1 THE ISSUE

1.1 This report examines the local implications on residential care provision of the new Care Standards Act 2000 regulations.

1.2 This report presents options for consultation concerning the re-provision of Bath & North East Somerset Elderly Persons Homes.

2 RECOMMENDATIONS

2.1 Decide on the preferred Model of Care for consultation.

2.2 Decide on the preferred range of sites for consultation.

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

2.4 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.

3 FINANCIAL IMPLICATIONS

3.4 The highest capital cost option would therefore add more than £5 million to the existing capital programme. The lowest capital cost option would be within the original capital budget.

3.5 The Council has significant capital resource needs over the medium term for a number of projects, including the Elderly Person's Homes. At the time of writing, no specific means of funding the Financial Plan provision has been identified. In addition, the Council is facing a reduction in capital resources at the end of its debt free status (likely to be March 2003, but could possibly be extended to March 2004 depending on the rate of spending and capital approvals).

3.6 Council has instructed the Resources Director to produce a plan for addressing the shortfall in capital resources of funding for the medium term, which will be incorporated in the draft financial plan in January 2003.

3.7 It is anticipated that the majority of costs for the reprovision of homes will fall in 2005/06, which means that any capital shortfall compared with the financial plan would arise from 2005/06 onwards. It is likely that the new borrowing powers outlined in the recent Government White Paper and Local Government Bill will be in place within that timescale. If so, the Council will be able to borrow freely to meet any capital resource shortfall, provided that it is able to demonstrate that the loan repayments are affordable within its medium-term revenue budget projections. Demonstrating `affordability' will therefore be a key test for all future investment decisions. As an indicator, an additional £1m borrowing would increase the council's revenue commitments by approximately £90,000 pa.

3.8 It may be possible to receive funding from the Housing Corporation to offset the capital costs of the Extracare schemes within Option 3. The current Housing Capital Programme is £18 million over 6 years with additional Housing Corporation funding of £11 million which is all fully earmarked. Grant funding may be possible of between 30% and 50% of the costs of the Extracare provision, possibly up to £1 million but this would represent a significant level of funding for one scheme out of the Housing Corporations overall funding. However the implication of doing this would be that we would receive very little or no grant funding for the provision of affordable housing for families and vulnerable younger people.

3.9 Further work on the phasing of the capital costs will be required once the actual site locations and implementation plans are determined.

3.10 Revenue

3.11 The revenue costs for the options are detailed in Appendix two. These take into account the provision within the financial plan in 2004/05. The most expensive option is the provision of four 60 bed homes which costs an additional £901,000. The three home option costs an additional £70,000 with the residential and Extracare option leading to a reduced financial plan provision of £25,000 which could offset the cost of borrowing the additional capital required for this option.

3.12 It will be necessary to calculate the phasing of costs and compare them with the financial plan once the implementation plans are determined.

3.13 The revenue costs do not include any potential additional costs related to the inclusion of nursing care within the homes. These costs may be abated to some extent by Free Nursing Care funding. Further work and discussions with the PCT will take place during the consultation period.

3.14 The revenue figures contained in appendix two and summarised here include no assumptions concerning the impact of "Single Status" on the authority.

4 THE REPORT

4.1 Forward Planning

4.2 In order to meet the new building thresholds for Residential Care Homes required by the Care Standards Act 2000 the Council, in October 2001:

"authorised officers to commence the detailed planning for a programme of redevelopment and rebuilding of the Council's existing residential care service for older people designed by 3 - 4 care homes of 50 - 60 beds which fully comply with the national minimum of standards for new care homes and which are owned and operated by the Council".

4.3 In coming to a view on the options to put forward for consultation in relation to Care Homes officers have explored the wider picture of predicted future needs for Older People's care, accommodation and support in Bath & North East Somerset over the next 20 years.

4.4 In addition to providing options to meet the parameters set by the council decision made in October 2001 consideration has been given to how the re-provisioning project could incorporate the wider implications of the local and health authorities' responsibilities and aspirations contained in its Health Improvement Plan (HimP). One of the fundamental aims of the HimP is to provide services which empower older people and promote independence through offering support services which assist them to maintain many of their individual rights as ordinary citizens whilst at the same time being supported in safe, secure environments. To this end this report sets out an alternative model of care that goes beyond providing support through registered care beds. This type of service provision is known as "Extracare" and is described in more detail later in the report.

4.5 Recently close working co-operation in Bath & North East Somerset between the Primary Care and other Trusts and the Local Authority Social and Housing Services Department has become commonplace. Joint planning for services for various client groups has been seen as the cornerstone of providing for local citizens a more user friendly and co-ordinated raft of health and social care provision.

4.6 In the field of care for Older People many of the support needs evident among the population impact equally on health and social care professionals and planners alike. This has encouraged officers from the various local stake-holding organisations to begin developing overlapping strategies to prevent, combat or attempt to reverse increasing dependency among an over 65's population which itself is increasing. People are generally entering supportive accommodation provision when they are older. The line between nursing/medical care and social and personal support is becoming increasingly difficult to draw. They are often more frail/dependent and require more intensive input than was the case a number of years ago.

4.7 In particular people with dementia or mental health needs are increasing in number. This group creates a clear joint focus for health and social services colleagues representing as it does a shared challenge in terms of nursing, medical and social support provision. Thus it has become apparent that in the area of EMI/Dementia at least it would be sensible to pursue possibilities concerning innovative frameworks for joint service delivery.

4.8 In addition scarcity of resources in both fields makes a joint approach imperative if the continuum of acute, secondary and tertiary health care is to link usefully with the long term registered care of older people.

4.9 In short the aims and objectives of the local authority and the PCT concerning older people are at the very least interdependent and in some instances inextricably linked and central to the well being of individual citizens. It is in this context that the two organisations have continued to develop coherent planning arrangements through the "Joint Strategy for Older People" and explore further the possibilities for joint service provision in the area of nursing/EMI care.

4.10 At the same time it is the case that more people are being supported in their own homes by the increasingly sophisticated community based support systems, which emanate from both health and social care organisations. Thus, where alternatives exist, fewer people overall are wishing to enter traditional residential care.

4.11 Taken together all these factors mean local and health authorities have to think differently about how they plan for future supportive care provision whether that is nursing/medical or non-medical/nursing care support that provides safety and security for the most vulnerable older people in society. It is in this wider context that this report seeks to set out options for moving forward from the decision made by full Council on October 25^th 2001.

4.12 Re-Provisioning Objectives

4.13 The question is how much supported care provision will be required to meet the needs of older people in Bath & North East Somerset over the coming 2/3 decades? What kind of care support will people want? How much of that provision needs to be within the Council's own management and how much should be purchased from the Independent and Voluntary Sector?

4.14 In October 2001 the Council asked Officers to explore whether three or four new 60 bed EPH's would be required to meet future demand and to research possible locations for them. In order to provide a basis for the options which follow in this report, Officers have analysed population predictions based on data held by the finance system Series X and population data from the census.

4.15 Demographics & Needs of Population in Bath & North East Somerset

4.16 It is predicted that the population of older people in Bath & North East Somerset will grow over the next 20 years. Using forecasts of prevalence of dementia amongst the Bath & North East Somerset population aged 65 , there will be a marked increase in the number of EMI (Elderly Mentally ill) people over the next 20 years.

4.17 We have data from our Series X Finance System on the numbers of older people currently placed in residential care both within Local Authority provision and in the independent and voluntary sector. (Note: These figures do not include those people on "Preserved Rights") At the end of March 2002, there were a total of 334 people placed in residential care homes (excluding EMI) of which 163 were in Local Authority homes and 171 were in voluntary or independent sector homes. There were 139 EMI placements in residential and nursing homes and of these 26 places were being provided by the Local Authority.

4.18 The first line of Table one below demonstrates how these numbers are estimated to grow over the period to 2021 based on the current numbers of older people needing some form of supported care.

Table 1 - Forecast of Demand

4.19 Table two models Bath & North East Somerset's share of directly provided residential provision over the same period. It is the intention to continue to purchase residential and nursing home care from the independent sector in order to promote a mixed economy of care. This model supports this and at the same time supports a managed increase in the provision of EMI services. (Note the model takes the ratio of residential to EMI care in 2001 and maintains the difference to build the figures through to 2021).

Table 2 - Local Authority Provision

4.20 Based on the premise that a growing number of people will require some form of support and increasingly this will be targeted at supporting and enabling them to retain their independence in their own homes, or in Extracare Units a more detailed range of possible care options are set out in paragraph 4.32 to 4.67 below.

4.21 The Council currently purchases significant levels of care from the independent sector and this model supports continuation of purchasing. Using the same baseline figures, the projected purchasing levels are shown in Table 3.

Table 3 - Independent and Voluntary Sector Provision

4.22 Trends towards home based care solutions

4.24 Needs of current EPH population

4.25 In a recent survey of the people who currently live in the local authorities eight EPH's it was found that a significant number were relatively physically fit. Whilst these residents were clearly too vulnerable to remain in their own home (or even Sheltered Housing) at the time of admission, many could have been supported in a care milieu which is less intense than a registered Part III Residential Care Home and more supportive of an independent life style.

4.26 The same survey indicated that people now are generally more frail, less able to fend for themselves and more likely to be on the edge of dementia at the point of entry to the care system. At the same time many new residents improve in health and well being shortly after admission.

4.27 In short the future population of vulnerable older people will not only want to chose different ways of support but also, on the evidence available in relation to people already in our own EPH's, could be cared for in a variety of supportive care scenarios.

4.28 Likely direction for the voluntary and independent sector

4.29 The 2000 Care Standards Act of course applies equally to the voluntary and independent sector. The impact of the room size regulation on the small to medium size non-council provider is clearly at least as significant as its impact on the local authority. The government at first set a target of April 2002 for compliance with the new regulations. The impact of this target on the overall "market" of residential and nursing care was raised with the government by the voluntary and independent sectors and as a result changes in the regulations themselves and the timing for compliance were made.

4.30 Whilst it is possible to speculate about the effect of the new regulations on the local care market it is by no means possible to be robust in predicting the actual outcome of the changes except of course in retrospect. However local knowledge gleaned from a number of sources suggest that as little as 40 non council beds may be vulnerable and that these in any event could easily be replaced by new players coming into the market over the same period.

4.31 Based on all these assumptions officers are recommending that the level of re-provision of supported care beds in Bath & North East Somerset should therefore reflect the current usage rather than increase or decrease by any significant amount.

4.32 Range of Future Care Support Provision Envisaged

4.33 The aim of the local Joint Older People Strategy is to ensure that a full range of care options is available to vulnerable older people in Bath & North East Somerset.

4.34 Care and support solutions can be seen along a continuum of increasing input from, at one end of the scale, to those who live in their own home through to, at the other, those who require nursing and/or EMI care. All forms of support can play a part in delaying (or in some cases preventing altogether) admissions to high support, highly expensive care provision. When considering the re-provision of residential care it is therefore important to reflect on the available alternative care solutions to make sure that decisions in one discreet area of care provision neither under or over provide for a particular section of the care continuum.

4.35 The following paragraphs set out current and planned services, which join together to provide the continuum of care described above.

4.36 CTOP's Team

4.37 There are two jointly funded multi-disciplinary Community Teams for Older People, both covering the Bath and North East Somerset area. One focuses on facilitating discharge of older people from hospital and community rehabilitation and is based in Bath. The other, based in Keynsham, is a rapid response team that intervenes with older people at times of crisis to prevent their admission to hospital.

4.38 The teams have had their capacity strengthened recently with government funds from the "Building Care Capacity" initiative and as a result now expect to facilitate the discharge of 240 people in a full year from hospital, and divert the same number from admission. The teams work to preserve and promote independence of older people and have had significant success in helping to maintain people in their own homes.

4.39 Home Care

4.40 The Home Care Services (including the independent sector) work with over 1,250 people at any one time. These services are currently under review as the provision of intensive home care - that is the level of care required to maintain older people with more extensive needs in their own homes - does not reach the level expected by the Government. In Bath & North East Somerset only 3.4 people per 1,000 population over 65 received intensive home care (defined as 10 hours or over with 6 or more visits) in 2001/02 compared to an average in our family of like authorities of 7.3.

4.41 The intention therefore is to reshape the services so as to provide a greater proportion of intensive home care. This will then both complement and follow up the work of the Community Teams for Older People (whose intervention is limited to six weeks) and thus assist in maintaining people in their own homes and preventing their admission to institutional care.

4.42 Sheltered Housing

4.43 Traditional sheltered housing provides self-contained supported accommodation for older people. Across Bath & North East Somerset there are over one thousand sheltered flats provided by housing associations. 554 of these are in the Bath City area whilst in North East Somerset there are 483 flats. A group of units is generally supported by one (on or off) site warden who provides minimal advice, guidance and assistance to the tenants. However the changing aspirations of older people and policies that seek to maintain older people in their own homes longer has seen the popularity of sheltered housing reducing.

4.44 In addition currently if an older person needs more support than the small amount available from a sheltered housing warden the person concerned has to move to a registered care home. Therefore the emergence of Extracare solutions is timely as it offers older people the chance of higher levels of care provided in their own self contained home.

4.45 Extracare Housing

4.46 Extracare housing offers an alternative to residential care for frailer, older, and/or disabled people. It combines the advantages of high quality self contained accommodation, occupied with full tenancy rights by the service user and the provision of flexible care services tailored to tenants needs and based in the scheme. The service enables the tenants to retain control of their lives while receiving the support they need in a secure environment. Extracare is not designated as Residential Care under Part III of the 1948 National Assistance Act but offers the local authority a means of providing equivalent support in a more independent setting in line with its objective of "promoting independence".

4.47 Different local authorities have different names for Extracare. It is sometimes also referred to as "Close Care" or "Very Sheltered Housing". All these names are used to describe what is essentially a very similar model of housing and care.

4.48 In Bath & North East Somerset Extracare provision is being planned taking advantage of some existing easily adapted housing stock. Three possible schemes are in the process of being explored providing up to 45 units of Extracare in and around the city of Bath. There are no immediate plans to develop similar supported care facilities outside the city in other populated or rural areas.

4.49 Part III Residential Care

4.50 Section 21 of Part III of the National Assistance Act 1948 states that every local authority must provide:

4.51 The assessed dependency levels and significant "lengths of stay" of many of the current residents in the Bath & North East Somerset in house homes suggest that some of them, who met the above criteria, and local admission thresholds, have been admitted to registered care homes when a lesser form of care support may have been adequate or, in some circumstances, better for them. This may in part have been due to the absence of Extracare facilities. Certainly for the future it seems wise in planning terms to assume this will be more of a trend.

4.52 There will always be a need for Registered Residential Care to provide for heavily dependent people with disabilities. In particular most agree EMI/Alzheimer's support is best provided for through using a registered care home model although for a minority of dementia sufferers care can be managed in an Extracare situation.

4.53 Rehabilitation

4.54 Rehabilitation services to enhance daily living skills and confidence for those older people who have experienced some form of traumatic event (often involving a hospital admission) are currently available from the Homeward Centre which is part of the Hawthorne House EPH.

4.55 Under the re-provision scenario it would be possible to offer these services from each of the new build complexes. One clear advantage of this is that the rehabilitation service could be available from more than one site thus avoiding the current situation where people from parts of Bath & North East Somerset other than Keynsham are sometimes reluctant to take up the service. As the service could be included in the overall re-provision project the revenue funding from the Homeward Centre has been included in the financial calculations.

4.56 Respite

4.57 Each of the current homes offers respite care to vulnerable older people from the surrounding community. This is an essential support service for relatives and carers. It is envisaged that the new build complexes will offer the same service and may even be able to offer an extended service since it is planned that each site is to have a day centre provision attached to the main EPH. The Care Standards Act requires that where respite services are provided in a registered care home particular attention be paid to how those service Impact on the core residents of the home. The design of the new homes will take this into account.

4.58 Day Care

4.59 The current EPH's do not, as a regular feature, offer day care support as part of their in-house service. It is envisaged that each new build EPH will have capacity to offer up to 15-day care places per weekday. A purpose built building attached to each EPH will be developed to provide this.

4.60 Goldney House at Temple Cloud has, for a number of years given over part of its building to the Alzheimer's Society who run a five-day a week day care service for their client group. The Society has invested a good deal of finance and effort in to the service and the local authority plans to formally consult with the Society in the light of the proposed changes to see how this much needed and quality service can best be re-provided in the new build project depending on the model of care selected.

4.61 Nursing Care

4.62 The local representative of the new National Care Standards Commission, which came into being in April 2002, has tentatively (and informally) indicated support for the notion of moving towards a seamless nursing/social care provision model. The previous regulatory framework mitigated against local Authorities running nursing homes. Consequently nursing care has hitherto been provided almost exclusively in the independent and private sector.

4.63 This general rule has meant for local authorities that residents in their own residential care homes have needed to move if their support needs develop into the nursing category. This has long been seen as detrimental to the individual resident's well being but no alternative has existed.

4.64 As a result of the recent change in regulations and their more flexible interpretation it looks as if it may be possible to explore with the PCT whether, under the new Health Act Flexibility's Act 1999, nursing care could be provided to residents in Council Care Homes. This may make it possible for people to "stay put" and continue to receive appropriate care at a time when they might be at their most vulnerable.

4.65 Early indications from the local Bath & North East Somerset PCT and the Avon & Wiltshire Partnership (the Mental Health Trust) suggest that it may be possible to develop some form of shared care (same site) support particularly for residents with Nursing/EMI support needs. Much work needs to be undertaken to bring this possibility to fruition and officers from all sides are keen to pursue this exciting innovation.

4.66 In particular financial models for providing nursing care in a Registered Care Home will need careful exploration as inevitably the revenue cost per bed will rise in the context of the need for 24-hour nursing cover in the home. In other words even if it is found possible to provide nursing care the financial viability of doing so will have to be carefully assessed.

4.67 The decision on numbers and location of local authority managed supported care beds needs to reflect the essential nature of creating a mix of support in each of the major population centres. In addition this report suggests that predicted need over the next 20 years favours the creation of in the region of 180 rather than 240 beds leading to a three home (or equivalent) model. In the final analysis it is clear that Bath & North East Somerset needs a mix of Independent and Voluntary sector and Local Authority provision all of which extend across the Extracare, Residential, Rehabilitation, Respite, Nursing and EMI spectrum. Taken together these factors would naturally lead to developing the new build council EPH services in Keynsham, Midsomer Norton and Bath.

4.68 Model of Care

4.69 Under the arrangements set out in this report two models of care are possible. The first involves the council re-providing its eight current EPH's with four or three larger (up to 60 beds) Elderly Persons homes. This would offer the older people of Bath and North East Somerset either 240 or 180 Registered Care beds to use in a variety of ways. People who are very frail, physically heavily dependent, or who have EMI and/or nursing needs would be assessed and directed towards the appropriate type of bed to meet their needs. Respite and rehabilitation care could be offered from the new homes. Each of the homes would also offer up to 15-day care places per weekday.

4.70 The alternative model is one where a combination of 180 Registered and Extracare care support beds is developed across each of the three main population centres across Bath and North East Somerset. This model is based on the premise that some people who would have previously been admitted to an "old style" residential care bed will, in the future, take up residence in one of the Extracare units and be supported in a rented "home of their own". These people will be too frail and vulnerable to remain in their own community based homes. This form of care will help to maintain their level of independence, afford them full tenancy rights and provide a secure environment in which to receive a package of care appropriate to their assessed needs.

4.71 In this model the registered care beds will be reserved for those older people who are the most vulnerable in Bath & North East Somerset such as those with nursing/EMI/heavily dependent needs. This group of people is unlikely to be able to maintain themselves even with support in an Extracare setting. Therefore it is essential to retain a core of registered care beds to meet the full range of need of the older peoples' population in Bath & North East Somerset.

4.72 As in the previous model respite and rehabilitation care could be offered from the new homes and each of the homes would also offer up to 15-day care places per weekday.

4.73 Potential Locations for New Build Complexes

4.74 In October 2001 the Council specifically asked officers to explore whether three or four new 60 bed EPH's would be required to meet future demand and to research possible locations for them.

4.75 Officers from Social and Housing Services and Property Services considered all the current EPH sites and identified those which would be able to support the "footprint" of a new build 60 bed Registered Care Home. Only four were of a suitable size and none from the Bath City area. Subsequently officers trawled the Bath City Local Area Plan map and identified all sites in the councils ownership which would be able to support the "footprint" of a new build 60 bed Registered Care Home. From this exercise a further three sites were short-listed. All seven sites have been studied with the assistance of external property consultants and presented to the Councils Development Control Team for scrutiny.

4.76 In addition officers have explored the possibility of creating a different kind of care provision complex. The notion of supporting vulnerable people in an Extracare setting (referred to in paragraphs 4.45 and 4.70 above) where previously they may have taken up a place in a registered care home has led officers to consider whether this model of care could be developed as part of this re-provision programme.

4.77 Consequently where there was sufficient space within the current site each of the North East Somerset locations has been considered for either model. i.e. a 60 bed Registered Care Home or a 30 bed Registered Care Home with 30 sheltered housing units attached 15 (or more) of which could be designated as "Extracare" Units.

4.78 In the Bath City area however the sites have only been considered for a 60 or 45 bed registered care home as up to 45 Extracare units are already under development on sheltered housing sites in and around the city.

4.79 What follows is a brief description of the seven potential new build sites across Bath & North East Somerset. A summary of the opportunities and constraints attached to each site and site-specific capital implications is contained in Appendix Four. The external property consultant's' report which contains detailed information relating to each site is available in the Executive Members' room.

North East Somerset Sites

(See Appendix 5 for a map indicating the location of these sites)

4.80 HAWTHORN HOUSE, KEYNSHAM

4.81 SUNNYSIDE HOUSE, PEASEDOWN ST. JOHN

4.82 GREENACRES HOUSE, MIDSOMER NORTON.

Bath City sites

(See Appendix 5 for a map indicating the location of these sites)

4.83 TYNDALE HOUSE, BATHFORD

4.84 CARRSWOOD CENTRE, TWERTON, BATH.

4.85 ENGLISHCOMBE LANE, SOUTHDOWN, BATH

4.86 MEARE ROAD, COMBE DOWN, BATH (Land Off Meare Road/Axbridge Road)

4.87 Summary of Revenue implications (Details in appendix 2)

4.87.1 Option One

4.87.2 Option Two

4.89 Phasing

4.90 It is difficult at this early stage to be definitive about how the re-provision programme might be phased. Much will depend on the sites chosen and the situation in each of the homes at the time the programme starts. It is however clear that the most vulnerable people already in the Bath & North East Somerset care system (those at Sunnyside) will require special attention and need to be moved either all together or in two separate groups. For the other homes it is less easy to suggest an order of re-provision particularly as the timing of any move is likely to be somewhat extended.

4.91 Progress towards bringing the re-provision strategy to fruition will be steady but lengthy and must be achieved by the year 2007. After final decisions have been made on actual models of care and locations for the new buildings a process of tendering for a "Design and Build" partner could take up to nine months. Formal planning permission could also be time consuming. The process of building a home takes around one year to complete. In the light of this it is possible that no actual resident moves would take place until early 2005.

4.92 It is clear therefore that the eight current homes will need to continue to deliver quality services for a substantial period to come. Given the age of the Bath & North East Somerset EPH's it is reasonable to assume that the buildings will require regular maintenance. It is also the case that due to uncertainty concerning the long-term future of the buildings themselves officers have tried in the past to invest capital programme maintenance finance in a targeted fashion with a view to minimising council outlay.

4.93 Greenacres House

4.94 Whilst all the homes will require some investment ahead of the re-provision process Greenacres House is alone in needing a significant amount of spend in the next 2/3 years. A detailed condition report is annexed to this report at Appendix3.

4.95 One of the aims in bringing this re-provision programme to a conclusion is to move and disrupt current and future residents as little as possible. The Greenacres condition report gives rise to a number of concerns. Chief amongst these is the possibility that any failure of the boiler and therefore the hot water and heating system, may lead to residents having to be moved out to effect an emergency repair only to be moved back, to face a later move to their new service provision. In addition early indications suggest that the Greenacres site may well be a suitable new build possibility.

4.96 In the light of this officers request permission to consult with residents, their relatives and staff at Greenacres to move forward with an early closure. The consultation would include individual resident assessments with a view to identifying needs and seeking alternative service provision to meet the identified needs of those individuals concerned including any regular users of the respite service.

4.97 Assessments may show that some will choose to remain in the local area and move to the voluntary and/or independent sector, others may be placed in the councils own homes whilst still others may need to be moved to nursing or EMI provision. In the event that Greenacres is chosen as one of the new build sites the current residents may chose to return to the new service delivered from that site. However since this possibility would only become available some two years after leaving it is likely people will have settled in their new setting and may chose to move with their then fellow residents to another location.

4.98 Legal Implications

4.99 Previous reports to Council Members have identified a number of legal issues that need to be taken into account when considering the future of Elderly Persons Homes. These included:

· The duty to deliver best value;

· Human Rights Act 1998 - the requirement of respect for home and family life;

· The legal requirements for consultation;

· Property and Planning issues;

Summaries of the main considerations are set out below for ease of reference for members.

4.100 Human Rights Act Issues

4.101 Where there is a proposal to close a local authority home this affects the residents' 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 home and correspondence.

4.102 To defend a challenge on these grounds, the local authority will need to show:

4.103 It will be possible for the authority to rely on the "economic well-being" ground or the "protection of the rights and freedoms of others" where a home is to close on financial grounds and where the Authority wish to re-provision in line with the Care Standards Commission's guidelines.

4.104 The closure must be necessary and proportionate.

4.105 In other words is this the only way that the legitimate aim can be achieved? Does it go further than is necessary?

4.106 The actual process of closure should follow best practice in terms of assessment of needs before identifying alternative placements and following the Choice of Accommodation Directions.

4.107 There have been cases where authorities have allegedly "promised a home for life" where the court has ruled that such a promise cannot be broken except in very exceptional circumstances. However, there is also case law to the effect that the courts will not read an implied promise into a placement in a home.

4.108 Individuals may wish to appeal against any final decision to close a home. Article 6 of the European Convention is likely to apply. This requires that, in the determination of a person's "civil rights and obligations," there should be a fair hearing by an independent and impartial tribunal. There are a number of appeal mechanisms available to individuals which include the right to make representations to the Secretary of State, the internal complaints procedure and Judicial review all of which are likely to be Article 6 compliant.

4.109 The law is clear that consultation must be meaningful i.e. it must take place at an early stage and must include, so far as possible, the examination of a range of options. There should be proper arrangements for seeking the views of all relevant interested parties, including respite users and where appropriate translation facilities should be made available.

4.110 The decision making body needs to demonstrate that it has taken all views into consideration before making the final decision and should give detailed reasons for that decision. It is reasonable for the consultation document to highlight any option that is currently seen as most likely to meet the Council's objectives. This allows consultees the opportunity to focus their representations on the most crucial issues. However, care needs to be taken to ensure that consultees do not feel that the final decision has already been taken

4.111 Since the first report to committee on 18 January 2001 there has been a High Court decision, which may be significant to the procedure to be followed in cases where decisions are being made about the closure of local authority homes. In a case involving the London Borough of Camden a judge decided that a closure decision was unlawful if it failed to take account of

· The assessed needs of individual residents and the impact on them of a move

And

· A promise that residents would be able to remain in the home for life unless their health meant they could no longer remain.

4.112 The judge pointed out that community care decisions should be needs led and not simply fitted in to broader best value considerations. In that case his conclusion was that the council had fitted the residents into the service which it intended to make available. He pointed out that "needs" in context covers psychological as well as physical needs.

4.113 There are significant differences between the facts and considerations in the Camden case and the possible future options after the decisions, which are to be made by this Council. There is a need however, for this report to address the relevance of the decision in the Camden case.

4.114 As members will appreciate, the proposals in this report if adopted, will lead to a subsequent consideration of the closure of one or more of the homes. Before a proposal is put to the Council Executive as to which home or homes should be considered for closure, information should be gathered about the impact of closure on individual residents, in addition to completing a consultation process. Members will be supplied with all relevant information before being asked to make any decisions about closure.

4.115 The law is very unclear as to the timing of assessments but where a proposal exists to change or reduce service provision under the NHSCCA 1990; the local authority is under a legal obligation to carry out a re-assessment of individual needs.

4.116 Consultation and assessment must be carried out with all the residents, relatives, carers, and respite users as well as staff to identify the current needs of residents. If necessary translation facilities should be made available. This process is to enable officers to model the proposed future care homes around those needs and identify any impact of a move on individual residents. Where clearly defined psychological needs are identified further assessments may be required.

4.117 In respect of the residents at Greenacres if the Council Executive decide that Greenacres should be considered for closure in the very near future then a needs assessment must be carried. The Council Executive should look very carefully at how closure affects each individual and what alternative arrangements might be available.

4.118 In respect of those residents where a move is not to take place in the very near future, i.e. those residents who do not live at Greenacres, it would be premature to carry out the processes described above. Since the closure process is still some 2 to 3 years from completion, similar considerations will apply to those residents nearer to the time a move is being considered.

4.119 Choice of Accommodation Regulations

4.120 Consultation Process

4.121 Residents, their families, staff and Trades Unions will all be consulted in the light of directions from Members concerning this report and within the guidance of the advice received from the councils legal department. A timetable will be drawn up and special attention will be paid to the dual consultation that will be necessary at Greenacres House. Officers are attuned to the importance of the possible difference in time scale for those residents and staff at Greenacres as against those in other homes.

4.122 In the event a decision to explore further the possibility of using the Carrswood site for a new build complex is made, consultation will take place with users, carers and staff at the Centre in parallel with the consultation in the EPH's. Wider consultation with local interested parties and connected stakeholders will also take place following Member guidance from the July Executive meeting.

4.123 Consultation will also take place with a wider range of stakeholders such as the local voluntary sector, trades unions, ward councillors and other appropriate parties who represent the interests of older people in Bath & North East Somerset.

4.124 HR and Personnel Implications

4.125 The Re-Provisioning Project

4.126 Following the councils resolution to build 3 to 4 new homes staff are aware that some disruption will follow. They are aware of the discussions and feasibility studies that are taking place regarding potential new sites. Each staff group in the eight homes have been visited by David Smallacombe (EPH Re-Provision Project Manager) and Ainslie Saunders (Personnel and Training Manager) to talk about the possible type of care that could be provided in the new homes. The views of staff have been sought about what models of care they believe are important and how such care could be provided. Staff and the unions will continue to be consulted at all stages of the project and one of our objectives will be to keep fears or concerns to a minimum.

4.127 One of the positive aspects about the decision to keep the service in house is that staff will retain continuity of employment and remain with the Local Authority. This was the option that was favoured by most staff and the unions. Whilst the redevelopment of the homes will involve some disruption to staff it will help ensure that we not only retain existing skills and expertise, but also offer a greater variety of training and job opportunities.

4.128 With the proposals which include sheltered housing, extracare housing, part III residential care, rehabilitation, respite provision, nursing care and EMI this will increase the career opportunities for the existing staff and offer job opportunities to the communities in which the new services will be sited.

4.129 Regular meetings with union representatives have been taking place and will continue. As it is planned that a wider range of services are to be provided from the new homes work will need to be undertaken on staffing structures, job descriptions and payscales. As consideration will need to be given to possible changes to terms and conditions detailed discussions and negotiations will take place with staff and union representatives. As was noted in an earlier report any increase in staffing costs associated with the implementation of Single Status are still not known.

4.130 Once the Executive has made the decision as to the preferred model of care staff will be consulted on this. Firmer proposals will then be placed before the Executive at a later date.

4.131 Whilst disruption will be kept to a minimum the needs of the service will continue to be our primary concern.

4.132 Proposal to consult on a possible early closure at Greenacres House

4.133 If, later in the year a decision is made to close Greenacres, this closure will be earlier than staff had originally expected. This means Greenacres staff will be the first to move and will have to face a second move in the future, once the new homes are built.

4.134 It is anticipated that through a combination of measures we will be able to redeploy current staff. These include natural staff turnover, no new appointments being made to permanent posts within the Elderly Persons Homes, assistance with travel, additional training, some flexibility by both the Authority and staff when matching staff to posts, considering any suitable vacancies within Social and Housing Services or within the council. We will be working to achieve the council's preferred option of no redundancies. It is our firm intention to retain existing staff and their skills to help continue to provide the current and future service.

4.135 A consultation programme with staff and unions will be set up to ensure that staff are involved in the transition, so that any disruption and cause for worry is kept to a minimum. It is recognised that staff may have concerns so individual meetings will also be offered to them to discuss any personal issues and to work with staff in finding the most appropriate alternative employment within the authority.

4.136 Guiding process for this report

4.137 Officers have kept the EPH Re-Provision Steering group fully informed of progress towards compiling this report. Regular meetings have taken place and a final draft of this report was scrutinised by the group just prior to it being lodged with Democratic Services. Core membership (in alphabetical order) of the group is as follows:

Jane Ashman Director S & H S

Joy Davis UNISON

Jane Tapper Elected Member