Meeting documents

1 THE ISSUE

1.1 On July 12^th 2002 The Executive received a report on the above subject with the following recommendations. Councillors were asked to:

1.1.1 Decide on the preferred Model of Care for consultation.

1.1.2 Decide on the preferred range of sites for consultation

And require officers to:

1.1.3 Consult with residents, relatives and staff at Greenacres House EPH (Midsomer Norton) with a view to affecting an early closure.

1.1.4 Provide a report in October 2002 for decision-making on the overall EPH Re-Provision programme and the potential early closure of Greenacres House, Midsomer Norton.

1.1.5 Refer the report to the appropriate Overview and Scrutiny Panel

1.2 This report provides for the Executive the results of the above consultation.

2 RECOMMENDATIONS

The Councils Executive agree that:

2.1 A mix of Registered Care Home beds and Extracare Units (within a Sheltered Housing complex) is the appropriate "new build" option to meet the future support needs of vulnerable older people in Bath and North East Somerset.

2.2 One hundred and eighty supported care beds (as set out in the July 12^th 2002 Council Executive EPH Re-Provision report) on three sites (Registered Care 105 and Extracare 75) in the format suggested in 2.1 across the Authority is appropriate for the future support needs of vulnerable older people in Bath and North East Somerset.

2.3 Provide support for older people across the social and nursing care spectrum in the above building option in conjunction with Primary Care Trust colleagues is the preferred way forward for Bath and North East Somerset to provide for the future support needs of its vulnerable older people.

2.4 The three sites across Bath and North East Somerset upon which to develop the "new build" options outlined in 2.1 above should be Bath (Carrswood), Keynsham (Hawthorne House) and Midsomer Norton either on Greenacres House site or if available another more appropriate site in Midsomer Norton.

2.5 Greenacres House be closed as soon as all its residents have been found suitable alternative accommodation

2.6 Officers explore the benefits and dis-benefits of Greenacres House being demolished as soon as possible after its formal closure and the Executive Member to decide on the final arrangements based on the most economical option.

2.7 The Executive Member to decide on the final arrangements for meeting nursing needs depending on the outcome of discussions with the Primary Care Trust and National Care Standards Commission

2.8 That officers continue discussions with Registered Social Landlords to explore additional funding opportunities and the Executive Member to decide on final arrangements for provision of the sheltered /Extracare accommodation pending the outcome of those discussions.

2.9 That officers explore, as a separate exercise, with PCT colleagues the need for, and financial viability of, providing Extracare facilities in the Chew Valley area.

2.10 Refer this report with any additional background information to the relevant Overview and Scrutiny Panel for further consideration of new information.

3 FINANCIAL IMPLICATIONS

3.1 The latest capital and revenue implications are attached at appendix 1and 2 respectively.

3.2 The capital implications have changed due to an increased estimate in the cost for the replacement of the Carrswood Day Centre. This is due to a clearer and more detailed sense emerging of what a new day centre for the Learning Difficulties users might need to contain. The Council's Financial Plan includes capital provision of £4.3 million whereas the net capital costs for the reprovision is currently £8.03 million. Officers have been investigating potential opportunities to reduce the capital costs, to be within the financial plan provision, with the Registered Social Landlord of a neighbouring housing scheme.

3.3 The main changes to the revenue costings are refinements to the costs for Extracare and the Homeward Unit. The figures are also revised to allow for the recently agreed pay awards. Overall these changes mean that the revenue costs are still within the financial plan budget.

3.4 At present the proposals are estimated to be within the Council's Financial Plan. In the event that the financial plan provision is exceeded, the Council will need to agree a revision to the financial plan before the scheme could proceed.

4 BACKGROUND

4.1 Secretary of State Announcement

4.1.1 On July 23^rd 2002 the Government announced a proposed change in policy concerning the environmental standards for existing Registered Care Homes. Of particular importance was the change in the previously laid down standard that all Registered Care Homes had, by 2007, to comply with minimum resident bedroom size thresholds. Bath and North East Somerset's existing homes did not meet this standard. This rule has changed and the government's "draft" guidance requires that only new build accommodation must meet the enhanced standard.

4.1.2 The draft guidance (recently circulated to local authorities and other stakeholders for consultation) makes it clear that the original environmental standards set out as part of the Care Standards Act 2000 should remain a firm goal for all registered care providers. In addition it makes clear that if a provider is unable to comply with the thresholds their advertising material and homes brochures must state clearly where they are failing to meet what the Government sees as being appropriate standards. A brief document comparing the draft consultation changes to the original guidance is attached at appendix 3

4.1.3 As a result of the new guidance officers reconsidered the Authorities position and explored the cost implications of retaining the current stock of Elderly Persons Homes for a further 10-year period to 2012. The planned maintenance investment suggested by Property Services for that period is summarised in appendix 4 and amounts to £5.8m. (Inclusive of alterations to become DDA compliant). Additional revenue spend would also be required to meet the enhanced staffing levels set out in the Care Standards Act. These are summarised in appendix4.

4.1.4 One of the benefits of this changed set of circumstances and time scales is that the authority is now able to plan more fully, creative ways of bringing the new model of care to fruition with its PCT colleagues. Much work is still to be completed in this area. The views of the Care Standards Commission, with whom officers are in discussion, will obviously be critical in this matter.

4.1.5 Initial soundings indicate that the Authority may be able to partner with the Primary Care Trust in developing a peripatetic qualified nursing presence across the new Registered Care Homes. This would mean staff in the Registered Care Homes could offer "nursing auxiliary type" care (supervised off and on site by qualified nursing staff) to residents whose needs require higher levels of support. This would allow the resident to "stay put" whilst their care support system extends or develops to meet their increasing needs rather than as now, where the resident has to move to a new care setting to obtain the additional care. The revenue implications of this model for the local authority will have to be carefully considered and explored with the Primary Care Trust.

4.1.6 In addition officers will also have time to explore with local Registered Social Landlords (RSL's) possible options for co-operative working related to the sheltered housing and Extracare aspects of the new arrangements. The Authority already has a raft of relationships in place with a number of RSL's through its Joint Commissioning Partnership. Arrangements to develop new services such as Extracare can take time and the lifting of the 2007 deadline for full implementation of the new Registered Care Home standards means the Authority can explore with the Joint Commissioning Partnership access both to sheltered housing expertise and alternative streams for capital investment in the overall EPH re-provision process.

4.1.7 The Secretary of State, in his July 23^rd 2002 House of Commons statement also made reference to the fact that the government wishes to encourage local authority providers and others to increase the availability of Extracare Housing and that additional government funding would become available to achieve this.

4.2 Consultation Process

4.2.1 This phase of consultation was effectively stage two of an overall process, which commenced in 2000/1 with extensive consultation on a broad set of issues. The recent round of consultation was based on the preferred options for implementation agreed by the July 12^th Executive. It therefore concentrated on current residents and their relatives and staff as the "core" consultees (i.e. those most likely to be effected in the immediate future), with some consultation with wider stakeholder groups.

4.2.2 Individual consultation meetings in each of the eight current EPH's have taken place. Separate meetings (16 in total) were held with staff, residents and relatives although where relatives thought it appropriate, or where residents had no relatives and wanted to attend, some joint resident/relative meetings have been held. In addition each resident, where appropriate, has been seen (either individually or in small groups) by the EPH Team Manager, and the appropriate Home Manager to explain in more detail the proposals upon which the consultation was based.

4.2.3 All residents were offered the advocacy support of a member of staff from Age Concern. Some availed themselves of the opportunity and advocates were present at some of the meetings between the Team manager, Home manager and the resident.

4.2.4 At each of the larger meetings a detailed presentation using PowerPoint together with still photographs and building layout plans was given by the EPH Project Manager. After this presentation members of the audience asked questions which were recorded together with the answer given. Minutes of each meeting were kept and are attached at appendix5.

4.2.5 During each of these meetings each resident, relative and staff member was given a questionnaire to complete. (appendix6) The content of the questionnaire, its purpose and eventual audience was carefully explained. The return slip attached to the questionnaire is anonymous but identifies whether the recipient is a relative, resident or staff member. Some relatives chose to help the resident they are related to in completing the form.

4.2.6 In addition questionnaires have been sent to a wider stakeholder group. (See appendix 7 for a complete list) A letter, (appendix8) which set out the recommendations contained in the July 12th 2002 Executive EPH Re-Provision report and the decisions that flowed from that meeting accompanied the form. The return slip on the questionnaire therefore included further respondent categories such as Doctor, Vol. Organisation, Councillor and Other.

4.2.7 The letter also included an extract from the July Executive report (paragraphs 4.68 to 4.87.2) that set out the "Model of Care", "Potential Locations for New Build Complexes" and "Summary of Revenue Implications". The Bath and North East Somerset Website reference for committee reports was included in the letter for those who wished to access the report in full.

4.2.8 A brief summary of the events triggered by the Governments announcement on its draft revised Environmental Standards for current Registered Care Homes subsequent to the July 12^th Executive was also included.

4.2.9 The wider stakeholder group was asked to return the reply slips directly to the Project Manager by October 11^th 2002 whilst EPH based audiences were asked to return them via the Home Manager or directly to the Project Manager by the same date.

4.2.10 Regular meetings have been held with Trades Union representatives from UNISON and GMB to discuss the overall re-provision plans and to prepare for negotiations concerning pay and conditions under the new arrangements. Both unions have been represented at a number of the staff consultation meetings and in particular at Greenacres House.

4.2.11 Both Trades Unions have endorsed the Authority's plans to create new build Registered Care Homes and Extracare facilities in Sheltered Housing blocks and have been supportive of the consultation process.

4.2.12 Consultation has also taken place with users and carers of the Carrswood Learning Difficulties Day Centre, as this is one of the sites officers were asked to consult on for the Bath City location for a registered Care Home. The Learning Difficulties Day Services Review undertaken in 2000/1, suggested that any new formulation of the day service should consider carefully the connection between the people who use day services provision and the wider community. The aim is to develop much closer links with community based groups and create access for people with learning difficulties to integrated services across the community. Likewise the review envisaged community groups accessing the service building which, whilst its primary function may be to support people with learning difficulties, should also be seen as being available to the wider community.

4.2.13 With this in mind discussions about redeveloping the site to include a re-provided Day Centre have been started with a small steering group consisting of users, staff, carers and outside professionals at the Centre. An initial meeting has been held but further work is required to explore exactly what a new day/community centre might need to include in the way of infrastructure rooms and equipment.

4.3 Consultation

4.3.1 A detailed analysis of the returned questionnaires is attached at appendix9. The data gathered has been used to create a series of charts. The first chart in appendix 9 indicates the spread of responses followed by five charts that give an overall picture of the answers to the formal questionnaire questions including all respondents. A final chart indicates resident's preferences for Registered or Extracare.

4.3.2 Copies of the original returned questionnaires are located in each of the Members Rooms in Bath, Keynsham and Radstock.

4.3.3 Overall 92% of the respondents felt the Model of Care was a useful way forward and 93% indicated that the decision to suggest locating new facilities in the three main population areas of Bath and North East Somerset is appropriate.

4.3.4 In the main respondents tended to indicate a preference for one site in questions 3,4 and 5 but be less sure about the other two. One hypothesis would be that people responded positively about the location with which they are most connected and took the view that since they knew little of the other two it would be best not to comment.

4.3.5 Residents were also asked to complete questionnaires. Where they asked for help and their relatives had not been able to assist managers from each of the current EPH's assisted each resident to complete the questionnaire. Where this happened the questionnaire is annotated to show officer involvement with its completion.

4.3.6 Residents were seen individually or in groups and asked to complete the questionnaire after its content had been explained to them. Not all residents were seen, as for some it would not have been appropriate to discuss the subject. As well as being asked to complete the questionnaires residents were asked a further three questions.

4.3.7 Appendix 9 sets out the answers given to the EPH Group Manager.

4.3.8 There were two further opportunities on the questionnaire for respondents to write additional comments. These are attached as appendix10.

4.3.9 Carrswood Consultation

4.3.9.1 The consultation process at Carrswood has been different because the question under consideration has been the development of the site rather than specifically about changes in Older Peoples Registered and Extracare Services. A range of stakeholders attended a meeting at Carrswood on June 10^th when the EPH Project Manager and the Learning Difficulties Group Manager explained that the Carrswood site had been included in the July 12^th Executive report as a possible City of Bath site for a new registered care home.

4.3.9.2 The overall re-provision plan was described in some detail and members of the audience asked questions of both officers at the end of the presentation. Minutes of this meeting are attached at appendix 11.

4.3.9.3 Following this meeting the Carrswood "Spring into Action" and "Up-2-Us" groups discussed the question of change at the Centre over a number of weeks in their regular meetings. Notes form these meetings and an overview report are also attached at appendix 11.

4.3.9.4 A follow up meeting was held at Carrswood on September 23^rd with a small steering group, the membership of which was identified by staff at Carrswood. The focus of the meeting was to begin to harvest ideas for what a re-provided day centre for people with Learning Difficulties might look like. This was to gain a sense of whether the estimate for the new centre contained in the July 12^th Executive report was sufficiently robust. As a result the financial information in this report includes an increased figure (£1.9m) as a more robust estimate than the £1.3m originally envisaged.

4.3.9.5 Further meetings will be required with the steering group to refine the detail of the new centre in the context of the November 6^th Council Executive decision, the continuance of the Learning Difficulties day centre review process and the progress of the EPH Re-Provision Project.

4.3.9.6 The general view from the stakeholder group at Carrswood was that providing the new Day Centre meets the needs of current and future users of the Learning Difficulties day service and that the Registered Care Home and Day Centre are constructed in a way that allows for separate service delivery, a plan to develop the site to make better use of the land space available would be a good idea.

4.3.9.7 People were concerned to emphasis the need for careful planning of any change to the current service and the Group Manager reiterated the Authorities commitment to ensuring that everyone connected to the centre would be consulted as the process developed.

4.4 Greenacres House

4.4.1 Greenacres House residents, their relatives and staff who work in the home have been specifically consulted on a number of occasions concerning the possible early closure of the home based on the high cost of planned maintenance over the next two years (see appendix 12).

4.4.2 There have been a number of meetings to discuss the possible early closure. These have been with residents, their relatives and staff at Greenacres House and were held on:

June 18 Staff and relatives (separately)

June 25 and 26 Residents

July 15 Staff and relatives (separately)

July 16/17 Residents

July 29^/30 Staff, residents and relatives

July 29 and 31 Residents

August 1 Residents

August 30 Residents

September 4/5/16 Residents

September 24 Staff (separately) and relatives and residents,

September 27 Residents

October 2 Residents

October 22 Staff

4.4.3 The focus for relatives and residents at Greenacres House has however been the immediate implications of a potential closure. Therefore most of the comments and questions in meetings (even the one to discuss the overall plan for new build homes) have concentrated on the local changes and the planning for residents to be placed elsewhere. Minutes of the consultation meetings are attached as appendix 13.

4.4.4 A steering group consisting of a cross section of staff at Greenacres House, Personnel representation from the Social and Housing department, the Social Workers assessing the residents and local management was set up and has met on a number of occasions. Its focus has been to ensure all aspects of the business of a potential closure were attended to i.e. resident assessment and placement finding, staff redeployment requirements and building and equipment redistribution.

4.4.5 Currently there are 9 residents residing at the home. When the process of consultation started after July 12^th, 19 residents were living at the home. In the intervening months 6, as a result of their changing needs, have moved to nursing home placements, 2 have transferred to other residential homes as a result of their (or their families) own personal request and choice and sadly 2 have died.

4.4.6 A needs assessment on each resident has been undertaken by qualified social workers who have involved families and relatives, as well as key worker staff and the manager of the home in conjunction with the EPH Team Manager. Copies of the assessments and care plans of the remaining residents are included in appendix 14, which is exempt under paragraph 4 of the Local Government Access to Information Act 1985.

4.4.7 Placements which can meet the individual needs of seven of the remaining nine residents are available elsewhere within the current EPH service. However two of the remaining residents have been assessed as needing nursing or dual registered care. One has already been found a placement whilst the other is about to be hospitalised. A summary of the clients preferred placement and fallback placement is contained in appendix 14. Group placements are available for residents who have expressed a wish to move together.

4.4.8 Some residents have already visited (either with staff or relatives) a number of Bath and North East Somerset Homes to explore whether they would like to move to a particular place. Most remaining residents are now relatively sure where they would like to live should a change of placement become necessary.

4.4.9 In the event Greenacres House is closed it will be important to ensure (after all the residents have left and the building has been decommissioned) continued security for the disused building. The Authority will want to avoid any situation that might encourage vandalism, whilst not having to invest extensive revenue cost to maintain its security. The best way to achieve both these aims may be to demolish the building as soon as is practically possible although further work to ensure the value of the site is maintained is required. The current Social and Housing Capital Plan is able to provide for demolition costs if this course of action is decided upon as the best option.

4.5 Greenacres site

4.5.1 As plans have developed and discussion has taken place over time, some questions have been raised about the suitability of the site upon which Greenacres House stands in terms of offering ideal and easy access for a new Registered Care Home and sheltered housing Extracare facility. The Orchard Vale area (where the home stands) in Midsomer Norton is some way from the main High Street facilities and the approach to the Greenacres House itself is on a fairly serious upward incline. In the context of 4.1.6 above and questions being raised about the site officers have begun tentative discussions with joint commissioning partners to establish whether a better site exists in Midsomer Norton not previously known to the Council. Should this not be possible, Greenacres remains a viable option.

4.5.2 This new information should not however influence the decision on possible early closure of Greenacres House. The abiding questions to be considered in whether to close or refurbish are the cost of planned maintenance (appendix12) and the risk to residents should the home remain open and suffer significant mechanical and/or electrical failure such that the residents have to be moved in an unplanned way.

4.6 Comments from the October 22^nd 2002 Overview and Scrutiny Panel

4.6.1 These appear in appendix 15.

4.6.2 Members of the Overview and Scrutiny Panel were concerned by a possible lack of balance of service under the new arrangements. Members asked if the Extracare element of the Keynsham site (Hawthorn House) could be placed in the Chew Valley area to try and balance the provision geographically. One of the advantages of the new integrated arrangements is the bringing together of Registered Care and Extracare where possible, therefore removing the Keynsham Extracare facility would not be helpful.

4.6.3 However a separate exercise could be undertaken to explore the demand for, and financial viability of, Extracare provision in the Chew Valley area as part of our (joint PCT) Older People's Strategy of "promoting independence".

4.7 Personnel Implications

4.7.1 Greenacres House staff have been offered a more intense consultation service than other EPH staff who are likely not to be so directly effected in the immediate future. All Greenacres staff attended 1 to 1 meetings with a member of the personnel team. In these meetings staff outlined their job preferences, willingness to consider increases or decreases in hours and preferred locations. Some staff indicated they were unable to drive or had no access to transport and were limited in where they could work. However by including Domiciliary Care vacant positions in the potential redeployment pool it is anticipated that these staff members can be accommodated.

4.7.2 Some staff are unhappy about having to move their work locations. It has however to be recognised that the decision to retain the EPH services "in house" and to rebuild the homes was always going to involve some disruption to staff and residents. This was the preferred choice of both staff and trade unions at the time of the original Council decision in October 2001and was strongly supported by residents.

4.7.3 Staff have also been made aware of vacancies in the other Bath and North East Somerset Elderly persons homes and have been asked to state their preferences of role and location in order or priority. If the decision is made to close Greenacres House staff will be relocated to the other homes in Bath and North East Somerset to the same type of post and on the same hours, or where they have indicated flexibility, on increased or decreased hours. This will be done via consultation meetings and agreement. Where more than one member of staff is interested in the same post, interviews will be arranged and the successful candidate will be appointed on merit. Whilst staff do have flexibility clauses in their contracts excess travel expenses will be paid in line with the Bath and North East Somerset policy

4.7.4 Overall re-provision programme

4.7.4.1 Consultation meetings have been held in all the homes on the reprovisioning project as reported above. In the event of the decision being made to proceed with the rebuild project further consultation meetings will take place in all the homes and a timeframe for the overall project will be provided. During the tendering process, which will take up to six months staff will be kept informed of progress via the Registered Homes Managers and the Group Manager.

4.7.4.2 During the "specification" stage a working group should be set up to include representatives from staff, residents and possibly relatives who will work with the developers on setting out what they would recommend should be included in the new provision. It is important that the new homes include practical and workable facilities.

4.7.4.3 Staff will continue to be kept informed throughout the project. As the time approaches for each home to close staff will need to be re-located. Again we will work with the staff and the unions to do this in as sensitive a way a possible and with the minimum of disruption to staff and the service. 1 to 1 meetings will again be offered so we can work with staff to redeploy them in line with their contractual rights, and where possible their preferences.

4.7.4.4 The needs of the service will be paramount, where more than one person (with equal rights) is interested in a post selection will need to take place and we will work on the basis of `the best person for the post'. We will seek to redeploy staff to other homes or to the new service, how this is done will depend on whether the new homes are built in sequence or in parallel. As each home approaches closure a steering group will be set up in each home to help manage the closure, again to minimise any disruption to staff or residents

4.8 Legal Implications

4.8.1 Decision making process

4.8.2 Legal issues

4.8.3 The Process of Consultation

4.8.4 Assessments

Residents at Greenacres House have been individually assessed as set out in paragraphs 4.4.6 to 4.4.9 above.

4.8.5 Timing of assessments

4.8.6 Human Rights Act issues

4.8.7 Relevant considerations for Members to take into account when deciding whether to close Greenacres

4.8.7.1 In addition to the above considerations being taken into account Members should conduct a balancing exercise having taken into account the full results of the whole consultation process which has been described above.