Rethinking the future of care: supporting local authorities to plan sustainable older people’s services
Across Wales, local authorities are facing growing pressure to rethink how care and support will be delivered over the next decade.
Ageing populations, increasing complexity of need, workforce pressures, outdated buildings and rising operational demands are creating difficult questions about the sustainability of current models of care. At the same time, councils are being asked to think more strategically about prevention, integration, housing, wellbeing and long-term financial resilience.
Practice Solutions has recently supported two local authorities in Wales to undertake large-scale strategic reviews and options appraisals focused on the future of older people’s services. While each authority faced its own unique context, the work revealed strikingly similar themes, pressures and opportunities across both systems.
The challenge
Both authorities were grappling with a combination of demographic change, increasing demand and ageing infrastructure. One study identified projected growth in the 65+ population of more than 20% over the next decade, alongside a significant projected rise in dementia prevalence.
At the same time, existing residential care provision was increasingly under strain. Across multiple care homes, managers described systems and processes that were consuming disproportionate amounts of operational time, including payroll administration, rota management, paper-based care planning and fragmented digital systems.
The reviews also highlighted broader strategic pressures, including:
- Growing complexity of need in residential care
- Challenges in recruitment and workforce stability
- Limited digital integration
- Fragmented pathways between health, housing and social care
- Increasing demand for dementia and preventative support
- Pressure to modernise existing estate and infrastructure
Despite these pressures, the work also revealed strong leadership, committed workforces and a clear appetite for innovation and long-term transformation across both authorities. Multiple homes were described as “well-led”, with long-serving staff teams and strong person-centred cultures.
The idea
Our role was to help both authorities move beyond short-term operational pressures and develop a clearer strategic view of what future care models could look like. This work spanned several interconnected areas.
Strategic care and accommodation reviews
We undertook in-depth reviews of residential care provision, including site visits, stakeholder engagement, systems analysis and options appraisals. This included reviewing the condition and suitability of existing care homes, future population demand, operational pressures and opportunities for redevelopment or redesign.
Across one authority, the review covered six local authority managed care homes and more than 200 registered beds.
Integrated care and place-based models
Alongside traditional residential care review work, we supported thinking around more integrated approaches to health, social care and community wellbeing.
This included feasibility work exploring integrated care hubs, co-located services, preventative models, and stronger links between housing, social care, primary care and community infrastructure. Stakeholder engagement highlighted the importance of “whole system” approaches and place-based partnership working.
Wellbeing Villages and future models of care
We also explored broader, longer-term models of care and support, including Wellbeing Villages designed to integrate housing, wellbeing, social care and community infrastructure into a single model. One proposed definition described these as mixed-use developments integrating residential housing with on-site health, social care and recreational services to reduce isolation and ease pressure on hospital and bed-based services.
The work considered:
- Extra care and supported living
- Intergenerational and community-based approaches
- Dementia-friendly environments
- Preventative services
- Workforce sustainability
- Partnership opportunities with health boards and housing providers
The result
The work provided both authorities with a significantly stronger evidence base for future decision-making.
Importantly, it helped move conversations beyond individual services or buildings and towards broader strategic questions around sustainability, integration and the future shape of care.
The projects produced:
- Detailed operational and systems reviews
- Population and demand analysis
- Stakeholder engagement findings
- Options appraisals for future provision
- Feasibility studies for integrated models
- Recommendations for digital transformation and workforce improvement
- Evidence to support future investment and funding discussions
Across both authorities, the work also surfaced practical opportunities to release management capacity, improve workforce resilience and modernise systems that were creating unnecessary operational burden. Reviews repeatedly identified that experienced managers and committed staff were spending excessive time navigating fragmented processes rather than focusing on care leadership and quality improvement.
Why this matters now
Many local authorities are now entering a critical period of service redesign, Population Needs Assessments, Market Stability reporting and long-term capital planning.
This creates an important opportunity not simply to respond to pressure, but to rethink how care, wellbeing, housing and community support can work together more effectively in the future.
Our work across these two authorities demonstrates the value of combining operational insight, stakeholder engagement, strategic analysis and practical delivery understanding to support realistic, evidence-based transformation.
Whether the focus is residential care, integrated hubs, wellbeing villages, workforce pressures or future accommodation models, councils increasingly need robust, independent analysis to help shape sustainable services for the future.
