Archived decisions

Gill Duncan (01962 833022): [email protected]

Contact: Lynne Green (01962 847265): [email protected]

1. Summary:

1.1 The executive member is asked to endorse the strategic direction for Older People Day Care Services including the following recommendations:

1.1.1 That authorisation is given for the modernisation of day services for Older People in Hampshire. This will ensure that the Department's resources are targeted to those who meet the eligibility criteria, thus supporting financial recovery, and at the same time develop a network of external organisations in this sector to support the wider community in accordance with the wellbeing agenda.

1.1.2 That authorisation is given for the implementation and development of a commissioning plan for day services for older people that support the delivery of sustainable financial recovery and joint working with key stakeholders and partner organisations.

1.1.3 That authorisation is given for the reconfiguration and re-negotiation of external block contracts when these are due for renewal, to ensure that commissioned services meet the current and future needs of older people assessed as meeting the eligibility criteria. This will involve non-renewal of some contracts or it may involve a reduction in capacity aligned with demand in that locality.

1.1.4 That authorisation is given for cessation of spot purchasing for new service users with the exception being where there are complex assessed needs and there is no other available resource in the locality.

1.1.5 That authorisation is given for the proposed strategy for in-house day care centres to focus on providing a more specialist re-enablement service for older people with dementia and those with high physical needs.

1.1.6 That the authorisation is given for the involvement and engagement with service users, carers, and other local stakeholders, including actively involving elected Members and utilising the Hampshire Action Team structures in proposed changes to services.

1.1.7 That, the Director of Adult Services be authorised to take the necessary steps to realign day care services in accordance with the modernisation strategy, provided that all such steps are taken in accordance with the Council's Standing Orders and having taken the appropriate advice.

2. Reason

2.1 The purpose of this report is to set the context for the modernisation of day services for Older People in Hampshire. The drivers for the changes are national policy, demographic changes in the population of older people who live in Hampshire, their changing needs, impending national standards, financial recovery, and modernisation plans.

2.2 Given current and future budgetary pressures, savings of £600 000 are to be achieved in 2007/ 08. That is, £500 000 Financial Recovery Plan and £100 000 Efficiency Savings.

2.3 The first phase of modernising services is to ensure resources are invested in services that are "fit for purpose", which involves the reassessment, reconfiguration, and re-negotiation of external block contracts when each contract becomes due for renewal.

2.4 This report supports the corporate strategy in terms of making Hampshire safer and more secure for all, maximising well being, and enhancing our quality of place. It does so by providing appropriate day care services for those with high dependency needs, providing breaks for informal carers, and working with partner organisations to identify and/ or develop lower level preventative opportunities in the community setting, promoting social inclusion and integration.

3. Other Options considered and rejected:

3.1 To continue to provide day care services with no change

Outcome:

· Current overspend of Adult Service budgets will continue, which is not an option

· Day care services will not be fit for purpose/ meet the needs of current and future service users

· Day care services will continue to be a "placement for life" thereby not encouraging independence, draining valuable resources, and limiting access for those with high needs

· There will not be the impetus for mainstream community resources to "modernise" to meet the needs of the increasing ageing population

3.2 Option 2: Cease all day care provision

Outcome:

· This will place current and future service users and their carers at risk

· Increased potential of the carer becoming physically and/ or mentally ill

· Increased potential of elder abuse - particularly when caring for an older person with dementia/ mental health problems

· Increased potential for respite care and permanent residential care

· Increased pressure on the NHS - hospital admissions & GP visits

· Reduced opportunities for intervention/ rehabilitation/ promoting independence

· Will not meet the well being agenda

· This may increase costs to the department, as in some cases day care is the most cost-effective way of meeting assessed need

4. Conflicts of Interest declared by the decision-maker or other Executive member consulted

None

5. Dispensation granted by the Standards Committee

None

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

Not Applicable

Approved by: ........................................... Date: ................

Councillor Patricia Banks

Executive Member for Adult Social Care

Gill Duncan 01962 833022: [email protected]

Contact: Lynne Green 01962 847265: [email protected]

1. Summary

1.1 The purpose of this report is to set the context for the modernisation of day services for Older People in Hampshire. The drivers for the changes are national policy, demographic changes in the population of older people who live in Hampshire, their changing needs, impending national standards, financial recovery and modernisation plans.

1.2 Given current and future budgetary pressures, savings of £600 000 are targeted to be achieved in 2007/ 08. That is broadly allocated as £500 000 Financial Recovery Plan and £100 000 Efficiency Savings.

1.3 The first phase of modernising services is to ensure resources are invested in services that are "fit for purpose", which involves the reassessment, reconfiguration, and re-negotiation of external block contracts when each contract becomes due for renewal.

1.4 This report supports the corporate strategy in terms of making Hampshire safer and more secure for all, maximising well being, and enhancing our quality of place. It does so by providing appropriate day care services for those with high dependency needs, providing breaks for informal carers, and working with partner organisations to identify and/ or develop lower level preventative opportunities in the community setting, promoting social inclusion and integration.

1 Strategic Context

1.1 In July 2006 the Executive Member - Adult Social Care approved the future direction of Older Persons Services, focussing on financial recovery and modernisation of services across all Adult Services user groups.

1.1.1 In order to deliver the national Public Health and the Well Being agenda, promoting independence and empowering individuals, it is essential that Adult Services links into and harnesses wider resources such as access to universal services. The outcome to be achieved is to ensure that older people and other adult service users are not excluded from continuing to reach optimum independence.

1.2 The strategic context also sets out key principles for modernising social careⁱ which are:

· Organising services around people rather than people around services

· Empowering people and supporting them to live their lives in the way they choose

· Achieving a step change in the way services are delivered so that service users experience tangible changes in service choice and quality

· Recognising the need of those caring for service users

· Delivering services in a seamless way between agencies

· Ensuring that services are sensitive to the needs of minority ethnic communities

· Developing a confident and well-supported workforce to take forward the changes

1.3 One of the main focuses of the recent Local Government White Paper "Strong and Prosperous Communities"ⁱⁱis partnership working and community engagement to maximise resources to achieve services people want that are cost effective and affordable .

1.4 Within Adult Services the vision for Day Care has been defined as "intervention to reduce long term dependency, and promote choice, wellbeing, use of universal services and citizenship"

1.5 Modernising day care services

1.5.1 Day Care Services have evolved over the past few years with a lack of strategic direction. Day centres have become a "placement for life", with minimal re-enablement or rehabilitative interventions. There are wide variations between day centres in the level of service that can be provided and the dependency levels of those attending.

1.5.2 Day care services are in a strong position to implement current government and national direction for the future of Social Care Services and to contribute fully to the agenda outlined in the white paper "Independence, Well being & Choice" 2006.

1.5.3 A review of how day support services are commissioned has commenced focussing on how to improve access to universal service and develop a range of choices for people to maximise independence and wellbeing. There are opportunities to move from care group focus to day opportunities based on specific interventions, interests and activities. The development of community support services under the well-being agenda will take time to realise, as it is a change in the way services are commissioned and delivered. This will provide appropriate support for older people and their carers who do not meet the eligibility criteria.

1.5.4 Outcome based day care services with timely referrals and reviewing mechanisms will ensure service users, who no longer require the service are provided with alternative options. This requires improved information and knowledge of the community support services in the locality.

1.5.5 Day care services have a valuable role to play not only in providing a stimulating environment for the service user, but also by providing regular breaks for carers. Carers of older people are often older people themselves requiring support in their own right. The Carer's Grant, funding for the provision of breaks and respite for carers, doubled by 2006.

1.6 New Service Model

1.6.1 The service model and eligibility criteria need to be fully understood by commissioners and providers. Service specifications with agreed targets, must be monitored and reviewed in a consistent manner across the county. Care plans for each individual will be outcome-based, with timely reviews and re-assessments, to ensure that their specific needs are being met. Definitions of day care can be found in Appendix 1.

1.6.2 Given the high dependency level of older people receiving this service, only a small percentage will move on to community and universal services. However ensuring care pathways, which encourage independence and choice, will free up valuable resources.

1.6.3 Partnership working with other departments, voluntary sector, district councils, housing associations, leisure and sports facilities etc. to identify and develop low-level preventative community services to meet the well-being agenda will promote independence, choice and empower older person.

1.6.4 Improved partnership working with health will provide timely input that for some service users will reduce longer term dependency on statutory health and social care services.

2 Current Investment

2.1 The current value of in-house day care services is £1.2 million per annum for the nine day centres, which were operating on 1 April 2006.

2.2 The current value of the external block contracts is £2.4 million per annum. There are funding arrangements in place with the North Hampshire Primary Care Trust (NHPCT) for some of the block contracts (£138 000), although there are indications that NHPCT may not wish to continue.

2.3 Expenditure on spot purchased placements is estimated to be £420 000 per annum. A decision was taken (June 2006) to cease spot purchasing as an option for new service users. The exception generally being where a service is needed to meet complex needs that cannot be met by an alternative resource in that locality. Alternative internal and external block contracted placements are to be sought for service users assessed as meeting the eligibility criteria. Where there are limited resources in a locality, it is suggested that a block contract is negotiated with the preferred provide. Over the next two years it is estimated that this will reduce expenditure by £50 000-£100 000 in 2006/07, £100 000-£150 000 in 2007/08.

3 Progress to date

3.1 A preliminary stage to modernising services is mapping existing services. A review of internal and external day care services for older people provided information necessary to identify those services, which are not cost effective and/ or in a position to meet current and future needs.

3.2 The review of the nine Internal Day Care Centresⁱⁱⁱinvolved measuring all elements of service delivery against a set of standards, to include assessment of the premises and transport. The main objectives were to identify shortfalls in service delivery; prioritise actions to ensure all day centres will meet National Standards for Day Care if these are introduced (2010?); improve cost effectiveness and efficiency; and to agree the strategic direction for internal day care services.

3.3 The proposed strategy for in-house day care centres is to focus on providing a more specialist re-enablement service for older people with dementia and those with high physical needs. Centre managers are to actively encourage and support service users to access community resources where appropriate.

3.4 Across in-house day care services there has been a reduction of 100 placements per week to align capacity with demand, and to take into account the increased physical dependency of service users. These savings will not fully be realised until 2007/ 08.

3.5 The review of block contracted external provision took place in March 2006. A number of external provider contracts are due for renewal, with a six-month notice period required if a contract is to be terminated. A small number of providers are finding the higher dependency levels of service users increasingly more challenging as reflected in the reduction of referrals to those services. For a number of contracts there are local PCT funding arrangements in place, requiring involvement of the PCT in re-negotiation of those contracts.

3.6 Where there is a proposal that contracts should not be renewed, there is an agreed process in place to ensure continuity of care in relation to the assessed needs of service users/ carers, and to reduce as far as possible the impact on the service provider. This includes a communication plan. This is set out in Appendix 2.

3.7 The outcomes and recommendations from the internal and external day care reviews dovetailed to ensure maximum use of retained day care resources, and minimum disruption for service users.

3.8 The New Forest locality provides an example of successful re-configuration of services which have taken place over the last two years. This includes the development of a new service as an alternative to providing day care in centres. That is, Older Persons Extended Community Care Service (OPECCS) which involves input for an individual in their own home environment.

3.9 Additional on-going efficiency savings which are difficult to quantify in budgetary terms will be achieved by:

· Maximising capacity in retained resources through improved attendance reporting and monitoring mechanisms

· Assessing and reviewing all service users on a regular basis against the eligibility criteria

· Focussing on person-centred outcomes (time-limited) - with regular reviews

· Sign posting older people/ their carers who no longer meet the eligibility criteria to community support services i.e. care pathway approach.

4 Financial Recovery Plan

4.1 Table 1: Summary of FRP Savings for External Block Contracts & Internal Day Centres

* The total savings on external block contracts was £142 000. However some of these savings have been re-invested in OPECCS

The above table shows the predicted efficiency savings for internal and block contracts and the re-assessed predictions based on actions to date (October 06). Although the identified savings for 2006/ 07 will not be achieved, progress has been made which will ensure that predicted savings for 2007/ 08 will be nearer target. Reasons for the shortfall include:

· Lack of dedicated time required for re-negotiation of external block contracts and reviewing individual service users with higher priorities taking precedence (e.g. in Fareham/ Gosport).

· NHPCT restructuring delaying negotiations (Aldershot & Basingstoke localities)

· Delay in the re-adjustment of the internal day care centre budgets.

4.2 Spot purchasing is difficult to quantify and predict for the future, by the very nature if this method of commissioning. The current estimated cost of spot purchased placements is approximately £420 000, with a savings target of £50 000- £100 000 for 2006/ 07, and £100 000 - £150 000 for 2007/ 08 achieved through ceasing spot purchasing for new service users. The exception is where a specialist service is required to meet complex needs and there are no alternative resources in the locality.

4.3 The shortfall between the departmental target (£500 000 for the FRP plus £100 000efficiency savings) for 2007/08 and the estimated savings of £416 000 will be met through further reconfiguration of in-house day care services.

5 Impact Assessment

In undertaking the reviews and developing the strategy, regard has been given to the County Councils' duties in relation to the Race Relation Amendment Act 2000 and Hampshire's County Council own race equalities policy.

6 Conclusion

The review of internal and external day care centres provided a starting point for the modernisation of day care service. It is essential to ensure that retained day care centres are in a position to meet minimum standards, and can provide a quality service for current and future service users assessed as meeting the eligibility criteria.

Further actions will need to be taken if the target of £600 000 savings are to be achieved in 2007/ 08. Service reconfiguration and rationalisation takes a period of time to complete as it involves changes to contractual arrangements. Where a contract is not renewed, disruption to current service users/ carers will be minimised by offering an appropriate service to meet their assessed needs.

The next phase in the modernisation of day services agenda involves identification of new models for service delivery, assessing financial feasibility of options, and consulting with service users/ carers as to the future direction. That is a transformation of day services from the traditional day care provided in designated buildings, to identification of a range of options that provide opportunities within the local community. A cross care group Adult Services "Modernisation and Transformation of Day Services" steering group is taking this work forward.

8. Recommendations

The executive member is asked to endorse the strategic direction for Older Persons Day Care Services including the following recommendations:

1) That authorisation is given to the modernisation of day services for Older People in Hampshire. This will ensure that the Department's resources are targeted at those who meet the eligibility criteria, thus supporting financial recovery, and at the same time develop a network of external organisations in this sector to support the wider community in accordance with the wellbeing agenda.

2) That authorisation is given for the development of a commissioning plan for day services for older people that supports the delivery of sustainable financial recovery, and joint working with key stakeholders and partner organisations.

3) That authorisation is given for the reconfiguration and re-negotiation of external block contracts when these are due for renewal, to ensure that commissioned day care resources meet the current and future needs of older people assessed as meeting the eligibility criteria. This will involve non-renewal of some contracts or a reduction in capacity aligned with demand.

4) That authorisation is given for the cessation of spot purchasing for new service users with the exception being where there are complex needs and there is no other available resource in the locality.

5) That authorisation is given for the proposed strategy for in-house day care centres to focus on providing a more specialist re-enablement service for older people with dementia and those with high physical needs.

6) That authorisation is given for the involvement and engagement with service users, carers, and other local stakeholders, including actively involving elected Members and utilising the Hampshire Action Team structures in proposed changes to services.

7) That, the Director of Adult Services be authorised to take the necessary steps to realign day care services in accordance with the modernisation strategy, provided that all such steps are taken in accordance with the Council's Standing Orders and having taken the appropriate advice.

Section 100 D - Local Government Act 1972 - background documents

The following documents discuss facts or matters on which this report, or an important part of it, is based and have 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:

Definitions of day care

"Day Care" is a general term that has been used to describe any kind of organised activity that takes an individual out of the home during the day, such as to a Day Centre. There are three basic categories of Day Care. Day care services commissioned by Adult Services will focus on the rehabilitative and maintenance models.

1. Rehabilitative: This involves a planned therapeutic programme tailored to meet assessed health and social care needs. It focuses on re-enablement and tends to be time limited. This may involve the provision of personal care

2. Maintenance: The aim is to meet ongoing high to medium dependency needs of the individual and/ or the carer. The focus is on sustaining and improving abilities where possible. This includes specialist provision for people with dementia, mental health problems, physical and/ or sensory disabilities. This may involve the provision of personal care.

3. Social or Luncheon Clubs: This focuses on the low-level preventative agenda, aiming to provide services that will promote independence by providing opportunities for social inclusion, and improve the quality of life of potentially "vulnerable" people. This would not involve personal care. Social Clubs have a valuable role in addressing the needs of people from minority groups, to include, ethnic communities, people with specific sensory or physical disabilities. In addition to the social contact, a hot nutritious meal is usually provided.

Appendix 2:

Non-Renewal of a Contract

There may be a range of reasons for non-renewal of a contract and action will differ depending on the circumstances. Examples of reasons for non-renewal:

A) The provider is not in a position to meet the service specification or terms and conditions of the contract, placing service users and Adult Services as commissioners of the service at risk. The shortfalls will have been drawn to the attention of the provider by the Contract Support Officer during contract review meetings The provider will have been given a realistic period of time to rectify these shortfalls depending on the assessed risk to Service Users and Adult Services Department. Examples of shortfalls that place Adult Services at risk:

· The provider does not have the appropriate level of insurance cover - Public Liability and Employers Liability not less than £10 million

· Staff are not trained to an adequate level in essential skills such as Moving & Handling, Food Hygiene, Health & Safety

· Key Policies and Procedures are not in place e.g. Health & Safety, Adult Protection

· Staff and/or volunteers do not have the necessary clearance before commencing work with the vulnerable clients e.g. Criminal Records Bureau clearance, references

B) The provider cannot meet the high dependency needs of service users who meet the critical and substantial eligibility criteria. This may be for a range of reasons:

· The premises is not considered suitable for older people with a disability or people with dementia

· There is insufficient equipment such as: hoists for moving & handling or the equipment is not regularly maintained/ serviced

· Staff are not trained to a competent level to meet the high dependency needs of older people

· Inadequate staffing levels to meet the needs of service users

C) The Day Centre meets the service specification and the terms of the contract. However, there is no longer the demand in that locality or new service models have been introduced that more effectively meet the service users assessed needs. In these cases capacity may be reduced or the contract not renewed.

D) The service provided is no longer considered value for money/ affordable and re-negotiations cannot reach a satisfactory solution

Process to be followed when a contract is not being renewed

1 Contracts are reviewed and monitored on a regular basis by the Contract Support Officer in consultation with the locality Service Manager

2 If a decision is made not to renew a contract the provider is given 6 months notice in writing as agreed in the terms of the contract. The reasons for non-renewal are explained to the provider. The notice period provides time for the provider to re-assess their future plans and identify alternative sources of funding if they wish to continue to operate.

3 HCC funding officer contacts are provided as appropriate

4 Clarification is sought from the Legal Practice whether TUPE arrangements apply if the day centre is to cease operating

5 A communication plan is activated to ensure all relevant people are informed of the decision. A named person will co-ordinate communication. The actions to be taken include:

· Informing the local Councillor

· Meetings arranged to inform ASD existing service users and relatives of the decision; to give reassurance that they will be offered a service to meet their individually assessed needs; and that a care manager will visit them to agree a care package

· Care Managers to arrange meetings with each service user/ relative to identify their needs/ options. Every existing ASD service user will be offered an appropriate service.

· Legal advice to be sought on a case by case basis as to the requirement to consult on a proposal not to renew a contract.