Residential and nursing care

To use this page, you can view:

• the current landscape
• CQC ratings
• contract management
• Medway Council Rates
• Adult Social Care charging reforms and other costs that impact on fees
• Medway's current residential care position
• current service use (as of April 2024)
• list of current block beds and in-house capacity
• recommissioning Residential and Nursing Services.

There's a diverse residential and nursing care market operating in Medway with a range of providers from large national providers with numerous homes across the country, to small independent providers operating only one care home in Medway.

Most residential and nursing care settings in Medway are for older people (aged 65 and over). Adults below the age of 65 can have their needs met in residential and nursing homes. These homes generally specialise in providing care for those with a:

• learning disability
• physical disability
• mental health need.

The majority of all care homes in Medway are in the private or not for profit sector.

The current landscape

In April 2024, the Care Quality Commission (CQC) data shows that there are currently 70 residential and nursing care homes in Medway. These homes have a combined total of 1685 registered beds. The type of service registered to be provided at these homes is broken down by service user band below:

Older persons: 42 homes (1465 beds)

• residential care: 28 homes (670 beds*)
• nursing care 14 homes (795 beds*)

Working age adults: 28 homes (286 beds*)

• mental health: 7 Homes (62 Beds*)
• physical disability: 7 Homes (69 Beds*)
• learning disability: 23 Homes (155 beds*)

*Some care homes have dual registrations. This means they are able to provide care and support to different service user bands. The bed numbers listed above therefore exceed the total number of beds and care homes in Medway (some beds and care homes have been counted twice).

As is shown in the data above, care homes are predominantly for older people delivering a range of services including:

• long term care
• respite
• reablement
• discharge to assess (assessment beds) used to determine someone’s long term care needs.

CQC ratings 

These ratings are correct as of April 2024.

• inadequate: 33 (1%)
• requires improvement: 460 (17%)
• good: 2075 (75%)
• outstanding: 122 (4%)
• not rated: 78 (3%).

For the entire country (National, 14,701 homes)

• inadequate: 207 (1%)
• requires improvement: 460 (18%)
• good: 2075 (73%)
• outstanding: 122 (4%)
• not rated: 78 (4%).

This data suggests that CQC rating across homes in Medway compares lower than the average across the Southeast region and nationally.

The number of homes is comparatively smaller in Medway and is subject to large percentage swings based on a small number of homes. This means Medway has a higher percentage of care homes rated as requires improvement and a lower percentage of homes rated as good.

Medway is committed to supporting providers to improve quality standards within the service provided and continues to work with providers through dedicated resource to support improvements.

Contract management

The CQC regulates care homes. The Council's Quality Assurance Team and Commissioners also review and audit the services provided. We use these to review the performance of commissioned services and ensure the safety and wellbeing of users.

Contract monitoring is key to improving outcomes for older people who need residential care with and without nursing.

The contract for care and nursing homes has new quality requirements and improved standards. These have been developed in consultation with: 

• service users
• families
• carers
• referrers
• service providers.

Medway Council rates

In March 2024, we informed the market of our uplifts for the financial year 2024 to 2025. In our correspondence we referenced the:

• council’s financial situation
• measures we have taken including a link to the independent financial specialists the Chartered Institute of Public Finance and Accountancy (CIPFA) report
• the independent review undertaken by the LGA (Local Government Association)
• the Adult Social Care Finance report.

Our residential and nursing care weekly band rates for 2024 to 2025:

• standard residential: £690.74
• dementia residential: £800
• standard nursing: £874.64
• dementia nursing: £945.64.

Adult Social Care charging reforms and other costs that impact on fees

Proposals to change the fee charging structure by October 2023 have been postponed. There's still a need for clear understanding regarding the government’s long term strategy around the financial plan for Adult Social Care. Additionally, the results from the Fair Cost of Care exercise in 2022 saw limited engagement on a national level.

The sector has been significantly impacted by an unparalleled surge in costs, including:

• the rapid rise in inflation
• energy expenses
• the repercussions of the pandemic
• the ongoing cost of living crisis
• national living wage increases.

Medway's current residential care position

Medway has a robust provision for residential care, although there are deficiencies in certain areas, such as:

• lack of adequate care for those with high frailty and nursing needs
• shortage of residential and nursing beds for dementia patients, as well as for functional mental health, which has led to several individuals being accommodated outside of Medway
• lack of long-term, planned nursing respite care
• scarcity of specialised care for individuals under the age of 65
• both Medway Council and independent providers are under financial strain
• shortage in the residential and nursing care workforce, which reflects the national position
• fewer services in the more rural wards of Medway.

Current service use (as of April 2024)

We currently commission 887 Residential and Nursing Care placements. This includes placements in Medway and outside of Medway.

Of these, 604 placements are for older people. The breakdown of which is below:  

Residential care (383 placements)

• residential standard: 96
• residential dementia: 287*.

*Includes block beds, which are all assumed dementia placements.

Nursing care (221 placements)

• 141 nursing standard
• 80 nursing dementia.

We currently commission 283 residential care placements for working age adults, these are broken down as follows:

• learning disability: 159 Placements
• physical disability: 69 Placements
• mental health: 55 Placements.

More information about current service use can be found in our Joint Strategic Needs Assessment (JSNA).

List of current block beds and in-house capacity

We have 3 25-year block contracts for older person’s residential care. The number of beds varies during the lifetime of the contracts. The current bed numbers are listed below:

• Strode Park Foundation (Platters Farm): Contract started 1 April 2013 to 31 March 2038 - 26 beds
• Agincare (Rochester Care Home and Victory Care Home): Contract started 1 September 2013 to 31 August 2038 - 66 beds
• Avante Care and Support (Amherst Court): Contract started August 2010 to July 2035 - 22 beds
• 36a Birling Avenue, Rochester is a Medway Council owned and operated residential care home that provides respite care to working age adults with learning disabilities.

Recommissioning Residential and Nursing Services

The current framework contract for residential and nursing care for older persons and working age adults was developed several years ago and there's a need to update the specification and terms and conditions of the contract. The commissioning of good quality nursing and high-frailty dementia nursing care continues to be a top priority, ensuring we meet the complex needs of our most vulnerable population.

We look to work with providers that will:

• collaborate with the acute hospital discharge services and all relevant partners, including Adult Social Care, other commissioned services and the voluntary and community sector as required, to enable safe timely transfers of care
• facilitate planned and timely admissions of new residents in the care homes 7 days per week, including the evening
• work within a trusted assessor model, as appropriate
• complete the NHS Capacity Tracker daily to support system flow
• continue to engagement with quality officers and commissioners to further improve quality standards
• join new framework agreements for the provision of residential care
• ensure the use of Medway's Integrated Community Equipment Service (MICES) that will deliver good care and timely admissions.

Discharge to Assess (assessment beds): short term placements

We are keen to develop new partnerships with providers that may not have provided short term placements (Discharge to Assess/Assessment Beds) within Medway to date to ensure the right care for people leaving the hospital.

We would like to hear from providers that may be able to offer these services, particularly those who are able to provide residential care to older adults with dementia who present with complex and challenge behaviours. A tender opportunity is expected to be published via the Kent Business Portal in quarter 1 of 2024 to 2025.