What do we mean by residential and nursing care services?
A care home provides accommodation, meals, personal care and support 24 hours a day for people who can no longer live safely or independently in their own home. All care homes are registered to provide residential care, nursing care or can provide both.
Residential care supports people with daily living, such as washing, dressing, taking medication and moving around. Nursing care provides the same support, with qualified nurses available 24 hours a day for people with more complex health and nursing needs. Both aim to help people live as independently, safely and comfortably as possible while maintaining their dignity, choice and quality of life.
North Yorkshire has a large and generally high-quality care home market. There are over 200 care homes in North Yorkshire which are registered with the Care Quality Commission (CQC) and more than 5,300 beds. Between 2,400 and 2,600 people are in Council-arranged care home placements at any one time. On average, care home are usually 90% full, which means there is usually a choice of available care home beds for most people requiring care home support. Quality of care in care homes in North Yorkshire is also good, with 84% of care homes rated Good or Outstanding by the Care Quality Commission. You can find out more in our Market Position Statement.
How does the Council arrange and purchase residential and nursing care?
The current arrangements have been in place for several years and are due to come to an end in 2027.
At present, the Council purchases residential and nursing care through an Approved Provider List (APL). Care homes that meet the Council's requirements can join the APL and set their own prices for care. When someone needs a care home placement funded by the Council, suitable homes are identified based on the person's assessed needs, availability and cost from the Approved Provider List.
While this approach provides choice and flexibility, it can mean that similar care is provided at different prices, and it can sometimes be difficult for people and families to understand what is included in those costs.
We are proposing to replace the current system with a new Care Home Framework. This would be a clearer way for the Council to work with care homes. It would set out which care homes can provide care for people supported by the Council, the standards those homes must meet, how people are helped to find a suitable care home, and the weekly fees the Council would pay for different levels of care and support.
It does not mean that people can only access one care home or that all care homes will be the same. Instead, it provides a clearer structure to help us make sure people receive the right care for their needs, that providers meet consistent quality standards, and at agreed weekly rates.
The new Care Home Framework would apply only to care homes in North Yorkshire. If someone needs to live in a care home outside North Yorkshire because it is the best place to meet their needs, the Council would continue to arrange this separately. We would agree individual arrangements and costs directly with the care home, rather than through the North Yorkshire Care Home Framework.
People who are eligible for social care under the Care Act have a financial assessment to work out whether they need to pay anything towards their care costs and, if so, how much. The new Care Home Framework would not change this. This is different from choosing to pay a top-up for a particular care home or room, which is explained in more detail later.
This consultation explains why change is being considered, the proposed new approach, the potential benefits and risks, and how the changes could affect people who need residential and nursing care. We want your views to help shape the final design of the new framework before any decisions are taken.
How have we designed the proposed new framework?
The proposal has been developed through engagement with care providers, people who use services, family members and unpaid carers, health partners and Council staff. We have looked at what works well within the current arrangements and where improvements could be made.
We have also considered:
- feedback from care providers and social work teams
- national policy and best practice
- the Care Act's requirement to promote a diverse, sustainable care market
- evidence about current and future demand for care
- the actual cost of delivering care services
Our aim has been to design a framework that puts people's needs first while supporting a strong and sustainable care home sector across North Yorkshire.
What are the main changes being proposed?
Clear levels of care and support
The biggest proposed change is the introduction of a framework based on different levels, or "tiers", of need. This means that care homes would be grouped according to the levels of care they can provide and we would introduce agreed fees for different levels of need.
Each tier would clearly describe:
- the level of care and support which is offered by the care home
- the skills, experience and staffing that a care home must provide
- the standards that care homes are expected to meet
This will create a clearer link between a person’s needs, the care provided and the price paid. It will also set clearer expectations for providers and help ensure people receive safe, effective and consistently high-quality care across North Yorkshire.
Clearer and more consistent fee levels, linked to different levels of need.
At present, care homes can choose whether to accept the Council’s standard rates or to set their own rates for care that is arranged by the Council. This means that people with similar needs can sometimes be charged different amounts depending on which care home has space.
The new framework would mean that the Council would pay care homes a set weekly rate based on the tiered level of care and support a person needs. Care homes would receive a fixed weekly rate based on the person’s level of need and the standards the care home must meet. The Council has asked independent experts to review the cost of providing care to help ensure rates are fair and enable care homes to continue providing services in the future. Their findings will help us set fair fixed weekly rates under the new framework.
For people with profound and multiple disabilities who need highly specialised support, the Council would agree the placement cost individually using recognised costing tools.
This proposal should make it easier for people and families to understand the care available, how much it costs and why costs may vary.
Better support for people with more complex needs
The proposed framework encourages providers to develop services that can support people whose needs change over time, including people living with dementia and people who require more complex care.
The aim is to reduce situations where people need to move to another care home simply because their needs have increased.
Providers would need to show that they have enough staff, with the right skills, experience and training, as well as a suitable care environment, to safely meet the level of care they propose to provide. They would also need to show that care is person-led, built around each person’s needs, preferences and strengths, and supports their dignity, choice, independence and quality of life.
Stronger focus on quality and outcomes
The Council already has measures in place to monitor the quality of care homes and works with providers to support them to improve where needed. The proposed framework would build on this work by setting clearer expectations based on the new tiers of care. Providers would continue to be assessed against a range of quality measures, including:
- person-centred care
- workforce skills and training
- staffing arrangements
- the quality and suitability of the care home’s facilities and living environment
- support for independence, wellbeing and choice
The framework will focus not only on what care is provided, but also on the outcomes it achieves for people.
What are the potential benefits?
Most people who already live in a care home would see little immediate change
If you already live in a care home, you would not be expected to move because of these proposals. If your needs change, a social worker would review them with you and consider whether your current care home could continue to support you. If it could not, we would help you understand the level of care you need and choose from suitable care homes that could meet your needs.
Most people already living in a care home would not see any immediate change to what they pay. The amount someone contributes towards their care would only usually be reviewed if their care needs or financial circumstances changed and they had a new financial assessment. Any changes would be explained and discussed with them.
Better information and transparency
People and families should have clearer information about:
- what different care homes can provide.
- the level of care they need.
- how care home fees are determined.
- what standards can be expected from providers.
More homes able to meet changing needs
We want more care homes to be able to support people as their needs increase. This could mean fewer moves between services, more stability and better outcomes for residents and their families.
Improved quality and consistency
The framework is intended to create more consistent expectations across care homes in North Yorkshire, helping ensure people receive safe, good-quality care regardless of which care home they choose.
A sustainable care home market
By setting rates that are linked to levels of need, we aim to pay a fair price that covers the costs of meeting care and support needs. This will help care providers to stay in business and continue investing in improving their services for local people.
How will this affect people who pay for their own care?
If you are responsible for paying the full cost of your care, any care home contracts will usually be between you and the care home directly. People who pay the full cost of their own care would continue to agree fees directly with their chosen care home. The Council’s proposed fixed rates would apply only where the Council arranges and funds the placement. Care homes may continue to set different private fees, so people should check what the weekly fee includes, how and when it may increase, and whether additional charges could apply.
In certain, limited circumstances, we can help you to arrange this care. Further information can be found in our arranging care for self-funders factsheet. The proposed Care Home Framework does not include any changes to these arrangements.
What are the potential risks and concerns?
Could this reduce choice?
Some people may be concerned that these proposals will reduce their choice of care homes that can meet their needs.
The intention is to ensure people receive care from providers who can safely meet their needs. However, in some parts of North Yorkshire there may be fewer homes that are able to provide particular levels of care. This could potentially reduce the number of options available to some individuals.
If the care home you choose is not part of the Framework, the Council may still be able to arrange your care there. However, if the cost is higher than the amount the Council would normally pay, you may need to pay the difference.
The Council will continue to work with providers to develop services and maintain a diverse range of care home provision across the county.
Could people have to pay additional top-up fees?
Under the current arrangements, some people already pay an additional contribution, known as a top-up, if they choose a care home or room that costs more than the amount the Council would normally pay. Further information is available in the guidance for choice and third party 'Top up' for people in residential or nursing care homes, who are financially supported by the council.
The proposed Care Home Framework does not include any changes to the Council's existing top-up policy.
The new framework is intended to make care home fees clearer and more consistent. However, there may still be situations where someone chooses a care home or room that costs more than the amount the Council would normally pay. In these circumstances, a top-up payment may still be required, in line with the Council's existing policy.
Could providers decide not to join the new framework?
When the new arrangements are introduced, some care homes may decide not to take part if they do not think the arrangements are right for them and their business.
This could affect the number and range of providers available through the Council's arrangements. The Council is working closely with care homes while developing the new arrangements. This helps us understand any concerns and make sure there are enough good-quality care homes available to meet people's needs now and in the future. The independent review of care costs will also help the Council set fair rates and reduce the risk of care homes deciding not to join the new framework.
Could there be fewer care home beds available locally?
There are currently enough care home places available in most parts of North Yorkshire. However, if the number of people needing care grows faster than the number of care home places available, it may become harder for some people to find a suitable care home close to where they live. The proposed new arrangements are intended to help care homes continue providing good-quality care and encourage the development of services that meet future needs. However, they cannot remove all of the challenges facing care home services.
What happens next?
We want to hear the views of residents, families, unpaid carers, care providers, healthcare professionals and the wider community.
The feedback received through this consultation will help shape the final design of the new Care Home Framework before any decisions are made. No final decisions have been taken and your views will play an important role in helping us develop future care home services in North Yorkshire.
Summary
The proposed new Care Home Framework aims to create a fairer, clearer and more sustainable way of arranging care home services. The changes are designed to ensure care homes can better meet people's changing needs, improve consistency across the market, provide greater transparency about care and costs, and support people to receive high-quality care for the future.
Return to the Shaping Adults’ Residential and Nursing Care in North Yorkshire survey.