Agenda item

Purpose of the report:

To update the Adults and Health Select Committee on progress made by the Accommodation with Care and Support programme with particular focus on the following:

·       identifying a provider to deliver phase 1 of Strategic Extra Care (Design, Build, Finance and Operate five new Extra Care facilities across Surrey); and

·       identifying a provider to Design, Build, Finance and Operate a residential, dementia & nursing facility in North West Surrey.

Declarations of interest:

None

Witnesses:

Cliff Bush, Chair, Surrey Coalition of Disabled People

Mel Few, Cabinet Member for Adults

Jennifer Henderson, Senior Commissioning Manager, Adult Social Care, Surrey County Council

Matt Lamburn, Project Manager, Adult Social Care, Surrey County Council

Matt Parris, Deputy CEO, Healthwatch Surrey

Key points raised during the discussion:

1.     An introduction to the report was provided by officers who informed the Committee that demographic changes had put pressure on Surrey County Council’s (SCC) capacity to find affordable residential accommodation for those with social care needs. Projections had shown that over the next ten years SCC would be required to expand its residential accommodation by a further 10% in response to increased demand arising from a growing elderly population. The Committee heard that the Council needed to ensure that it had enough affordable accommodation to place those with care needs. SCC had initiated a number of projects to increase its provision of accommodation for those with social care needs one of which was to stimulate growth in the Extra Care market.

2.     Members were advised that SCC’s strategy to expand the availability of Extra Care places was predicated on a Design, Build, Finance and Operate model (DBFO) whereby land would be offered to the private sector to build and operate Extra Care housing on the proviso that a certain number of units would be reserved to place those who received social care support from SCC. Five locations across the County had been identified to build Extra Care housing which would be offered to the market in accordance with the terms outlined in the report. The Cabinet Member for Adults highlighted that the report to the Select Committee referred specifically to the provision of Extra Care for older people but indicated that SCC had also purchased land in the south of the County to build Extra Care Units for use by those with learning disabilities.

3.     More clarity was sought on the procurement process and Members asked whether SCC would seek just one provider to build and operate Extra Care facilities on the five sites referenced in the report or whether there would be a different provider for each of the five sites. Officers stated that the Council would run a bespoke, flexible procurement process which meant a variety of different configurations was possible as regards the number of contracts that SCC entered into.

4.     The Committee highlighted the important role that local communities play in supporting elderly residents in ensuring that they didn’t become isolated. Members stated that moving older people with social care needs into Extra Care accommodation outside of their local communities could sever existing support networks. Officers stated that the existing strategy concentrated on priority areas with an identified need for more residential care but the ultimate goal was to have Extra Care units in conurbations across the County to ensure that this type of support could be delivered to older people within their existing community.

5.     Detail was sought on how Extra Care units would be equipped to support those with physical disabilities. Members were advised there would be a contractual requirement for providers to construct units in accordance with national guidelines which would ensure that the buildings were capable of accommodating equipment, such as hoists, that might be required to support those with physical disabilities. It was further highlighted that the interior of Extra Care houses built under this scheme would be designed to support those with dementia.

6.     The Committee enquired about the potential savings that could be achieved through placing those with social care needs in Extra Care accommodation. Officers stated that financial projections indicated that savings of £4,600 per person per year would be achieved when compared with placing them in a residential care setting. This equated to a direct of saving of £1.7 million to the County Council once the five Extra Care schemes were operational with significant further savings to the health and social care system in Surrey as a whole by reducing the risk of older people being committed to hospital and then reducing the time that it took for them to be discharged from hospital.

7.     Officers advised that initial architectural drawings indicated that approximately 600 beds would be created across the five schemes highlighted in the report. Members stressed the need to ensure that a significant number of these beds were made available to SCC for placing those who received social care support from the Council. The Committee heard that clear expectations would be placed on providers for the number of beds that would be made available to SCC in exchange for providing the land on which the Extra Care facilities would be located.

8.     Members emphasised that Surrey would remain below the national average for the availability of Extra Care accommodation even after these schemes were operational and further clarity was sought on how the SCC would catch up with other local authorities. The Committee was informed that an evaluation process would be undertaken following completion of phase 1 of the project to consider opportunities for further increasing Extra Care capacity within Surrey beyond the 600 places that would be delivered through this strategy. Officers indicated, however, that further announcements on social care support from the Government would impact on any future strategies pursued by the Council to deliver residential placements for older people with social care needs.

9.     Information was sought on when the Extra Care sites detailed in the report would become operational. Officers advised Members that they were unable to provide a definitive timeline but indicated that savings from these Extra Care schemes had been incorporated into the Medium Term Financial Plan (MTFP) for the financial year 2020 – 2021 and so it was anticipated that these schemes would be up and running by then. Officers stated that extensive building work funded by provider(s) would take place at each of the five sites identified in the report to deliver appropriate and suitable Extra Care accommodation for those with a diverse range of social care needs.

10.  The Committee asked what opportunities there would be for service users to contribute to the design of these Extra Care schemes. Members heard that it was anticipated that consultation with both service users and the wider community would be built into the design phase of individual projects. Officers further advised that SCC had been working closely with district and borough councils as well as parish councils to embed the development of Extra Care into both local and neighbourhood plans.

11.   Further detail was sought on the level of influence that SCC would have over the development of individual Extra Care schemes outlined in the report. Witnesses responded by stating that SCC would enjoy joint partnerships with the chosen provider(s) which would be enshrined within the final lease as well as in contractual agreements signed with providers. These documents will be designed to ensure that SCC can work closely with the provider throughout the lifetime of the contract.

12.  Attention was drawn to the legal right to occupy which legislation extended to residents of Extra Care accommodation and Members asked how this would work when the provision available through Extra Care housing was no longer able to meets the needs of its occupant. The Committee was informed that the intention was to build units capable of supporting those with very high care needs right through to the end of their life. In those instances where it was necessary to move a resident to another type of supported accommodation a conversation would be initiated with the inhabitant in order to relocate them.

13.  More detail was sought on how Extra Care accommodation supported early discharge from hospital. Officers highlighted that delays in discharging elderly people from hospital often arose as a result of the need to find accommodation or design a package of care to support them. This was not necessary for those who live in Extra Care accommodation as they were capable of meeting the support needs of those discharged from hospital.

14.  The Committee heard from the Director of Surrey Coalition of Disabled People who requested further information on how the five schemes outlined in the report would support residents at the end of life care so that they were required to go into hospital to receive palliative care. Officers stressed that people should be able to choose where they wish to die and emphasised that the provision of palliative care was a central facet of Extra Care accommodation.

15.  The Director of Surrey Coalition of Disabled People also asked what involvement Sustainability and Transformation Partnerships had in the development of the five schemes outlined within the report. Members heard that both SCC’s Extra Care Strategy and the needs assessment which underpinned the scheme had been developed in collaboration with colleagues from Surrey’s Clinical Commissioning Groups (CCGs). More generally, officers stated that Extra Care accommodation was about improving the integration of health and social care by facilitating more effective collaborative working between the Council and partners in the NHS.

Recommendations:

The Adults and Health Select Committee welcomes the Extra Care programme and supports the award by Cabinet of:

1. the provider(s) identified to deliver Phase 1 of Strategic Extra Care whilst pointing out the need, if possible, to facilitate a number of providers acquiring expertise in the delivery of Extra Care; and

2. the provider identified to deliver the residential dementia & nursing facility in Brockhurst, North West Surrey.