes to what and why Shared messages and ease of process – joint working Extra Care is not suitable for everyone – difficult decisions

12. Critical Success Factors Move-in support is essential – orientation to a new home, new community and new opportunities. Don’t assume anything – extra care changes peoples’ perception and reality of what they can achieve. Built environment and service model must BOTH be right Prevention and reablement outcomes don’t just happen by accident 24-hour staffing model is critical

13. Critical Success Factors Failure to invest in the service model = failure to achieve required outcomes Failure to invest in early days = missed opportunities for peer support and promoting independence Success looks expensive but ultimately costs less – invest in people and they are more independent with lower lifelong care costs. Easier said than done?

14. Sustainable Service Models Sustainable care services… might look radically different but perform better More people will be asked to contribute to the cost of the core service – ‘topping up’ or ‘full funding’ – income maximisation is key. This drives more on-site accountability and resonance to community need. Providers must step up and become (in)formal brokers to other services and develop small change assessment capabilities.

15. What makes it work Getting the balance right -Optimum dependency mix -Tenure mix -Robust sales programme -Integrated housing and care service How can this be sustained in future?

16. Warwickshire Model Early agreement that the service model must be fit for for purpose Shared cost of care between Local Authority and Residents Affordable for residents Clarity on roles/ responsibilities and service offer Compulsory core support charge No reduction in choice for planned and private care Quality monitoring to Warwickshire County Council – no loss of accountability.