Contact: Vincent Oliver, County Manager - Residential / Day Care for Older People Ext: 5720

1 Summary

1.1 The following decisions are sought.

1.2 That approval be given to proceeding with the specific schemes for providing Intermediate Care facilities at 6 of the In-House residential care homes for older people. The schemes will be at: Copper Beeches, Andover; Emsworth House, Emsworth; Ticehurst at Aldershot; Thurlston House at Fleet; Solent Mead at Lymington and Bishops Waltham House at Bishops Waltham.

1.3 That approval be given to negotiate contracts with LST Building Contractors to complete works on Emsworth House and Copper Beeches.

2 Reason(s)

2.1 Approval was given to the variation of the core business of this service at the Social Care Executive meeting on the 28 January 2002. This report gives details of the specific schemes which have been identified, and the current operational dates.

2.2 Capital funding has been made available by the Government through the Building Care Capacity Intermediate Care allocation and revenue through the Cash for Change revenue funding.

2.3 This provides an opportunity to extend the range of services offered at up to 6 In-House residential care facilities for older people.

3 Other options considered and rejected

3.1 This provides an opportunity to work collaboratively with Health to address the issue of delayed transfers of care and not to do it would add further pressure to the problems encountered in this area.

4 Conflicts of Interest declared by the decision-maker or a Member or Officer consulted

4.1 Not applicable.

5 Dispensation granted by the Standards Committee

5.1 Not applicable.

6 Reason(s) for the matter being dealt with if urgent

6.1 None

Approved by: Date of decision:

Councillor Felicity Hindson

Contact: Vincent Oliver, County Manager - Residential / Day Care for Older People Ext: 5720

1 Summary

1.1 The purpose of this report is to seek approval for the development of intermediate care facilities at up to 6 of the In-House residential care homes for older people.

2 Background

2.1 At a meeting of the Social Care Executive on the 28 January 2002 approval was given to a variation in core business of the In-House Residential Care Homes for Older People to include the provision of intermediate care facilities. At that time only a broad picture of possible sites was given, and this report gives specific details to date. Further work is required on 2 of the schemes.

2.2 Each of the schemes have been identified as part of local commissioning needs with health colleagues reflecting local health and social care economies.

2.3 Intermediate residential care is about providing short term accommodation (up to a maximum of 6 weeks) for older people who require additional support and active intervention to regain their life skills to enable them to return home. The schemes in question will provide mainly to two groups of people: firstly, those who live at home and need that extra intensive support by care staff, occupational and physio therapists and other allied health professionals within the residential home to enable them to return home - this is known as `step-up' care, and secondly, those people requiring the above (extra) support who live in hospital but not requiring medical intervention but an intensive 2 to 6 weeks intermediate care before returning home - this would be seen as `step-down' care.

3 Proposals

3.1 Four sites are ready to proceed in the next 4/5 months, with a fifth site awaiting approval of the National Care Standards Commission and the last site awaiting a final feasibility study by Property, Business and Regulatory Services.

3.2 An additional intermediate care facility will be part of the Malmesbury Lawn re-development, subject of a separate report to the Social Care Executive meeting. This will provide 6 intermediate care beds due for completion in the Spring of 2004.

3.3 The first four sites are:

i) Emsworth House, Emsworth providing 9 beds for older people with dementia. The building plans for this scheme were approved, subject to some minor alterations, by the National Care Standards Commission on the 14 October 2002. This scheme will operate with the input of the local Elderly Mental Health Team. Completion date is expected by end of January 2003.

It has been agreed by the funding body that the Building Care Capacity Intermediate Care Capital money can be profiled over 2 financial years but that the expenditure at Emsworth House is to be made by the end of this financial year (2002/03). The current proposals as prepared by property services are estimated to cost in the region of £100,000. To meet the urgent need for the provision of these spaces in the local health economy it is proposed to procure the works via negotiation with LST Building Contractors.

Funding has also been made available from the Performance Fund to purchase special electric beds and other equipment to assist staff in the moving and handling of residents. This will cost £12,750.

ii) Copper Beeches, Andover providing 10 beds for people with physical frailty in both the Winchester and Andover areas. The scheme will involve the input of the local Health Preventing Dependency / Rehabilitation Team. The building plans were approved, subject to some minor alterations by the National Care Standards Commission on 14 October 2002. Completion date is expected late December 2002.

As for Emsworth House the funding spend profile requires the expenditure at Copper Beeches to be complete by the end of March 2003. Again there is a high demand for this type of provision in the Andover area. The earliest possible completion would be advantageous. The current value of the works is estimated at £55,000. It is proposed that to meet the tight timescales and the high demand in the local health economy for these provisions that the works be negotiated with LST Contractors.

Funding has also been made available from the Performance Fund to purchase special electric beds and other equipment to assist staff in the moving and handling of residents. This will cost £14,000.

iii) Ticehurst, Aldershot will provide 9 beds for older people with dementia, linking in with the local Community Mental Health Team. Building plans for this scheme were approved by National Care Standards Commission on the 14 October 2002. Building work will not begin until March 2003. The capital costs for the conversion are £103,000.

Funding has also been made available from the Performance Fund to purchase special electric beds and other equipment to assist staff in the moving and handling of residents. This will cost £12,750.

iv) Thurlston House, Fleet will provide 5 beds for people with physical frailty and will be working with the local Health Rehabilitation Team. Approval for the building plans were given by the National Care Standards Commission on the 14 October 2002 and building work not due to start until end of March 2003. The capital costs for the conversion are £113,000.

Funding has also been made available from the Performance Fund to purchase special electric beds and other equipment to assist staff in the moving and handling of residents. This will cost £7,330.

3.4 Two other proposals which are under active consideration are:

i) Solent Mead, Lymington where 3/4 beds for people with physical frailty are being proposed. Work has recently been taking place with the New Forest Primary Care Trust and colleagues from the Rehabilitation Team. Given that there is a major refurbishment of Solent Mead, which is nearing completion, an opportunity was taken to look at 4 beds for an intermediate care facility. Unfortunately, the National Care Standards Commission were not prepared to approve the proposed location of the scheme, so further, urgent proposals are being considered. Building costs are yet to be identified on this project.

Funding has also been made available from the Performance Fund to purchase special electric beds and other equipment to assist staff in the moving and handling of residents. This will cost for 4 beds, £5,000.

ii) A proposal for Bishops Waltham House at Bishops Waltham is looking at providing a dedicated 4/5 bed unit for people with physical frailty and currently a feasibility study is being carried out by colleagues in Property, Business and Regulatory Services but capital funding costs have not therefore yet been identified. However, funding has been made available from the Performance Fund to purchase special electric beds and other equipment to assist staff in the moving and handling of residents. The cost of this will be (for 5 beds) £7,050.

4 Financial Implications

4.1 Funding for these schemes come from two different sources, the building works from the Government Intermediate Care Capital, and initial revenue costs from the Building Care Capacity revenue grant. It is also anticipated that some of the transitional costs resulting from the redesign of service provision will be met from the Performance Grant. The ongoing revenue costs need to be identified from the 2003/04 allocations

4.1.2 A summary of the financial estimates for all the intermediate care projects is attached in appendix 1.

4.2 Capital Funding

4.2.1 The capital funding allocated for this project is £1.01m and the detail on how this will be spent on the individual sites is still being worked on by the Property, Business and Regulatory Services. It is proposed the Performance Grant will be used to fund some of the in-house capital, an estimated cost of £200,000. This grant may also be used to fund specialist equipment as shown in appendix 1 at an estimated cost of £75,000.

4.3 Revenue Funding

4.3.1 The revenue funding requirements will be incremental to match the various projected completion dates of the building work. For this financial year the currently estimated cost will be £424,000 and the full year effect current estimates indicate £701,000.

4.3.2 The revenue funding estimates have taken into account: additional staffing costs to meet the Hampshire Standards; loss of income, initially as a result of keeping beds vacant during the building work and ongoing loss is due to there being no charge for Intermediate Care; additional purchasing as a result of the reduced long-term capacity. The implications of the National Care Standards Commission staffing requirement are being reviewed separately as part of the work on the 2003/04 budgets.

4.3.3 The Health contribution will be through the provision of specialist therapy and other health staff at the various intermediate care services.

4.3.4 This new approach of providing intermediate care facilities within in-house residential care homes, through the initial significant investment should deliver savings in the medium to long term, on both care packages and long term residential care as well as supporting the reduction of delayed discharges from hospital. It will assist the strategic direction of promoting independence by supporting people to return home and the consequent reduction in the need for long term residential care.

5 Recommendations

5.1 That approval be given to proceeding with the schemes as identified above.

5.2 That approval be given to negotiate contracts with LST Building Contractors to complete works on Emsworth House and Copper Beeches.

Section 100 D - Local Government Act 1972 - Background Documents

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1. Published works

2. Documents which disclose exempt or confidential information as defined in the Act

NONE

Appendix 1 - Summary of Intermediate Care Costs

SUMMARY OF INTERMEDIATE CARE COSTS appendix 1