NHS should sell surplus land to build more residential care, says former care minister

NHS Trusts should sell surplus land next to hospitals to build enough care homes and supported living apartments to meet increasing demand, says former care minister Paul Burstow.

It is just one of the many reforms he says is needed by the care sector as a result of a commission on residential care run by think-tank, Demos.

The year-long commission brought together academics, industry experts and providers to explore the future of the ‘housing with care’ sector – covering everything from care homes, villages and supported living for older and disabled people.

Over 450,000 people live in care homes in England. A rapidly ageing population and an increase in younger people with complex health needs will see this number continue to rise – leaving the sector and wider economy underprepared.

Less than 40 per cent of land held by NHS trusts is currently being used for hospitals and medical buildings, leaving over 5,000 hectares potentially available for other purposes such as care accommodation. This would also ease the strain on the NHS, where around 30% of acute hospital beds are filled with people who don't need acute care and could be better supported in a care setting.

The Demos final report calls for incentives, such as expedited planning permission and reduced purchase prices, to sell surplus land to providers who reserve a percentage of space for state-funded residents care, or contribute to local authority services. The idea mirrors Section 106 laws currently used to ensure property developers build affordable housing.

The report proposes more co-location in the sector – combining care properties with educational institutions or community centres such as nursery groups or libraries. This already happens in the United States, where ample land available on university campuses allows residents of care villages to attend courses and feel part of a diverse community.

Co-location also helps battle damaging negative perceptions of care homes by increasing people’s first-hand experience. Demos found only a quarter of people would consider moving into care if they became frailer in old age, compared with 43 per cent who would not.

However, polling consistently showed that people with first-hand experience of housing with care generally hold more positive views, and are more likely to consider care homes for themselves.

Mr Burstow also calls for a separation of housing and care costs along with the introduction of individual tenancy rights to give people moving into care homes the same security and rights as those moving into supported housing or care villages.

The proposal would prevent care home residents from being moved from their home through commissioner decision-making, allow them to decide whether or not to have CCTV in their property, and offer shared ownership and decision-making powers of communal areas.

The report also recommends:

  • The OBR should conduct regular 20-year projections to accurately predict future demand for care services and the financial and technological requirements in the sector.
  • Dropping the term ‘residential care’ from registration, local commissioning and national policy and replacing it with ‘housing with care’ to better describe a spectrum of options.
  • Expanding CQC’s role to inspect local health and care commissioners, not just providers; to focus exclusively on the quality of care rather than surrounding accommodation, to bring care home inspections in line with the current scrutiny of extra-care villages.
  • Introducing an industry-wide ‘licence to practise’ ensuring all care workers receive a minimum level of training before they are able to support people unsupervised. The licence could also be suspended or revoked in cases of malpractice or abuse.
  • Making housing with care a living wage sector, to boost staff morale, reduce turnover and help tackle negative perceptions that have damaged the sector.
  • All care providers must publish and respond to official feedback and complaints about their services via their website to encourage a culture of transparency and accountability.

Mr Burstow said: "As we are living longer lives, housing with care is going to become increasingly important in helping us stay independent, happy and healthy. It is vital that government wake up to this reality sooner rather than later and helps creates the right incentives to ensure older and disabled people have a genuine choice when they need to move.

"We can no longer be prepared to accept for others housing with care that we would not be happy to move into ourselves. This report sets out the roadmap for change and contains a set of robust recommendations designed to ensure that high quality housing with care becomes a reality for everyone who needs it”.

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