Hampshire County Council Item 5

Executive Member for Policy and Resources

31 January 2006

Re-provision of Elderly Persons Homes - Independence, Well Being and

Choice

Report by the Director of Adult Services and the Director of Property,

Business and Regulatory Services

How the conclusion in this report fits with the Corporate Strategy

This scheme will impact on the delivery of all Corporate Aims, focusing most immediately on:

Aim 5 - Improving Services - by reinvesting resources to re-provide facilities and services that meet the needs of future service users.

1

Summary

1.1

This report sets out the principal factors that have determined a review of the Elderly Persons Homes. This identifies the requirement for a reprovision of services from the homes at Pier House, Lee-on-Solent and, Chrismas Lodge, Aldershot and the consideration of re-provision options for Courtbourn, Farnborough.

1.2

The review identifies that improvements to services are achievable and recommends the rationalisation and the potential for reinvesting the capital receipts secured from the disposal of three homes into the retained properties.

2.

Background

2.1

The Cabinet, at its meeting in October 2005, agreed that the Directors of Property, Business & Regulatory Services and Adult Services consider the future of a number of elderly persons' residential homes. The ENHANCE programme to provide ten new nursing homes with 500 beds, and to refurbish a further seven of the existing residential homes, is well underway. The Cabinet, at its meeting in October, agreed that consideration should be given to the condition, safety and future of the remaining 19 homes. The early feasibility work on a number of the homes suggested that their future viability could not be guaranteed and that a further report on the relevant asset management issues and regulatory requirement issues and adult care policy issues be prepared. This report makes recommendations on three of the elderly persons' homes.

2.2

It was noted by the Cabinet that the sites in question could have particular values for reinvestment in the remainder of the homes and provide opportunities to re-provide other facilities, potentially with external partners.

2.3

The Adult Social Care Green Paper-Independence, Well-being and Choice lays down the challenge of delivering personalised services with people at the centre of the service delivery. Excellence in services will be achieved through listening to people who use services, and changing them to meet the needs and expectations of future service users. Following the implementation of ENHANCE there are opportunities to consider a wider range of options to ensure choice and access to mainstream services for targeted service users.

2.4

These include re-provision both within the Independent sector and Hampshire County Council Residential Homes. Investigations may also take place to explore how direct payments may be utilised by service users to broaden the range of services they wish to purchase and the commissioning of alternative housing solutions which will enable older people to remain supported in their communities.

2.5

The development of Extra-care is a major aspect of the Department of Health's approach to modernising services for older people. Extra-care provides a complete alternative to residential care, enabling people to live in their own homes, in most cases, for the rest of their life.

2.6

The 2005 Department of Health Green Paper "Independence, Well-being and Choice" states that "Extra-care housing has been developed to give choice to very frail or disabled people whose care needs might traditionally have been met by residential care. It offers a model which allows people to live in their own homes with a range of facilities and support designed to meet their needs." Extra-care housing gives frail older people a higher quality of accommodation than would be available through residential care.

2.7

Fit for Purpose

From an operational perspective the three homes at Pier House, Chrismas Lodge and Courtbourn do not meet the requirement of the Commission for Social Care Inspection in terms of being `fit for purpose' which is a term used within the Care Standards Act 2000. The main consideration here is to identify whether a building meets the needs of the current (and future) service users as well as regulatory requirements. With the increasingly frail profile of residents both physically and mentally, bedroom sizes are one of the most important factors. This enables care staff to use additional equipment such as hoists and electric profiling beds to ensure safe moving and handling of clients. Other considerations are the sizes of the bathrooms and toilets which need to accommodate mobility aids and wheelchairs.

3.

Operational Issues and Service Reprovision

3.1

A summary of the operational and key asset management issues is enclosed with this report as Appendix 1. For each of the three homes it identifies the main factors which impact on the delivery of the service, including the fit for purpose issues noted in section 2 of this report - room size and general layout, accessibility etc and the asset management issues covered in section 4.

3.2

In addition to the above, local management arrangements have been required to address the shortcomings both in fire precautions and security with staffing cost implications.

3.3

Pier House

This building has provided respite care services for up to 15 residents since 1999 and, despite extensive promotion of the service, occupancy was only 50% during 2004/5. The decreasing number of referrals is directly related to the buildings inability to accommodate service users with increasing frailty, mobility problems and dementia care needs.

Following consultation in December 2005 respite services have been reprovided from Pier House to other Hampshire County Council residential homes and through additional commissioning from independent sector homes.

These changes are in line with the Adult Social Care Green paper and have given us the opportunity to provide a wider range of services to meet the needs of service users such as those who are physically frail or have dementia care needs.

3.4

Chrismas Lodge

This is a specialist dementia care home and given the very poor physical condition of the home (very poor decorative state and the need for major asbestos removal) and its unusual layout (confused residents have to go downstairs to bed) the home has been operating at just below half capacity with 15 residents for the last 12 months. A care management plan was agreed in May 2005 to move the residents and staff to the newly refurbished Ticehurst Home (which is less than one mile away), to enable a detailed asset management inspection of the building to be undertaken.

The building has been deregistered, and in operational and care management terms, it would not be appropriate to move the service users and staff back from Ticehurst as they have now integrated into the service delivered from the joint Nursing and Residential Home, even if it were economical to refurbish Chrismas Lodge.

3.5

Courtbourn

Courtbourn is a home that provides care to residents who are physically frail. It has become increasingly difficult to accommodate potential residents whose needs are either high physical dependency or dementia care due to the layout and facilities of the home in terms of `fit for purpose'.

Due to the restriction on use of bedrooms as a result of the concerns identified in the fire safety strategy audit and the constraints of the building, the occupancy in 2004/5 was only 82%. There is also an overall reduction in demand for the type of service offered by the home in the Farnborough/Aldershot area. As a consequence, a process of consultation will be established to assess the re-provision options.

There are currently 22 permanent residents at Courtbourn (at 9 January 2006). The majority of these were admitted from within a 5 mile radius of the home, whilst others came from the Basingstoke and Alton areas.

There are 6 other local authority homes within about 12/15 miles of Courtbourn which may provide potential accommodation options, and shortly the refurbished homes at Oakridge House, Basingstoke and Marlfield, Alton will be available, whilst other independent care homes could be considered.

4.

Asset Management and the Development Potential of the Sites

4.1

Appendix 1 noted above also includes the key asset management issues, principally around the condition of the buildings and the services, fire precautions work required and asbestos. A broad liability cost for each home is also included on the schedule.

4.2

The analysis of both operational and asset management issues demonstrates that it does not appear to be economical to upgrade the homes. The real costs involved would be far in excess of the building condition figures shown, as the costs of addressing the under area rooms, other core facilities and accessibility issues would require in effect full refurbishment schemes (ranging from £1 million - £1.5 million per property).

4.3

All existing facilities will need to be assessed in terms of their community benefit as part of the planning application process arising out of any re-provision/disposal decisions. A development brief for each site will be prepared, probably outlining proposals for residential redevelopment, which will form part of the representation to the Local Planning Authorities in support of the proposed disposal of any surplus site.

4.4

In view of the likely timescale with this review, certain urgent fire precaution measures will be required at Courtbourn with estimated costs to be in the order of £10,000 - £15,000.

5.

Conclusions

5.1

In 2000 the former Policy and Resources Committee agreed a refurbishment package for Elderly Persons' Homes and a range of safety related works up to the value of £7.2 million. In 2003 the County Council approved the ENHANCE package with a works value of some £60 million. In asset management terms given the earlier investment in this sector, it would make sense to capitalise on the site values of those establishments where refurbishment would not be viable, but alternative development uses would release capital for reinvestment in the remaining homes. In view of the recent Green Paper and the development of more personalised social and adult services referred to above, it would make sense to develop a range of policy and service initiatives that could be delivered without further capital investment in assets where the components have come to the end of their life, or the reinvestment does not make economic sense in relation to the cost of the works and the future viability of the home. This proposed strategy is subject to the need to undertake a formal consultation exercise in relation to each of the homes to ensure that the needs of residents and the community are taken into account in any decision-making process.

Recommendations

1.

That following completion of the formal consultation process, the re-provision of services from Pier House be endorsed and the property brought forward for disposal, and that the Director of Property, Business and Regulatory Services (Head of Estates) be authorised to settle the detailed terms and conditions of sale.

2.

That following the management decision to move the residents from

Chrismas Lodge to Ticehurst, this has led to there being no residents at Chrismas Lodge with whom to consult on a formal basis as to its future and therefore that the property is brought forward for disposal, and that the Director of Property Business and Regulatory Services (Head of Estates) be authorised to settle the detailed terms and conditions of the sale.

3.

That consultation be undertaken, commencing in February 2006,on the future service provision at Courtbourn, and that a further report is received at the conclusion of that consultation process with recommendations as to the future of service delivery from that building.

4.

That following the above process, the Executive Member for Policy and

Resources be requested to allow 100% of the capital receipts resulting from

land sales to be retained by Adult Services to fund the fire safety and other

requirements of other core stock residential homes.