Aims of the strategy
The aim is to deliver a new development of Care and Support services and buildings in Wareham
To create a nursing & specialist dementia care home, extra care housing, supported housing, market housing and keyworker housing to Wareham alongside aspirations from Dorset Healthcare and NHS Dorset Clinical Commissioning Group (CCG) to develop a new Community Health Hub incorporating a non-bedded hospital and a GP surgery, and an ambulance station.
In this context:
This is a list of the the contexts
- keyworkers are people who will work in the new nursing, extra care and health hub facilities
- extra care housing is independent units of housing where extra care is booked separately for frail elderly people
- supported housing is independent units of housing where support is booked separately for adults of working age with learning or physical disabilities.
Context to the proposal
From October 2017 onwards there has been significant work underway to explore the concept of an integrated care and community campus in Wareham. This has grown from local NHS proposals for Wareham in the Sustainability and Transformation Plan, which calls for the replacement of Wareham Community Hospital with a non-bedded Community Health Hub incorporating new GP Practice facilities.
Following extensive stakeholder engagement and options appraisal, the preferred site for a new Community Health Hub is the site of the former Wareham Middle School on Worgret Road. This site is owned by Dorset Council and we have recognised significant opportunity for a joint care development on this site offering community health services, supported housing, social housing, and keyworker housing. This would also help to create a civic ‘campus’ across several sites in Wareham, incorporating Local Authority services at Westport House, and Recreation, Sports and Leisure facilities at the Worgret Road Recreation Ground, Playing Fields, and Leisure Centre.
This development is across three sites – the old Middle School site, the current health centre site and a site in Bonnetts Lane which currently houses Anglebury Court.
To underpin the partnership with health partners a Memorandum of Understanding has been signed by NHS Dorset CCG, NHS Dorset Healthcare, and Dorset Council.
The proposed development is also supported within both the Purbeck Local Plan and the Wareham Neighbourhood Plan.
This project is one of the key strands of the Building Better lives transformation programme
This workstream will reduce costs, improve outcomes, and respond to changing local and national policy and population change by ensuring Dorset has a range of accommodation across all ages that promotes independence and choice, develop the market for social care housing developers and investors, and use DC assets to influence and stimulate development. An aim of the Building Better Lives programme is to bring forward a development programme of four ‘Care Campus’ developments over the next ten years. The Wareham Development represents the second of these four developments and is the most comprehensive opportunity identified to date. This EQIA does not address questions about the impact of changes to local front-line health provision as these are within the scope of NHS Partners EQIA as part of the Clinical Services Review and Sustainability & Transformation Plan.
Wareham Town Council are engaged in this project. This development is in line with Public Health Dorset’s Healthy Places programme, an initiative recognising and promoting the positive impact that the natural and built environment can have on health and wellbeing and on the reduction of health inequalities.
The aim is to create a continuum of accommodation and services where there is benefit of being sited together and allows for changes over time without requiring people to be uprooted from their community and to create familiar spaces and environment.
This project represents a significant positive opportunity for the new Dorset Council, as this will be a flagship development delivered in partnership with Health partners and will improve how Dorset Council is providing access to affordable housing, meeting demand for modern services that promote independence, and show consideration of how place-making can impact on health and wellbeing of both individuals and their wider community.
The development of a Care Campus in Wareham represents a significant opportunity for the local community, the local economy, and the partner organisations involved. The development creates significant local employment prospects and opportunities for economic growth in terms of both construction and then delivery of the health, care and housing services.
The development creates new affordable housing and specialised housing services for Wareham, enabling more people to remain in Wareham as their social care and health needs develop, and creates the opportunity for people to return home from services that were previously only available in other parts of Dorset.
There are several factors which indicate the need to develop and enhance services in Wareham:
Demographic Need. The current population of Wareham town is 5,827 people, of which 30.1% (1,752) are aged 65 or over. Surrounding wards add a further 13,457 people, of which 20.7% (2,787) are aged 65 or over. These numbers are based upon 2017 Mid-Year Population Estimates, as more recent updates have not yet been processed.
The population of the South-East Dorset area as a whole (which includes Wareham) is 96.2% White British, and 3.8% Black & Minority Ethnic. 94.6% of the population were born in the UK. English is not the first language for 1.3% of the South-East Dorset population.
65% of the population of South-East Dorset identify as ‘Christian’, and 25.9% as ‘No Religion’. 1.2% are of ‘non-Christian religions’, with the remainder preferring not to say.
When taken together Wareham and surrounding area have a lower than average number of people aged 65 and over compared to Purbeck more generally, but this masks the concentration of people aged 65 and over within the town of Wareham itself.1
In Purbeck in general the population of people aged 65 years and over is predicted to rise by 32% between 2017 and 20352, and the number of people living in a care home either with or without nursing is currently predicted to rise by 71.6% between 2015 and 20353. Given that Wareham has a higher proportion of older people than Purbeck, it is logical to assume that the impact of these increases will be felt more acutely in Wareham. The Housing Target in the Purbeck Local Plan indicates that 2,500 new homes should be developed between 2006 and 2027, much of which is targeted in Wareham.
Prevalence of Dementia in Wareham and surrounding wards is not predicted to be significant for those under 65 years old but is estimated to increase by 52% from 318 to 484 people for all age groups over 65 years old. This increase is particularly pronounced for those aged 85 years and over, with a predicted increase of 73% from 150 people to 259 people.
Baseline estimates suggest that in 2017 Purbeck has a population of 601 people aged 18-64 with a Learning Disability, and that this number is predicted to decrease by 4% to 579 by 20354. Within this figure, the smaller number of 136 people are currently estimated to have a moderate or severe Learning Disability, and this group of people are more likely to be those eligible for support from Dorset County Council.
Data on Physical Disabilities is calculated applying prevalence percentages to actual and predicted population. The number of working age adults with serious physical disability in Purbeck is expected to fall by 4%, from 240 people in 2020, to 230 people by 2040. There is also an expected 2.5% fall in the number of working age adults with impaired mobility, from 1,600 to 1,560. This is expected to reduce to 634 and 168 respectively in 2035 mirroring the predicted reduction in total working age population in the area.
Based upon population estimates and prevalence rates, the number of people predicted to have a serious Mental Health condition in Wareham and the surrounding wards is 137, and this is predicted to fall slightly by 4.4% to 131 by 2035. There is a much greater prevalence rate of people with a common mental health disorder and improvements to local health services will be of benefit to them, but this group of people are not likely to fall within the cohort of people who need access to accommodation provided through this development.
These working-age adult population estimates follow a wider projected trend of a decreasing population of people aged 64 and under in Purbeck, estimated to be -5.5% by 20355.
Current Services and future demand.
Purbeck area currently has a total of 398 Care Home beds, of which 84 (21%) are funded by Dorset Council. However, of these only 2 homes are in Wareham or the immediate surrounding area, offering a total of 32 residential beds and 64 nursing care beds. By contrast there are 6 homes in Swanage (12 miles from Wareham) offering a total of 179 residential beds and 34 nursing care beds. The only other care home in Purbeck that is more than 50% funded by Dorset Council is Heathcore Care Home in Swanage.
Anglebury Court, a Dorset Council owned Care Home in Wareham operated by Tricuro, is the only Care Home in Wareham and is 81% occupied by Dorset Council funded placements. The other home in the immediate vicinity is Pine Martin Grange in Sandford, a luxury private Nursing Home provision with no DC-funded placements.
The Adult Social Care Accommodation Needs Assessment projects a need for 65 additional care home beds across the Purbeck within the next 10 years, and this project creates this capacity in Wareham by providing a new nursing & specialist dementia care home and replacing Anglebury Court.
As is true for the rest of Dorset, currently the increase in need is most acutely felt for people with more complex needs who require Nursing Care and Specialist Dementia Care.
Eight of the ten Care Homes in Purbeck are therefore occupied in the majority by self-funders, limiting Dorset County Council’s influence on the market – in particular on the fees set by these businesses.
People also would like a real alternative to residential care in the form of specialist housing such as extra care. Extra care housing offers an alternative to residential care in that it offers people greater independence, their own front door, while also providing an environment suitable for those with increasing frailty and developing personal care needs. Currently Dorset Council area has five extra care Schemes; two in Weymouth and Portland, one in Dorchester, one in Blandford and one in Christchurch. Further schemes are being developed in Gillingham and Bridport. There are therefore no extra care schemes in or near Wareham or Purbeck. Social Care Accommodation Needs Assessment indicates the need for 313 units of Extra Care Housing in Purbeck over the next 10 years, 130 of which are needed over the next 4 years.
For people with Learning Disabilities, although there is not a growing demand in population terms, there is nonetheless a demand for new services. People who currently live with their parents will need their own accommodation as their parents age and find their caring responsibilities increasingly difficult. Local and national best practice in Learning Disabilities shows a strong shift away from Residential Care services and towards Supported Living, which is in short supply across the county. The Supported Living accommodation we do have in Wareham and the surrounding area tends to be in shared housing. Shared Housing offers advantages when it comes to cost due to the opportunities for shared care but carries the risk of voids since it is difficult to successfully match people’s needs and risks. There are opportunities to develop clustered support schemes which can offer individual units of accommodation while retaining the ability to share support across groups of people. Development of new services at scale also create an opportunity to attract more Care and Support providers into Wareham, creating a more diverse marketplace. Social Care Accommodation Needs Assessment indicates the need for 42 units of Supported Living in Purbeck over the next 4 years.
As with Learning Disabilities, although the population is not expected to increase for working age adults with mental health problems, there is nonetheless a shortage of appropriate available accommodation – demand is most often for one bedroom flats which are in short supply.
The number of working age adults with serious physical disability in Purbeck is expected to fall by 4%, from 240 people in 2020, to 230 people by 2040. There is also an expected 2.5% fall in the number of working age adults with impaired mobility, from 1,600 to 1,560. There are currently 27 people on the Housing Register in Purbeck who have self-identified as Wheelchair Users, and a further 98 people who require housing with some form of adaptation. None have indicated that they are registered as Disabled, but this relies on the information provided by the applicant when they join the register. New developments established through the Building Better Lives programme will include units of accommodation built to accessible standards, and there are often requirements for accessible homes for people from within other client groups.
Housing for key staff is recognised as an area of demand in Dorset, although it is currently difficult to quantify this – the affordability and availability of housing and its impact on recruitment and retention of staff is anecdotal but difficult to evidence. Skills for Care know that the social care workforce is growing – by 4% in the South West since 2012, and is predicted to keep growing by 35% by 2020 in line with predicted increases in the 65+ population. Turnover rate in Dorset is higher than the England average, and 27% of workers in the sector are on zero hour contracts, which is higher than average. It is estimated that there are 950 vacancies in the sector at any one time in Dorset.
Although there is not more specific information available for Wareham or Purbeck as a whole, all partners recognise and agree that Purbeck is a difficult area for recruitment and retention in Social Care and Health workforce- for frontline care and support and nursing staff. The development of new Health, Care and Support services in Wareham will add to the demand for workers, and the provision of some units of affordable housing designated for key staff within the wider development is seen as a crucial part of sourcing a sustainable workforce in Purbeck.
This Equality Impact Assessment will consider the proposals agreed for progression by the Cabinet.
Intelligence and Communication
Data, information, evidence and research used and how it has influenced the decision-making process
This is a list of data used to assess the impact
- 2011 Census
- POPPI: Projecting Older People Population Information, which uses population growth
- projections and prevalence rates of various health conditions to project population change in cohorts of people aged 65 and over.
- PANSI: Predicting Adult Needs and Social Information, which is a companion to POPPI and uses the same methodology to predict population change in working age adults with a range of conditions.
- Supported Housing for Older People (SHOP) data via Housing LIN,
- directly from current Social Care caseload.
POPPI & PANSI information has been used to consider the demographic profile of Wareham and of the people likely to be affected by the proposed developments.
Census information has given us age and gender profiles, population diversity information, and information about disability prevalence.
Is further information needed to help inform this proposal?
Equality data on current service user cohort
Engagement or consultation that has taken place as part of this EqIA
We discussed the proposals with stakeholders in autumn 2018 and produced a report summarising their views.
We held a series of public engagement sessions in autumn 2019 and produced a report summarising what they said and what we have done as a result. View the report.
We have altered our proposals in line with the comments we have received.
Feedback
We have incorporated the views received from the consultation done in August 2019 into the design brief, and we have held two engagement sessions in partnership with the Neighbourhood Plan group with the public. Further public engagement planned for March 2020 was cancelled due to COVID-19 lockdown restrictions, but in October 2020 we plan to drop leaflets to all residents of Wareham and the surrounding area updating them on our plans and showing them how we’ve taken their comments into account.
Assessment
| Impacts on who or what? | Effect | Details |
|---|---|---|
| Age | Positive |
For working age adults, the impact is judged to be positive These are the reasons the outcome is positive • will create additional accommodation and service provision suitable for the following sets of people:
• could create employment and volunteering opportunities • will create more opportunities for older relatives to remain living in the Wareham area, close to family • will create respite opportunities to give carers a break • supports a new model of Day Opportunities, which is better suited to meeting individual needs and opens up choices for people about how to spend their day • will create new buildings and environments which are likely to be more pleasant environment for people to occupy and will be a more pleasant environment to work in, and will be designed for providing effective support • will create keyworker housing which will support employment and create opportunities for people to live and work in Wareham For people aged 65 and over, the impact is judged to be positive because the development: • will create new Housing services, giving people greater choice and support to stay independent in their community for longer • will create a consistent supportive environment for people as they age and as their support needs change – this should mean in the long-term people will have to move/relocate less • may deliver new specialist dementia and nursing care services or increase local care home capacity. For all age groups, no negative impacts have been identified to date |
What age bracket does this affect? |
n/a |
All adults (age 18 and over). Potential positive impact for Children in transition to adulthood |
Disability: (including physical, mental, sensory and progressive conditions) |
Positive |
The impact is judged to be positive, these are the reasons:
|
Gender Reassignment & Gender Identity |
Unclear |
No information is known about gender identity of the current caseload or the projected population. It is not expected that this development will have any negative impact on this cohort. Through the design of this scheme we can make sure that LGBTI needs are accounted for and further evidence is gathered. |
Pregnancy and maternity: |
Unclear |
No information is known about pregnancy/maternity in the current caseload or the projected population. It is not expected that this development will have any negative impact on this cohort. |
Race and Ethnicity |
Unclear |
No information is known about the race or ethnicity of the current Caseload, but we know that while the general population is predominantly White British, 3.8% of the population is Black Minority Ethnic. It is not expected that this development will have any negative impact on this cohort. |
Religion or belief: |
Unclear |
We know that for the population of South East Dorset generally, the largest group of people are of Christian faith, but there is a small minority of people. It is not expected that this development will have any negative impact on this cohort. There are three churches in the area, between two of the sites – St Edwards Catholic Church, St Martin on-the-walls Anglican Church and Purbeck Gateway Church. There are Mosques and Synagogues, as well as faith community groups, in Poole and Bournemouth, accessible from Wareham by direct train. |
Sexual orientation |
Unclear |
No information is known about sexual orientation of the current caseload or the projected population. It is not expected that this development will have any negative impact on this cohort. Through the design of this scheme we can make sure that LGBTI needs are accounted for and further evidence is gathered. |
Sex (consider both men and women): |
Unclear |
No information is known about sex of the current caseload or the projected population. It is not expected that this development will have any negative impact on this cohort. |
Marriage or civil partnership |
Positive |
No information is known about marriage or civil partnership status of the current caseload or the projected population. It is not expected that this development will have any negative impact on this cohort. Flexibility of accommodation and co-location of services should enable people in relationships to live together for longer as care needs develop. |
Carers: |
Positive |
This development includes a range of opportunities for care, all of which will enable those in the community who currently rely on carers to get alternative care for some or all of the time – eg extra-care housing allowing those currently in care to have more independence, a nursing & specialist dementia home and improvements to day care provision in partnership with Purbeck Connect. |
Rural isolation |
Neutral |
This development is an urban development, and Purbeck is a predominantly rural locality. Development of these accommodation will improve availability of services, but people will still need to travel into the urban environment. Transportation will be picked up as a key thread through the project Design Meetings. It is beyond the scope of this project to address wider issues of rural transport sustainability. |
Single parent families |
Positive |
No information is known about parental status of the current caseload or the projected population. It is not expected that this development will have any negative impact on this cohort. Flexibility of accommodation and co-location of services should enable single parent families to have better long-term accommodation and integration with their community. |
Social & economic deprivation: |
Positive |
This development includes key-worker housing to enable those on low incomes to live in the centre of their community. |
Armed Forces communities |
Positive |
Bovington & Lulworth camps are within the Wareham area, so there is an improvement in access to facilities, including mental health which is known to be worse in armed forces communities |
Key to impacts
Positive
the proposal eliminates discrimination, advances equality of opportunity and/or fosters good relations with protected groups
Negative
Protected characteristic group(s) could be disadvantaged or discriminated against
Neutral
No change/ no assessed significant impact of protected characteristic groups
Unclear
Not enough data/evidence has been collected to make an informed decision
Action Plan
| Issue | Action to be taken | Person(s) responsible | Date to be completed by |
|---|---|---|---|
Test assumptions of this EQIA |
Discuss Equality Issues and the EQiA as part of a wider group |
Adam Fitzgerald |
January 2019 |
Enhance data supporting this EQIA |
Seek wider Equality information on the existing cohort and on projected population (including potential staff pool |
Adam Fitzgerald |
January 2019 |
Name: Rosie Dilke
Job Title: Place Development Manager
Date: 7 Sept 2020
Who has agreed this EqIA?
Name Rosie Dike
Date 14 August 2020
Equality lead Susan Ward-Rice
Date 27 October 2020
Equality and diversity action group chair Rick Perry
Date 28 October 2020