Adult Social Care Accommodation Strategy 2024-2034

Challenges and gaps in meeting demand

There are limited opportunities to develop sufficient, high quality and affordable housing and care services within our densely populated borough and with ever leaner budgets. The scarcity of in-borough services necessitates searches outside of Islington for care homes and supported living placements. 

With limited financial resources, we need to constantly balance choice with value for money decisions. At times, difficult decisions must be made with regards to an individual’s package of care. Managing the tension between our responsibility to make best use of the public purse and the wishes and best interests of our residents can be challenging.  

Of over 2,800 residents who receive long term services, we support the majority, 60%, in their own home, with a range of community-based services. If the needs of the resident can no longer be met in their own home, they will be provided with care within a bespoke accommodation- based setting.  In July 2024, approximately 61% of demand for accommodation-based services was met within Islington. This meant that 39% (around 440 people) were living in homes out of borough. The shortfall impacts on residents’ journeys from hospital to rehabilitation to home, creating delayed discharges and step-downs. 

There are inherent challenges to developing the capacity the borough needs and residents cannot always be placed in their location of choice. While every effort is made to source a placement close to support networks, disruption to family and community is at times unavoidable. 

Furthermore, housing stock is ageing, with associated issues around accessibility, homeliness and climate resilience. This poses challenges for residents with care needs wishing to remain in their own homes as well as for those needing to access accommodation-based services. 

The cost-of-living crisis has had a negative impact on residents’ ability to live well at home and to sustain their tenancies. 

Despite the increased demand for social care provision, Central Government has cut its core funding to Islington Council by 70% since 2010 (Reference: Islington Council's budget proposals 2019/20, comments of the Policy and Performance Committee). There is pressure on the Housing Revenues Account and significant demand for council housing. It is crucial that new developments are financially viable, but housing must also be affordable for residents. This can only be achieved through rare grant funding opportunities or complex lease arrangements with registered housing providers.  

A more nuanced understanding of local demand helps to identify the pressure points and gaps, particularly for more specialist or complex needs, outlined as follows:  

• Supported living/supported housing: there is very limited supply of new/additional suitable and high-quality buildings in which to develop new schemes to meet unmet demand, offering either self-contained units or shared accommodation. New build developments have lengthy timelines and challenges around financial viability.  
• Extra care: Islington does not place residents into out of borough Extra Care Housing. However, taking into account the new Extra Care scheme due to open in 2026, Islington is estimated to have a shortfall of around 127 Extra Care units in the borough (see Appendix Two – Islington Extra Care Needs Assessment).
• Care homes: around 40% of residents receiving a care home service are living out of borough. Despite the ambition to move away from this more institutionalised model of care, there will remain a significant shortfall in capacity. 
• Behaviours of concern: since the pandemic, there has been an increase in the number of people with dementia, learning disabilities and mental health issues requiring more intensive care and one to one support due to their behaviour and associated risks.  
• Residential care for adults aged 18-64: Islington has a very limited amount of in-borough provision for the relatively small number of younger adults (up to the age of 64) with Learning Disabilities, neuro-disabilities and physical support needs who would benefit from residential care. 
• Older people with learning disabilities: people with learning disabilities are living longer, however the prevalence of dementia in this community is higher with onset occurring at a younger age compared to the rest of the population. Islington therefore anticipates a growth in demand for care services for older people with learning disabilities. There is a need to upskill the workforce in both the Learning Disabilities sector and the Older People and dementia care sector to meet this emerging need.
• Autistic people: Islington lacks services which can make reasonable adjustments, and specialist accommodation services, to meet the growing demand for autistic residents including supported living and residential care.  
• Complex and multiple needs in younger adults: residents who are placed in mental health services are presenting with increasingly complex and multiple needs, which can be difficult to manage within existing Supported Living provision. These include people with comorbid chronic substance misuse and mental health, and women with very complex mental health needs who require a trauma-informed approach. These are residents who fall between the gaps of long-term high dependency rehabilitation and residential care or supported living. 
• Step down options: there are currently insufficient options to enable residents to step-down from higher dependency services to greater independence. For instance, from hospital to long term care settings to general needs housing.  The lack of available options are restrictive and life limiting to residents, particularly those with learning disabilities and mental health needs. 
• Respite care: there is increasing demand for respite services to support carers and the people they care for to maintain wellbeing and sustain the caring relationship. Demand for residential and nursing care respite in 2022-23 was on average 3 beds at any one time. We have also seen an increase in need for respite for carers of residents with Learning Disabilities.