Meeting documents

1 THE ISSUE

1.1 In line with the decision made in November 2002 by the Council Executive to develop for Older People a mixed provision of registered, sheltered and extra care services in Midsomer Norton, Keynsham and Bath, an opportunity now presents itself to move into the next phase of the re-provision programme.

1.2 The development of Extracare provision at St John's Court in Bath will afford service users an opportunity to exercise choice over the care they receive; however, this cannot happen until staff resources are freed up from other parts of the service.

1.3 The current financial situation alongside the issues raised by the Commission for Social Care Inspection (formerly known as the National Care Standards Commission) and the duty to deliver Best Value, all point in the direction of further home closures as the next step in the re-provision programme. The consideration of further closures at this stage is a key requirement in order to consolidate staffing and occupancy levels across the service and to re-invest resources in the development and training of staff.

2 RECOMMENDATIONS

2.1 Approve the closure of Tyndale and Woodside Registered Care Homes.

2.2 Require officers to implement a programme of resident transfer in line with their assessed care needs and indicative placement outcome preferences.

2.3 Require officers to undertake a process of formal personnel action to engage staff, trade union and service management to achieve staff redeployment as set out in this report.

2.4 Require officers to make best use of and/or secure the vacated properties in order to maximise the eventual capital receipt to assist in the financing of the overall re-provision programme.

3 FINANCIAL IMPLICATIONS

3.1 The capital gain from the disposal of Tyndale and Woodside is estimated to be in the region of £1.6m. All of the capital receipts will be reinvested in the reprovision programme.

3.2 The Councils Registered Care Homes, taken as a whole faced a significant overspend in the 2003/4 financial year due to staff shortages, high use of agency staff and low occupancy levels.

3.3 The closure of Tyndale and Woodside would generate revenue of up to £432,000 in 2004/05 and £588,000 in 2005/06. The 2004/05 Financial Plan for Social Services made assumptions that £200,000 would be used to prevent other service reductions. The balance of savings of up to £232,000 in 2004/05 from two closures would enable the next phase of the re-provision programme to proceed by implementing the Extracare service at St Johns Court and the additional mandatory staffing requirements of the Commission for Social Care Inspection to be met.

3.4 The closure of only one home or delay in the closures will lead to a delay in the overall re-provision programme as there will be insufficient financial resources for re-investment. In addition, due to vacancy levels, use of agency staffing and The Commission for Social Care Inspection staffing level requirements, the revenue budget cannot sustain 7 homes without a high risk of overspending as happened in 2003/4.

3.5 The Financial Plan savings were planned for 2004/05 only and are currently built back in to the budget in 2005/06 to enable increased investment in the re-provision programme as the new extracare and residential sites are established.

4 THE REPORT

4.1 At the outset of the process Tyndale had 19 residents and Woodside 24 making a total of 43. On April 10^th 2004 Tyndale had 15 residents and Woodside 21 a total of 36. One person who was seriously ill before this process began has sadly died whilst the other six have transferred out of the council's service (see table below).

4.2 It is inevitable that once a process of change has been introduced as a possibility people begin to consider options that had previously not been part of their thinking. Thus during the assessment and consultation process we have found that a small number of residents and their relatives have actively explored, using their right to make a choice to move at any point in time, whether to transfer to the independent sector thus achieving only one further move in preference to considering which interim council home they might like to try whilst awaiting a place in the new Community Resource Centre Care Homes.

4.3 Although this is clearly a special set of circumstances with a number of people moving at the same time it is the case that residents in the Authorities service do move from time to time based on their continuing and assessed care needs. Both residents and staff are therefore used to a certain level of change and are experienced in managing the process.

4.4 Every resident in both care homes participated in an assessment of their current and future needs to the degree that was possible and most helpful to their own ability and in line with their personal request. Some made their views known on an individual basis, others did so with the help of family and friends whilst a few used the advocacy service organised by the Social and Housing Services Department.

4.5 Detailed assessment papers (anonomised) are to be found in appendix 1 but in summary residents have opted for the following placement outcomes should a decision be made to close either or both home.

1.1 The availability of placements in the councils registered care homes is as follows:

1.1 The current in-house vacancy situation therefore allows for the possibility of all the remaining residents transferring to vacant rooms in the council's own homes. However some residents and their relatives, as previously stated, have already moved or may choose to move to the independent sector so the choice in terms of location for those remaining will become even greater.

1.2 Part of the consultation process has involved residents and relatives visiting the councils other care homes to gauge for themselves where they might move if their current home were to close. The Council, in the form of providing transport for the journeys and staff with whom the residents are familiar to accompany them on the visit, has facilitated this process. Those residents who have explored moving to the independent sector have generally been facilitated and/or accompanied by relatives and friends.

1.3 Whilst this process has obviously been stressful and upsetting for residents, relatives and staff alike the general view is that were the Council to decide to close either or both homes the residents themselves would be keen to make a move as soon as possible. Most have prepared themselves by making their first, second and third choice of destination known. Local and senior management is ready (if required) to implement any agreed change with immediate effect and staff are committed to ensuring the smooth and supportive transfer of residents to other homes.

1.4 Consultation meetings with relatives have taken place. The minutes of those meetings are contained in appendix 2. The theme of the early meetings was sadness, shock and disappointment at the possibility of closure. Relatives recalled earlier consultation meetings when officers had indicated that residents (apart from those at Greenacres House in Midsomer Norton) would not need to experience an interim placement prior to moving to the new Community Resource Centres. This was fully acknowledged by officers in the meetings and the background to the change in position explained.

1.5 Whilst some acknowledged the need for the change and began to explore possible alternative placements in the meeting others held firm to the view that both homes should remain open until a "one move" option was available to their relative. There was however consensus in agreeing that whatever happened the needs of the resident population should be paramount in any consideration as to the future of either home.

1.6 It was also stated that the needs of the staff should be high on the agenda with relatives making it clear that they had the utmost respect for the work of staff in both homes. Related to this point most asked that staff, wherever possible, should accompany residents to their new homes. Notwithstanding individual staff preferences for future deployment and the potential for filling current vacancies in the receiving homes officers committed to trying to ensure residents would have at least some of their old staff in the new settings. Obviously it was made clear that for those choosing to move to the independent sector this would not be possible.

1.7 Taken together Woodside and Tyndale have 44 members of staff with substantive contracts of employment. Most work part time and some only work particular shifts or at specific times during the day. These arrangements have grown up over time and are usually connected to the particular staff members' domestic situation or through individual choice and/or the requirements of the care home rota.

1.8 The staff consultation process (minutes attached at appendix 3) included meeting all staff employed at Tyndale and Woodside to gain an understanding of each member of staff's preferences if a decision to close Tyndale and Woodside were to be made. This also gave staff an opportunity to raise any other issues they may have with the consultation process.

1.9 Human Resources staff met with staff on an individual basis to discuss their preferences and any other issues they wished to raise. Dates and times were sent to each of the homes in advance of the meetings. Each member of staff had the option of being accompanied by a trade union steward if they wished. The following is a record of the dates for the meetings:

1.1 All staff had an opportunity to indicate their preferences as to future work with the council. It was made clear to each person that the council had an obligation to look for "suitable reasonable" alternative employment within its own staff portfolio and if staff, by reason of working at a different location, incurred excess travelling expenses they would be entitled to Appendix E payments (a contribution to the excess travel incurred).

1.2 A clear message was given that the Council wished to retain the skills and abilities of all staff as their experience would be of benefit for the new service in the Community Resource Centres.

1.3 Staff raised concerns over the number of vacancies currently available against the number of staff that may need redeployment. Some were concerned about the possibility of the need for a selection process if the figures did not match. It was confirmed that in these circumstances the usual process of application and interview would be used.

1.4 After all the staff had been interviewed a paper exercise was undertaken to see if "in principle" existing vacancies in the other residential homes could be found for people who would be in need of alternative employment were the homes to close. It is important to stress that this exercise has been undertaken without reverting to staff to see if the Councils view as to what might constitute a "suitable and reasonable" offer of alternative employment meets with individual approval. The following table summarises the position as at April 10^th 2004.

1.1 From the above table it can be seen that plans to commission St Johns Court (SJC) as the next step in the overall re-provision programme as part of the Bath Extracare service dovetail well with achieving a successful redeployment process for night staff in the two homes.

1.2 During the consultation process many staff expressed an interest in working in the SJC Extracare service. The overall programme of works in the re-provision project has the service at SJC coming on stream in the autumn of this year. Officers are optimistic that, given a period of enhanced training will be required, the gap between potential EPH closures and the initiation of the new SJC service may actually be of significant benefit to the service in overall terms.

1.3 Early indications from the Trade Unions would seem to support this view and the programme of re-provision would benefit from a chance to have a clear run at creating a fresh team to source this part of the new service.

1.4 In addition the Domiciliary Care service is in the process of being re-organised and once the current substantive post holders have been placed vacancies will become available in that area. Some staff in the consultation meetings expressed an interest in moving across to this area of service, which may assist in the Day Support shortfall of 22 hours.

1.5 The shortfall in hours for the cook role may be assisted by potential retirement plans across the service.

1.6 Previous reports to Council Members have identified a number of legal issues that need to be taken into account when considering home closures. These include:

1.7 Any proposal to close a local authority home affects service users' rights under Article 8 of the Human Rights Convention which prohibits interference by a public authority with the right to respect for an individual's private and family life, his/her home and correspondence.

1.8 The local authority must be able to show that the proposed closures will be carried out "in accordance with law" and that they have "a legitimate aim".

1.9 Consultation so far with all stakeholders has been extensive and officers are committed to ensuring that this continues throughout the re-provision programme. Since a decision has already been reached that all seven registered care homes will close as part of the re-provision programme it has not been necessary to consult specifically on which will be the next homes for closure. However, it will be necessary, once a decision has been reached to share this with all relevant stakeholders in an appropriate and timely manner.

1.10 The actual process of closure should follow best practice in terms of assessment of individuals' needs as a first step in identifying appropriate alternative placements. Relatives and staff have of course been afforded an opportunity to contribute to this process. Resources have been secured from within Social and Housing Services to ensure that all service users received a comprehensive assessment of their needs and that their wishes and those of their relatives were honoured wherever possible within the existing spectrum of care and support services available.

1.11 It is anticipated that through a combination of measures the majority of staff would be re-deployed. Such measures include natural staff turnover, an appointment freeze, assistance with travel, additional training, flexibility within the authority and from staff when matching staff to posts and the consideration of opportunities within Social and Housing Services and across the Council.

1.12 A consultation programme was undertaken with staff and unions to ensure that staff were fully involved in the transition so that disruption and worry was kept to a minimum. In addition to the scheduled re-deployment meetings, further meetings were offered to staff if they had specific concerns or personal issues they wished to discuss.

2 RISK MANAGEMENT

2.1 The whole of the EPH Reprovision programme is subject to review by the Risk Management Panel and there is a comprehensive risk register associated with the programme.

3 RATIONALE

3.1 As well as making reference to exciting service developments this report sets out the financial backdrop against which the Social and Housing Services Department needs to manage its budget over the coming 2/3 years. It is clear from the information available that as well as being in line with the "direction of travel" for the overall re-provision process, closure action at this stage is central to creating a balanced budget for 2004/5 and 2005/6.

3.2 It is also true that the closure of two homes at this stage would represent a significant opportunity for re-investment and would allow resources released to be better employed across the remainder of the service to act as an important springboard to the greater change process in older peoples services in Bath and North East Somerset. In addition the Commission for Social Care Inspection requirement to staff remaining homes to levels that meet current residents needs means that the closure of these two homes is necessary.

3.3 The rationale for choosing Tyndale and Woodside care homes is set out in the report to the Executive Member for Social Services dated December 16^th 2003 (listed as a background document to this report).

3.4 Finally, and as part of the overall move towards a new service model, the Council needs to invest resources strategically in training and development to prepare staff for the delivery of a quality service in the new Community Resource Centres.

3.5 In the light of these combined factors a period of consultation has been undertaken and this report records the impact on residents and staff of the potential closure of two well loved and respected Registered Care homes.

3.6 Experience from this authority and elsewhere shows that residents, relatives and staff rarely find it easy to whole-heartedly support the kind of changes suggested here. However, unlike closures elsewhere these changes are part of a larger plan to provide for older people in Bath and North East Somerset a leading edge service, which will create for them a much expanded and enhanced care continuum.

3.7 The vast majority of those consulted in the process leading up to the decision to re-provide all the authorities registered care homes were fully supportive of the plans presented by the Social and Housing Services Department. Residents, relatives, staff and Trade Unions alike are clear that the end goal is not only worthwhile but also represents a major step forward for the care of older people in the authority. There will be a paper going to the Council in May that will update on the EPH reprovision and the current cost projections and consider enhancements to the original specifications (subject to funding) to reflect the increased opportunities afforded by the in-reach nursing structure and a need to make additional provision for EMI.

3.8 All the current residents have participated in an individual community care assessment the results of which are available to the Executive as an exempt appendix. They indicate that each resident's needs can be met in alternative provision. . For those preferring a move to the independent sector, funds are available within the Council's normal fees policy. This report also makes it plain that the councils remaining care homes has more than enough permanent vacancies to accommodate all the residents from Tyndale and Woodside who wish to transfer to another council registered care home. Many residents have already visited these homes and made their preferences known.

3.9 The majority of residents and their relatives in the two homes have already begun to plan for change and are ready to undertake this even though they would obviously prefer not to be engaged in the process ahead of being able to move to the new Community Resource Centres (CRC's). Some of those who have decided to move to the independent sector have enquired about whether, in the fullness of time, they could return to one of the new CRC's. Officers have made it clear this will be possible should they decide they wish to return once the authorities newly provided care homes are open.

3.10 The Authority's officers have a good reputation and much experience in helping older people through providing sensitive, dignified and caring support to move in the context of necessary closures. Any move of home will be managed at a pace dictated by the individual resident and in line with their Community Care Assessment and Care Plan and where appropriate the wishes of their relatives and/or friends.

3.11 In conclusion the closure of Tyndale and Woodside would present an opportunity to contribute towards a balanced Social and Housing Services budget in the short term, consolidate staffing levels and occupancy rates across the rest of the service (thus making best use of scarce resources) and in addition release resources to be invested in increasing staff training and qualification levels up to the standard required to deliver higher levels of care (including nursing care) in the re-provided service.

3.12 On balance therefore, and despite some opposition from important stakeholders, officers believe consideration should be given to closing these two homes at this time.

4 OTHER OPTIONS CONSIDERED

4.1 The only other options are not to close one or both homes. The service and financial implications contained in the main body of the report show why these are not being recommended. In essence, it would not be possible to start the new "extra care service" at St Johns Court and meeting the mandatory staffing requirements would lead to an inevitable significant overspend in the staffing budget and seriously impede the ability to prepare and train staff for the new services.

5 CONSULTATION

5.1 In order to gather feedback from service users, relatives and staff, the following consultation plan (as per that set out in the permission to consult report) has been followed: