Archived decisions

Contact: Vincent Oliver Ext: (01962)833016 email:[email protected]

1. Summary:

1.1 The following decisions are sought:

The Executive Member approve the overall strategy of commissioning alternatives to residential care and the proposal to consult on reprovision of the residential homes at Newman Bassett House, Basingstoke and at Linden House, Lymington. Further that the process on consultation is completed by August 2007 with the outcome presented for decision at the Social Care Executive decision day on the 31 August 2007.

2. Reason

2.2. This decision supports the corporate strategy by:

`Hampshire safer and more secure for all' by providing safe and secure environments for the service users at both residential and day care services.

`Maximising well being' for the residents of the homes and the service users of the day centre and `Enhancing quality of place' by improved environments in the reprovided services.

`Enhancing our quality of place' by providing improved reprovided quality services.

2.3. The demographic trends are well rehearsed and show that we can expect a significant growth in the over 85 population nationally and in Hampshire in particular. Adult Services has been reviewing its commissioning priorities in the light of these trends. In addition to the predicted growth in the older adult population, we are seeing a growth in the Learning Disability population as life expectancy improves for this group. There are also significant changes in the expectations of clients, with people with social care needs expecting to be supported in their own home as their first choice and in community based settings where they can no longer be sustained at home. This is particularly impacting on the demand for residential care.

2.4. In response, Adult Services has been reviewing its commissioning priorities and has determined that there is a need to develop the alternatives to residential care. The key strands of this are Home Care Modernisation, the Integrated Community Equipment Store and the development of Extra Care Housing.

2.5. In addition, Adult Services has been reviewing its stock of residential homes. HCC is the largest single provider of residential care in Hampshire as such reductions in demand are going to have a disproportionate impact on occupancy rates and unit costs. This work has focussed on two key areas of the overall asset management of the buildings and their fitness for purpose to meet the needs of current and future service users.

2.6. The review has highlighted Newman Bassett House in Basingstoke and Linden House in Lymington. It has become increasingly difficult to accommodate potential residents whose needs are either high physical dependency or dementia care (or both) due to the layout and facilities of both homes in terms of `fit for purpose'. The buildings were designed in the 1970s for a much fitter resident than those who need such accommodation today.

2.7. Refurbishment costs, including essential fire safety work, to bring the buildings up to the required standards, without an overall improvement of the facilities, would be (in total) in the region of £3.35m from a recent audit undertaken by Property, Business and Regulatory Services. To improve room sizes and facilities would add a significant additional cost as well as a greater loss in overall bed capacity for each home.

3. Other Options considered and rejected:

3.1 The alternative options are do nothing, which would not meet the needs of service users in future years and would result in declining occupancy rates and higher unit costs in increasingly unfit buildings, or refurbishment. The costs of refurbishment are set out in 2.7 above and are considered to be prohibitive.

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 Services

Contact: Vincent Oliver (01962) 833016 email: [email protected]

1. Summary

1.1 This paper brings together work that has been undertaken by Adult Services and Property, Business and Regulatory Services regarding future needs for housing solutions for vulnerable people and the fitness for purpose of Newman Bassett, and Linden House Older Persons Homes.

1.2 This process needs to be seen within the context of the Adult Services Financial Recovery and Modernisation programme and the development of a strategic commissioning plan which will include proposals to review the `fitness for purpose' and contestability of all of our in-house residential services.

1.3 This report sets out the overall strategy for meeting the future housing needs of those that meet Adult Services eligibility criteria and the results of a review of current in-house residential provision in the light of those future needs. The report sets out the reasoning for seeking to consult on the reprovision of two in-house residential homes.

1.4 The implementation of the plan will address the housing needs of current residents, future capacity requirements for residential and nursing care across Hampshire, and the development of alternatives to residential care.

1 Reason

1.1 The demographic trends are well rehearsed and show that there will be a significant growth in the over 85 population nationally and in Hampshire in particular. Table 1 below sets out the broad trends according to the Office for National Statistics. The growth in the over 85 population is significant as it is this age group that represents a major part of the older adult client group.

Table 1 source ONS

1.2 Adult Services has been reviewing its commissioning priorities in the light of these trends. There is little sign that there will be any significant growth in national resources to meet the social care needs of this growing older population. Strategies therefore need to be developed to meet their needs that are more cost efficient. Experience shows that home based care and community based supported living are more cost effective for social care in that they generally produce better outcomes and do not create as much pressure on the Adult Services social care budget, in that they attract alternative funding sources such as housing benefit and supporting people funding.

1.3 There are also significant changes in the expectations of clients, with people with social care needs expecting to be supported in their own home as their first choice and in community based settings where they can no longer be sustained at home. This is particularly impacting on the demand for residential care. The independent sector is reporting an overall reduction in occupancy rates of 1% per year. Adult Services' own placement patterns reflect this. In the last year placements into independent homes fell by 0.8%. Meanwhile domiciliary care orders rose by 6.9%.

1.4 In response, Adult Services has been reviewing its commissioning priorities ad has determined that we need to develop the alternatives to residential care. The key strands of this are Home Care Modernisation, the Integrated Community Equipment Store and the development of Extra Care Housing.

1.5 Home Care Modernisation aims to reflect current best practice with regards to the commencement of support to people in their own homes, the re-ablement model. This recognises that people's needs at the point of referral and assessment may not reflect long term needs. They may need a higher level of care at the point of crisis or discharge from hospital, the typical referral points, but they can frequently be helped to higher levels of independence with the right short term care. The in-house team will therefore focus on this re-ablement process, with long term care being commissioned from the independent sector once the long term pattern of need is established. This service model provides better outcomes in that it actively promotes independence and represents better value for money in that independent provision for long term care is significantly cheaper. This is important in meeting the needs of a growing older population.

1.6 Adult Service has been operating an Integrated Community Equipment Store with health for some time. The model of service has been reviewed and at her Decision Day on 30 March 2007, the Executive Member approved the plan to remodel the service based on a new single site, including the Technicians Service. The aim of this proposal is to provide amore coordinated and effective service. The timely provision of equipment is a key aspect of maintaining people in their own homes.

1.7 Work is also well under way to develop alternatives to residential care for those unable to be maintained in their own homes. HCC already commissions a range of supported living arrangements for all client groups and has an effective Adult Placement Service, which was recently assessed as being a level three service by CSCI (which is the top level). For those with relatively high support needs, Extra Care Housing is a viable alternative for those that might otherwise be placed in residential care. Extra Care provides specially designed housing and 24 hour on-site care, principally providing one or two bedroom flats and a range of communal facilities. It promotes community integration and independence, by providing people with their own homes rather than just a room. It can offer a range of tenure options, including renting and leasehold purchase.

1.8 The Better Housing Strategy will set out to expand the level of supported living arrangement, including Extra Care, available to service users. Adult Services aims to actively promote the development of these schemes to provide a quality alternative to residential care and to give a clear commissioning signal to the market that we wish to see further development of these schemes.

1.9 In addressing the changes in demand for residential care, Adult Services has been reviewing its own stock of residential homes. Hampshire County Council is the largest single provider of residential care in Hampshire. As such reductions in demand are going to have a disproportionate impact on occupancy rates and unit costs. This work has focussed on two key areas of the overall asset management of the buildings and their fitness for purpose to meet the needs of current and future service users.

1.10 This strand of the plan is being undertaken in partnership with Property Building and Regulatory Services and ensures consistency in approach.

1.11 The review of asset management and fitness for purpose has identified, Newman Bassett House and Linden House as not meeting the expectation 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 (a table identifying the key factors included in the regulations on `Fit for Purpose' is attached for both homes). The main issue here is to identify whether a building meets the needs of the current (and future) service users. With increasing frailty, both physically and mentally, of older people, the size of bedrooms and access to other communal areas are key factors. This enables carers to use additional equipment such as hoists and electric profiling beds to ensure safe moving and handling of residents. Neither building lends itself to these requirements and both buildings have restrictions as to their ability to provide suitable environments for dementia (currently Newman Bassett House has 13 bedrooms for dementia care but the environment is limited).

Development of Extra Care

1.12 The Green Paper "Independence, Well-being and Choice" promotes extra-care housing as an example of good practice, stating that "it offers a model which allows people to live in their own homes with a range of facilities, care and support designed to meet their needs. Extra-care Housing can also form the basis of a range of intermediate and outreach services, prevents older people from going into hospital and facilitates the discharge of people who have been in hospital". This direction is supported by the "Our Health, Our Care, Our Say" White Paper.

1.13 The County's aspiration is very ambitious: to produce the best possible models of housing care and support, comparable to any development in the country. The development of new build schemes will set the standard for extra care and promote independent development of extra care by signalling a clear commissioning intent for the future and give confidence to the independent sector about future requirements.

1.14 Extra-care Housing supports the overall aims of Hampshire County Council's strategic direction for older persons. The proposal is that extra-care Housing in Hampshire should respond not just to those who have retained most of their independent living skills but should also enable people to have the choice to live in their own homes until the end of their lives thus becoming a real alternative to Residential Care. This would achieve two outcomes, supporting an increasing number of older people in a non institutional setting and reducing the unit costs of care.

1.15 The detailed business case for the development of extra care is currently being produced. The project has two separate but linked objectives:

_ Working with internal and external partners including the Housing Corporation to develop 3 new-build standard setting schemes to replace reduced residential care provision.

_ Looking at the best use of existing sheltered housing and remodelling to provide extra care sheltered housing where appropriate.

1.16 The first phase will aim to produce up to 150 units in three schemes, with at least one fast track scheme being on site by Spring 2008. The longer term aim is to meet the LAA target of increasing provision of extra care services by 50 units per year for five years. More detailed proposals will be put forward to a future Executive Decision Day.

Newman Bassett House.

1.17 Newman Bassett House is a two storey purpose built older persons home constructed in the early 1970's of traditional brick and tile construction. It has an adjacent day centre which also accommodates a meals on wheels kitchen run by an organisation called Appetito. A map of its location is attached.

1.18 The residential care home provides care to 47 residents who are a mix of physical frailty and dementia . Being built in the 1970's, it was built for a much fitter resident group and was not therefore designed to take the more dependent resident admitted today. 37 of the current 47 bedrooms are very small and below 9.3 sqr mtrs, which means that it is very difficult to access for moving and handling equipment to enable staff to assist residents. The layout of the building with long corridors also presents difficulties for residents with mobility problems. Toilet facilities are particularly difficult to access and require modernisation. Access to bedrooms for residents who rely on wheelchairs is also a major issue with restrictive access, and would not be acceptable to the Commission for Social Care Inspection. The standards stipulate that 12 sqr mtrs is the minimum standard and therefore many of the bedrooms are not useable for that group.

1.19 A recent fire safety audit identified a number of shortcomings in relation to fire safety of the building, particularly fire alarms and emergency lighting, and the cost of this work is estimated to be in the region of £113,000. Some immediate remedial work will be undertaken to improve priority areas of fire safety of the building. If the building was retained for longer then the full works would have to be undertaken incurring the above costs.

1.20 Given the factors in the above paragraph, and in order to bring the building up to modern requirements and standards, major work would be required on bedroom sizes and facilities, which would lead to an overall loss in bedroom numbers of between 15 and 20, reducing capacity to between 32 and 27 bedrooms. All the other facilities and electrical/mechanical systems would need to be renewed and with the fire safety work the costs would be in the region of £1.75m.

1.21 The adjacent day centre (which is a separate building) accommodates 25 day centre service users per day for 5 days per week (total of 125 places per week capacity). In addition there is a large kitchen which is run through a contract with a company called Appetito, producing meals on wheels for the community in Basingstoke. The future of the day centre is subject to a separate review of day services in the Basingstoke area, which is part of the wider day services modernisation programme. Any changes to the day centre will therefore be to a longer timescale than that for the home. The results of this review and subsequent recommendations will be presented to a future meeting.

Linden House

1.22 Linden House is a two storey purpose built older persons home of traditional brick and slate construction built in the late 1960's (a map is attached). The property is designed around a quadrangle with all the 34 bedrooms on the top floor and reception/lounges and dining areas of the ground floor. Originally it was built as a home for people with visual impairments and had a rehabilitation unit for that client group prior to moving it to a day centre. The day centre was then relocated in 2003/4 to the newly built day centre at Solent Mead, the other local authority home about ¼ mile away.

1.23 The residential care home provides care to 34 residents who are mostly physical frail with some levels of dementia . Being built in the late 1960's, it was built for a much fitter resident group and was not therefore designed to take the more dependent resident admitted today. 26 of the current 34 bedrooms are very small and below 9.3 sqr mtrs (of which 19 are 8.5 sqr mtrs or less), which means that it is very difficult to access for moving and handling equipment to enable staff to assist residents. As with Newman Bassett, the layout of the building with long corridors also presents difficulties for residents with mobility problems. Toilet facilities are particularly difficult to access and require modernisation. Access to bedrooms for residents who rely on wheelchairs is also a major issue with restrictive access, and would not acceptable to the Commission for Social Care Inspection. The standards stipulate that 12 sqr mtrs is the minimum standard and therefore many of the bedrooms are not useable for that group.

1.24 As with Newman Bassett House, a recent fire safety audit has identified a number of shortcomings particularly fire alarms and emergency lighting, and the cost of this work is estimated to be in excess of £100,000. Some immediate remedial work will be undertaken to improve priority areas of fire safety. If the building was retained for longer then the full works would have to be undertaken incurring the above costs.

1.25 If work was initiated to improve bedroom sizes requiring major structural changes, the loss of bedrooms could be in the region of half reducing overall capacity to about 20 beds which would make the home economically not viable. Given the above factors, and the need to undertake major mechanical and electrical work at the home, the cost of bringing the home up to the required standard, without any major improvements, would be in the region of £1.6m,and significantly more if bedroom and other facilities were enlarged and improved.

Re-provision for existing service users

1.26 For Newman Bassett House there are currently 42 residents at the home. The majority of these residents were admitted from within a 5 mile radius of the home. As part of the consultation process, all residents will have an opportunity with their relatives to have a meeting with a care manager (supported by staff of the home) to discuss alternative accommodation options. Additionally, if there are any residents who lack capacity or are unbefriended under the new Mental Capacity Act, they will have access to the new Independent Mental Capacity Advocacy service. A Care Manager will be appointed specifically to work alongside the service users during this time.

1.27 There are two other local Authority Homes within 3 miles of Newman Bassett and another one some 10 miles away at Alton. Factors to be taken into account will include be the geographic location of relatives, and any other social groups among residents.

1.28 For Linden House, there are currently 26 permanent residents in occupation with 6/7 awaiting nursing home placements. The majority of residents come from the Lymington locality, where there is currently one other Local Authority home. There are two others within 10 miles and two nursing homes owned by Hampshire County Council. A Care Manager will be appointed specifically to work alongside the service users during this time.

Re-provision for future service users

1.29 As indicated earlier in the report, Adult Services' strategic direction is for older people either to be supported to remain in their own homes or into accommodation such as extra care housing. This not only prevents unnecessary dependency but is usually where older people prefer to be.

1.30 It is projected that the demand for ordinary residential care will reduce as more older people remain at home for longer and when residential care is needed, then it is often at the higher level of nursing care. This is borne out by the reductions in demand for residential care, where there are still some vacancies in Hampshire County Council In-house homes.

1.31 There are already a number of services within the locality to support older people to remain at home, including social clubs, meals on wheels, sitting services and transport. There is also the development of extra care housing, which both the District Council and private providers provide and keen to develop. It therefore provides a complete alternative to residential care, and at a much reduced cost to the Department, as " bed and board" elements are met by the individual.

1.32 It is proposed that any decrease in the overall residential care capacity will be replaced by additional extra care that is available at an affordable rent. A comprehensive strategy has been developed to address how to increase the provision available from registered social landlords, and specific discussions are in the process of being established.

1.33 For the better housing solutions, provision has been made within the recovery plan targets to fund additional placements within existing Extra Care Housing in each of the localities.

2 Consultation Process

Staff

2.1 At Newman Bassett, there are currently 60 staff working across the service, whilst at Linden House there are 42 staff.

2.2 The options for their future employment would be discussed in one to one meetings with representatives of management, Human Resources and a union member if they wished. Whist a number may wish to be considered for similar posts in other homes, there is an opportunity to consider any posts within the County Council.

Other Consultations

2.3 The reprovision of these services will be subject to a 12 week consultation period which is compliant with the Hampshire Compact and will include (as well as Service Users and Relatives):

Consultation with Unions

Briefing for local Members, Hampshire Action Teams leads and Members of Parliament, which would include site visits

Discussions with local PCT colleagues

Discussions with local voluntary organisations such as Age Concern, Alzheimers Association.

District and Borough Councils as appropriate

At the end of the consultation period a report will be submitted to the Social Care Executive with the outcomes of consultation and a decision as to the future of both homes. It is anticipated that this will take place on 31^st August 2007.

3 Financial Impact

3.1 The current gross 2007/8 budget for Newman Bassett is £966,500 for 47 residents with a net figure of £635,200. The occupancy for 06/07 was 96.6%

3.2 The current gross budget for 2007/08 for Newman Bassett Day Centre is £206,700 with a net figure of £183,500

3.3 The current gross 2007/8 budget for Linden House is £790,500 for 34 residents with a net figure of £551,100. The occupancy for 06/07 was 98.6%.

3.4 In considering the impact of reprovision, the staffing costs form a large part of the revenue costs of the running of the home, and this cost will thus be dependent upon the number of staff being redeployed, which will become clearer during the consultation period.

3.5 The cost of re-provision for future service users will depend on the extent to which residential care will be replaced by extra care in the community, as referred to in paragraph 2.9. In the short term, if the loss of local In-house capacity results in an increase of local purchasing of residential placements this will be based on an average net cost of £191 per place per week and is dependent upon how many residents can be placed in other Hampshire County Council homes.

5. Impact Assessment

5.1 In compiling this report account has been taken of the requirements of the Corporate Equalities Plan and Statutory Equality Scheme. The impact should be minimal given that there has been an assessment regarding availability of suitable alternative placements, which should provide a higher quality environment for current service users as well as a longer term benefit for future service users.

6. Recommendations

6.1 The Executive Member approve the overall strategy of commissioning alternatives to residential care and the proposal to consult on reprovision of residential services at Newman Bassett House, Basingstoke and at Linden House, Lymington. Further that the process on consultation is completed by August 2007 with the outcome presented for decision at the Social Care Executive decision day on the 31st August 2007.

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

LINDEN HOUSE - FIT FOR PURPOSE

NEWMAN BASSETT HOUSE - FIT FOR PURPOSE

*Regulation 23 of the "The Care Homes Regulation 2001" Statutory Instrument 2001 No. 3965