8. The number of care home beds continues to decline
The number of care home beds is falling while the number of nursing beds is more stable, but with wide regional variation in both
There has been a long, slow decline in the number of care home beds available, which continued in 2018/19 with the loss of more than 250 care homes and 3,000 beds. The number of nursing homes also fell, though the number of beds increased slightly because – as with care homes – the average size of newbuilt homes is increasing.
There are now fewer than 15 nursing or residential home beds for every 100 people over the age of 75. This downward trend might be expected, since it fits with a broad policy direction towards supporting more people at home, rather than in residential or nursing care. This trend away from admissions to residential care may, however, be flattening out now, and an increasing population means that the actual number of admissions has in fact increased slightly (see indicator 16). Note though, that because data is not available, we do not know whether home care capacity has increased to compensate for the decline in residential care capacity.
The national trend also obscures sharp regional differences. While there has been little national change in the number of nursing beds overall, since 2013 the East of England, South East and West Midlands have seen increases of 7–8 per cent, while the North East has seen a fall of 7 per cent and Yorkshire and Humberside a fall of 9 per cent. For residential care beds, the overall 4 per cent fall breaks down into very steep falls in London (15 per cent) and the South West (9 per cent), but smaller falls elsewhere. The exceptions are Yorkshire and Humberside (which has seen a 1 per cent increase) and the East Midlands (a 4 per cent increase).
One factor explaining this variation may be homes switching between residential care and nursing care registrations. Homes may switch from nursing to residential status because they struggle to find enough nurses (the vacancy rate is 9.9 per cent – see indicator 9).
One factor in this is the number of self-funders in each region. Though the fees paid by local authorities for publicly funded clients have been increasing faster than inflation (see indicator 7), there is a significant historic difference between the two. In 2017 the Competition and Markets Authority estimated that fees paid by local authorities were 41 per cent below the prices paid by self-funding clients. This creates more incentive for providers to build new homes in areas with larger numbers of self-funders, which has led to concerns about the existence of ‘care deserts’ caused both by lack of provision and/or lack of staff (see indicator 9).