Agenda item

Purpose of the report: To review and scrutinise the ongoing Accommodation with Care and Support programme of work.

Witnesses:

Mel Few, Cabinet Member for Resources

Steve Hook, Assistant Director of Disabilities, Autism & Transition

Wil House, Strategic Finance Business Partner (Adult Social Care and Public Health)

Jonathan Lillistone, Assistant Director of Commissioning (Adult Social Care)

Sinead Mooney, Cabinet Member for Adults and Health

Peter Walsh, Property Account Manager for Adult Social Care

Key points raised during the discussion:

1. The Assistant Director of Commissioning (ASC) introduced the report. It referred back to the October 2019 Cabinet report. The aim of the programme was to create housing that increased independence for residents and was more cost-effective.
2. The Cabinet Member added that the Council was committed to the delivery of the programme. She was aware of concerns around the pace of the programme, but pacing would now be a priority and the programme would be a consistent item on the Cabinet agenda and, she hoped, on the Select Committee’s agenda too.
3. Members expressed dissatisfaction with the late delivery of the reports to the Select Committee.
4. A Member expressed frustration at the slow pace of the programme and asked what the reason was behind the delay, what the ongoing challenges were, and how sure the Cabinet Member for Adults and Health was of a successful process. The Cabinet Member for Adults and Health expressed sympathy with Members’ concerns but said that the three sites for accommodation with care and support had been approved by Cabinet in October 2019, and her previous references to issues with pace were from that date onwards only. A Member acknowledged that the proposal had been approved by Cabinet in October 2019, but said that there had been conversations between Members and officers about the Pond Meadow site as long as three or four years ago. The Assistant Director of Commissioning (ASC) added that the focus since October 2019 had been on the Pond Meadow tender and a number of other aspects: approaching the market, structuring the lease, and linking that back into care and support. It was important to note that the Covid-19 pandemic had been a challenge for the Council and its partners; for example, the Council had had to redeploy commissioning staff, which had had an impact on progress. However, progress had been made since the end of May 2020 and the Council would be in a position to launch the Pond Meadow tender next week (week commencing 20 July 2020) and award contracts in autumn 2020. Market engagement had suggested that there was very much an appetite to bid for Pond Meadow. The Assistant Director also assured Members that the accommodation would be built in a way that was flexible and allowed the Council to respond to changes in the model of care in the long term.
5. The Cabinet Member for Resources emphasised the progress that had been made in recent months, thanks to the restructuring of the property team as well as private property expertise.
6. The Chair of the IMHN noted that mental health had been omitted from the Equalities Impact Assessment (EIA), and contended that it should have been included as mental health is a disability. The Assistant Director of Commissioning (ASC) expressed regret that this was not as explicit as it should have been, and explained that the Accommodation with Care and Support programme focused on learning disabilities (LD), so LD was more prominent than mental health in the report. The Chair of the IMHN pointed out that people with LD could also suffer from mental health issues and expressed further concern that there was no mention in the report of the mental health impact on staff. The Assistant Director of Commissioning (ASC) noted these points and the Assistant Director of Disabilities, Autism & Transition offered reassurance that there was a group that met every month to look at accommodation and supported living across LD, autism and mental health.
7. A Member anticipated that the Accommodation with Care and Support programme would generate significant savings for the Council. The Strategic Finance Business Partner confirmed that modelling indicated savings of £4,600 per unit per year would be delivered for Extra Care Housing schemes for Older People.
8. A Member expressed dissatisfaction with the content and clarity of the report. He requested more information on the timescale of the programme. The Assistant Director of Commissioning (ASC) explained that, put simply, what was proposed was engagement through a tender process with a development partner who would design, develop and deliver the building. The Council would enter into a lease with them – it was proposed this would be a long lease of 125 years – and there would be terms covering the possibility of a change of use, as the model of care could change in the next few decades. The Property Account Manager added that due to the long lease of the contract, the Council would be the landlord and would retain the right to design, build and operate the site, ensuring it would not have the same problems it had had in the past with the Joint Venture; it could also receive a grant from Homes England. Under the long lease, the building could be repurposed if the Council wished to do so. The development partner would pay peppercorn rent for the 125-year lease and would be responsible for grounds maintenance and everyday running, while there would be a separate care provider with a separate contract. Furthermore, there would be rent review clauses in the lease contract. The Member expressed uncertainty about the rationale for contracting the development partner rather than Surrey County Council developing the site itself.
9. A Member enquired whether the accommodation in question was for older people or people with LD. The Assistant Director of Commissioning (ASC) clarified that the report mentioned two strands: extra care, which was predominantly for older people (including older people with LD or mental health needs); and independent living, for people with LD. The July Cabinet report that had been presented to the Select Committee as a supplementary paper, however, covered specifically the Pinehurst and Brockhurst sites, which were both extra care sites.
10. A Member asked whether the Council was looking to be the registered social landlord. The Assistant Director of Commissioning (ASC) explained that the development partner would be the registered social landlord, and they would claim the Homes England grant, meaning the Council itself would not have to go through the process to become a social landlord. The Property Account Manager added that it was not necessary to become a social landlord in order to develop; it was just necessary in order to receive the Homes England grant. The Cabinet Member for Adults and Health emphasised the difficult and lengthy process involved in becoming a social landlord. The option to become a social landlord had been considered by Cabinet, but it was felt that contracting a developer was a better option.
11. A Member noted that there would be two or three accommodation with care and support sites in the west of Surrey. Did this mean that some residents from the east of the county would have to go to the west to use these sites? The Assistant Director of Commissioning (ASC) said that a focus of the programme moving forward would be to ensure that there were schemes in locations where there was demand.
12. The CEO of Healthwatch Surrey enquired about the implications of deregistration of existing residential care provision, as mentioned in the report. The Assistant Director of Disabilities, Autism & Transition detailed that the process of deregistration as mentioned in that report referred to the ability of care homes to deregister from being a residential care home service and become a supported living service instead. Supported living services entailed some advantages; for example, rather than being a resident under license (as they would be in a residential care home), in a supported living service the resident would be a tenant with greater rights. The process of deregistration was conducted through the Care Quality Commission (CQC) and had become a more rigorous process in the last year. Deregistration was one way of increasing the number of people in independent living. The Assistant Director of Commissioning (ASC) added that there had been incidents where the CQC had decided that it would be inappropriate to deregister a scheme, and there were some individuals for whom it would be more appropriate to be in a registered service.
13. The Property Account Manager confirmed that the issue of penalty charges for any delays incurred by the chosen provider was included in the contract.
14. A Member asked whether creating more retirement villages was an option that the Council had considered. The Assistant Director of Commissioning (ASC) responded that, as the programme focused on the quality of design, and extra care schemes were individuals’ homes, extra care homes had a similar feel to retirement villages. The Property Account Manager added that, as retirement villages required large plots of land, they were a potential longer-term idea.
15. A Member queried how confident witnesses were about adhering to the timescales as set out in the report. The Assistant Director of Commissioning (ASC) replied that he was very confident about Pond Meadow, the tender for which would be launched next week, and was generally confident with the tendering process and timescales.
16. A Member questioned whether the assessment of demand for accommodation sites was conducted for each borough and district and took into account the predicted population increase in Surrey. The Cabinet Member for Adults and Health replied that the report that went to Cabinet last year took into account the predicted increase in levels of demand for housing. There may be a future increase in needs, but once the model was established, this would be addressed.
17. A Member expressed concern about the 53 remaining void units mentioned in the report; 53 seemed a large number of voids and it did not look as though progress had been made on this. The Assistant Director of Commissioning (ASC) explained that the Council used a wide range of registered care schemes, some of which were in older buildings that were becoming less suitable to meet needs; the Council would not allow residents to move into unsuitable schemes, which led to voids in certain cases. The Council was looking at making decisions on whether those buildings would be suitable in the long term, but this had not been possible during the lockdown. This explained why it looked in the report as though limited progress had been made, but it would be accelerated soon.