Archived decisions

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

1. Summary:

1.1 The following decisions are sought:

a) That the Executive Member approve the proposal for the residential services at Newman Bassett, Basingstoke and at Linden House, Lymington to cease, and that the process to end the current services is completed subject to the care needs of the residents being met.

b) That the Executive Member authorise officers to negotiate block contracts, with the Independent Sector residential care providers in the Basingstoke area, should the need arise, to reprovide Newman Bassett residents, if Hampshire County Council services are unable to accommodate.

c) That the Executive Member endorse a recommendation to Cabinet that additional Extra Care sheltered housing be developed in partnership with district councils and registered social landlords, with particular emphasis at the beginning of the programme on Basingstoke and Deane and the New Forest.

2. Reason

2.1 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 the residential services.

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

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

2.2 Demographic trends indicate 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. There are also significant changes in the expectations of service users with social care needs expecting to be supported in their own home as their first choice and in community based settings when they can no longer be sustained at home. This is particularly impacting on the demand for residential care, which continues to decline by 1% per year. In response, Adult Services has been reviewing its commissioning priorities and has determined that there is a need to develop 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.

2.3 In addition, Adult Services has been reviewing its 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.

2.4 The review has highlighted both Newman Bassett House in Basingstoke and Linden House in Lymington, where 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 much fitter residents than those who need such accommodation today.

2.5 Refurbishment costs, including essential fire safety work, to bring the buildings up to the required standards, without an overall major improvement of the facilities, would be (in total for both) in the region of £3.35m from a recent audit undertaken by Property, Business and Regulatory Services. To improve all 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 it would not allow us to achieve the standards of care which is safe and acceptable. It would also result in declining occupancy rates and higher unit costs in increasingly unfit buildings, or refurbishment. The costs of refurbishment are set out in 2.5 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 Felicity Hindson

Executive Member for Adult Social Care

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 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 outcome of the consultation process on the future of two in-house residential homes.

1.3 The implementation of the plan will address the strategic commissioning plan for `Better Housing Solutions' which supports older people retaining their own front door with 24 hour support, as an alternative to residential care.

1 Reason(s)

1.1 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 and Hampshire County Council is one of the lowest funded Local Authorities. 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, as 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 and their families, 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 to the County Council's comprehensive service modernisation programme to ensure it meets the needs of more people with a wider range of conditions, Adult Services has been reviewing its commissioning priorities and has determined the need to develop the alternatives to residential care. Modernisation of Home Care, the Integrated Community Equipment Store and the development of Extra Care Housing are three examples of this.

1.5 Both the modernised home care service and the integrated equipment service have been developed to ensure that older people can be maintained in their homes for as long as possible. Extra care housing is being developed to provide an alternative option to residential care, whereby people can retain their own `front door' with 24 hour care support on-site, and access to communal facilities which can also give social support as well.

1.6 The Government policy direction in two key papers set out the framework for future service delivery:

Firstly, the White Paper, `Our Health, Our Care, Our Say' focussed on a new direction for community services giving people more control of their health and care services. As part of this was the drive to ensure that people kept active and healthy for longer, within the wellbeing agenda, and therefore postponing the need for care. This is to be achieved by close collaborative joint working with a number of agencies including health and voluntary organisations

Secondly, the Green Paper "Independence, Well Being and Choice" promotes extra care housing as an example of good practice and Hampshire's aspiration is very ambitious: to produce the best possible models of housing care and support. 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.

Extra Care Housing

1.7 The first phase will aim to produce accommodation units in four schemes, with at least one fast track scheme being at an advanced level of development. The longer term aim is to meet the needs of a greater number of people arsing from the demographic changes and therefore the LAA target of increasing provision of extra care services by at least 50 units per year for five years.

1.8 Current plans are being considered for a new extra care facility being built in Basingstoke and Deane and the development of an existing scheme in the New Forest district boundary, both offering 24 hour care support.

2.8.1 Extra Care Housing, Basingstoke (re-provision of Newman Bassett)

Some years ago a primary school (Beechwood) was the subject of a major fire which led to a school reorganisation in an area of Basingstoke and in the event the school was not rebuilt because of surplus places and other issues. The site is large and currently earmarked for disposal. It was agreed by Cabinet that in such circumstances there would in future be a review to identify how such communities could be supported with the Council's services in the future.

2.8.2 While part of the site is available for disposal, another part will be used for a used for extra care provision for older people with capacity for up to 60 units and would have potential for a day centre. This would provide an opportunity to use the Children's Centre/Nursery provision, and the remainder, subject to planning, could be Council's assets to create a mix of new provision on the Council's land. The use of the Council's land could therefore create the opportunity to make extra care housing a possibility. This model will be discussed with other district councils. The next step would be to select a suitable Registered Social Landlord as a partner.

2.8.3 Extra Care Housing, Linden House (re-provision options)

Current investigations into sheltered, extra care and residential provision in the Lymington area suggest that there is already significant provision of accommodation provided by the County Council, District Council and the private sector.

2.8.4 The opportunity therefore exists to (potentially in partnership with the New Forest District Council), upgrade existing sheltered accommodation closer to extra care models to make it even more effective, review the quality of day care provided in the area and reinvest in Solent Mead which is the other County Council's home about ¼ mile from Linden House. While this approach is different to the re-provision option of Newman Bassett, it has the same ingredients of reshaping provision to meet current and future provision - and is made possible by the Council's direct ownership of its assets. Recycling an asset in this way maintains a long tradition within the County Council.

2.8.5 Detailed planning on both these options is now underway and would see the loss of beds matched by equivalent but different and more modern provision for older people.

Newman Bassett House - Current Building

2.9 Newman Bassett House is a two storey purpose built older persons home constructed in the early 1970s 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.

2.10 The residential care home provides care to 47 residents who are a mix of physical frailty and dementia . 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 and currently do not afford dignity for residents as they access directly onto corridors. 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 a number of the bedrooms are not useable for wheelchair users. A copy of the National Minimum Care Standard 23 is attached to this report for reference.

2.11 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 ( included in the total figure in paragraph 2.12). Some immediate remedial work has been 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.

2.12 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 dependent upon building issues. All the other facilities and electrical/mechanical systems would need to be renewed and with the fire safety work the construction costs would be in the region of £1.75m plus professional fees at 16.5% and the cost of new furniture at £66, 000. The building work required for such a refurbishment at this level would necessitate the majority of residents having to move to other homes temporarily, with all the disruption that causes.

2.13 The adjacent day centre, (which is a separate building) is not directly part of this consultation process. It 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 and may well be into the middle of 2008. Adult Services will therefore continue to provide a day service for older people in Basingstoke but at a different location. Service Users are being kept up to date with the process. The results of this review and subsequent recommendations will be presented to a future meeting.

Linden House - Current Building

2.14 Linden House is a two storey purpose built older persons home of traditional brick and slate construction built in the late 1960s (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 changing 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.

2.15 The residential care home provides care to 34 residents who are mostly physically frail with some levels of dementia . 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. Accessibility to toilet facilities is particularly difficult and currently do not afford dignity for residents as they access directly onto corridors. Access to bedrooms for residents who rely on wheelchairs is also a major issue with restrictive space, 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.

2.16 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 (which is included in the overall total cost in paragraph 2.17) . 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.

2.17 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 unviable. Given the above factors, and the need to undertake major mechanical and electrical work at the home, the construction costs of bringing the home up to the required standard, would be in the region of £1.6m. plus professional fees at 16.5%, and the cost of new furniture at £48,000. The building work required for such a refurbishment at this level would necessitate the majority of residents having to move to other homes temporarily, with all the disruption that causes.

Re- provision for existing service users

2.18 In Newman Bassett House there are currently 37 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 have had 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 had access to the new Independent Mental Capacity Advocacy service. However this has not been required at Newman Bassett. Care Managers have been appointed specifically to work alongside the service users during this time. Full care management assessments have taken place, along with medical assessments from GPs and specialists (where appropriate) to ensure that all risks are taken into account for each individual.

2.19 There are two other local Authority Homes within 3 miles of Newman Bassett and another one some 10 miles away at Alton. One of those homes is one of the ten new Enhance Nursing Homes, which also has a care home attached, which received a major refurbishment. Factors to be taken into account will include the location of relatives, and any social groupings among residents. Vacancies have been held in these and 2 other local authority homes in Winchester for some while now (being used in the interim for respite care). In addition to this some residents have expressed an interest in moving out of the area altogether to be nearer to relatives. A number (yet to be finalised) of residents (and their relatives) have expressed a wish to remain in Basingstoke or surrounding areas and care management are working closely with Independent providers to secure suitable placements locally.

2.20 In Linden House, there are currently 24 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 additionally two nursing homes owned by Hampshire County Council. A Care Manager has been appointed specifically to work alongside the service users and has now met with all residents/their relatives and other interested parties during this time. Care management assessments have been completed and whilst final placements are still being worked on, there will be at least 11 people wishing to move to Solent Mead, another Hampshire County Council home about ¼ mile away in Lymington and others are considering other Hampshire County Council homes in the New Forest. The remainder are looking at local Independent care and nursing homes in Lymington and surrounding areas.

Re-provision for future service users

2.21 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. There are also people who will require a higher level of care either through physical or mental frailty, and this is why Hampshire County Council built 10 new nursing homes and has refurbished 11 existing residential care homes in the last 4 years to accommodate these higher levels of need.

2.22 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 despite Adult Services reducing the overall capacity over the last 3 years.

2.23 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 councils and independent providers provide and are 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.

2.24 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 within the district councils where the two homes are located. A comprehensive strategy is being developed to address how to increase the provision available from registered social landlords, and specific discussions have been in process for some months now, with interest from both District/Borough Councils and independent housing organisations (as indicated in paragraphs 2.7 to 2.8.5).

2.25 For 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

Staff

2.26 At Newman Bassett there are 51 staff whilst at Linden House there are 42 staff.

2.27 All staff have now had meetings with a Human Resources representative and union representative if appropriate and future employment options have been discussed. Assistance is available for those who have not had interviews for sometime and the homes have regular updates of current vacancies across the County Council

Consultation Process

2.28 The consultation process for both sites has been very extensive and a considerable number of responses received from both and the comments made have been taken into account including large petitions (over 3000 for Linden House and approximately 900 to Newman Bassett) from local people and others, requesting Hampshire County Council not to close the Homes. A copy of the Newman Bassett and Linden House petitions are available for today's meeting. The petitions have demonstrated the recognition of the high level of care that staff provide at each of the Homes. There has been an acknowledgement of the difficult decisions that have to be taken and whilst the petitions demonstrated the level of local feeling, they have not raised any new factors which need to be taken into account in reaching a decision.

2.29 A summary sheet is attached to the report of all the main responses received as part of the process.

2.30 The principal consultees have been the residents and their relatives (where appropriate). Advocates from the new Independent Mental Capacity Advocacy service could have been used where individuals with dementia did not have relatives or other friends to represent them. However, there has been no request for this service. Following on from the initial meetings with those groups each person has had individual sessions with the Care Manager(s) to discuss future options and opportunities offered to view alternative Homes. Although there has been a varying degree of anxiety among residents, once the initial news about the potential future of home has been made known, they have expressed a wish to move sooner rather than later. This has at times been difficult to manage and this is where staff have been good at supporting residents and explaining the issues surrounding the standards expected to provide a higher level of care. There have been just two letters from relatives of a resident at Newman Bassett excluding those sent to Care Managers. For Linden House, two letters have been received directly from relatives.

2.31 Member involvement and interest has been significant and helpful with a number of visits to each of the Homes where both residents and staff have had the opportunity to express their views. At Newman Bassett there have been two letters from local Councillors and one from the local MP. At Linden House, there have been three letters from County Councillors and extensive E Mail correspondence with another, as well as two letters from the local MP.

2.32 Both New Forest District and Basingstoke and Deane Borough Councils have responded and whilst expressing concern about the loss of residential care facilities, they have been generally supportive of the development of alternatives, although have been mindful of the timeliness of such developments. One letter has been received from Basingstoke and Deane Borough Council and one from New Forest District Council

2.33 The Primary Care Trust and other specialist Health services have returned comments which have generally been supportive in approach to the reprovisioning of the homes and a change in direction to extra care housing. There has been only one response letter from the local representatives of the PCT at Basingstoke. One letter has been received from a local surgery at Basingstoke and two letters from Consultants in the New Forest, one from a Consultant in Old Age Psychiatry and the other from a Consultant Physician in General Medicine. Both of the latter respondents were supportive of the reprovision and the new development proposals.

2.34 Voluntary organisations have been written to both locally and at County level but as yet no responses have been received. At Basingstoke a meeting was attended with the Basingstoke Disability Forum regarding Newman Bassett House with a main focus of the discussion about the day service at Newman Bassett. Assurances were given that the service would continue though possibly at another location.

2.35 Union consultation took the form of 3 meetings with cross union representation, including a meeting before the consultation started and then subsequently at two different joint Adult Services/Union meetings. In addition individual staff had the opportunity to discuss their future employment opportunities with a union representative present.

2.36 As part of the consultation process, the Safe and Healthy People Select Committee considered the consultation process at their meeting on the 4^th July 2007. The approach to consultation was generally agreed.

2 Financial Impact

3.1 The current gross 2007/8 budget for Newman Bassett is £968,500 at full occupancy with a net budget of £637,200.

3.2 The current gross budget for Linden House is £793,000 for full occupancy with a net figure of £553,000.

3.3 The additional costs to closure include: the costs of purchasing residential/nursing care in the independent sector; the potential redundancy costs for those staff who cannot be redeployed; and the costs associated with closing the building.

3.4 The costs for alternative independent sector residential care are dependent upon the number of residents who may be re-located in other In-House care homes and the number of people who wish to remain local. Care management assessments have yet to be finalised but initial indications suggest that in the region of 19 residents may need to be placed externally. Some of these beds will be spot purchased but it may be necessary to negotiate block contracts to secure replacement capacity. This report seeks authority to negotiate with providers on that basis to facilitate timely transfer from Newman Bassett.

4 Impact Assessment

4.1 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.

5 Conclusions

5.1 It will be seen (in particular) from paragraphs 2.9 and 2.17 that neither Newman Bassett House nor Linden House residential care homes meet the service requirements for the majority of existing residents or for future service users given the dependency levels of older people being referred to the Department for residential care. Even with significant investment of £3.35M (plus fees and furniture) for the two homes, it is unlikely that they would fully meet the standards and needs of future service users. As importantly is the need for the County Council to respond to the changing demands of older people requiring social care, where there is a shift to an expectation of maintaining independence, either by support at home, or where additional support is required in extra care housing.

5.2 The consultation process, as indicated above, has received a whole spectrum of responses, from views clearly stating that the homes should not be closed, to those who believe it is time to move forward to more innovative solutions such as extra care housing. There is an acknowledgement though, that there is a need for residential care, that would be able to offer services to people with higher level needs but in buildings that are `fit for that purpose'. However, neither of the buildings under consideration are able to meet that need even with significant investment.

5.3 The majority of responses received from the consultation on the closures has been about the lack of local capacity of the residential care market. Adult Services has undertaken a significant amount of work, using previous experience, to ensure that this has been addressed, both for existing and future service users. This was indeed a key objective of the Enhance programme to build 10 new nursing homes and improve 7 residential care homes to cater for the higher dependency needs of service users. This will have involved some additional short term costs to meet longer term objectives.

Recommendations

The following decisions are sought:

a) That the Executive Member approve the proposal for the residential services at Newman Bassett, Basingstoke and at Linden House, Lymington to cease, and that the process to end the current services is completed subject to the care needs of the residents being met.

b) That the Executive Member authorise officers to negotiate block contracts, with the Independent Sector residential care providers in the Basingstoke area, should the need arise, to reprovide Newman Bassett residents, if In-House services are unable to accommodate.

c) That the Executive Member endorse a recommendation to Cabinet that additional Extra Care sheltered housing be developed in partnership with district councils and registered social landlords, with particular emphasis at the beginning of the programme on Basingstoke and Deane and the New Forest.

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