Agenda item

1.     That the decision to close residential care provision by Surrey County Council at Brockhurst be approved. 

2.     That the decision to close residential care provision by Surrey County Council at Cobgates be approved.

3.     That the decision to close residential care provision by Surrey County Council at Dormers be approved.

4.     That the decision to close residential care provision by Surrey County Council at Longfield be approved.

5.     That the decision to close residential care provision by Surrey County Council at Park Hall be approved.

6.     That the decision to close residential care provision by Surrey County Council at Pinehurst be approved.

7.     That a phased implementation programme to move people to alternative services be undertaken, which must take account of best practice and be guided by individual assessments of those affected, including carers.

8.     That suitable alternative services for each affected person in those homes closing be identified.

9.     That further work be undertaken for each property to fully evaluate potential alternative use to meet future needs for adult social care.

10.  That a full staff consultation begins, with the objective, where possible, of retaining existing staff skills and knowledge. 

Reasons for Decisions:

 

After analysing all the consultation responses received and comments made in the individual meetings during the consultation period, and the council’s review of services, the reasons for closure of the provision of in house residential care homes for older people are:

 

·        The physical environment of the homes is not fit for purpose and cannot easily or quickly be made so. The poor quality of the environment impacts on the quality of care that can be offered.

·        The demand for residential care for older people is changing as is their preference, with support, to continue living at home. Optimum occupancy cannot be achieved in any of Surrey County Council’s six older peoples residential care homes due to the building limitations, which in part leads to low occupancy and higher staffing levels. This makes the continued delivery of services unsustainable.

·        It will remain difficult to accept the range of referrals and complexity of need being presented unless the current facilities are significantly upgraded to the modern standards identified for dignified care delivery. To complete the required level of works, residents would need to temporarily relocate, potentially meaning two moves at least, if they were to return to the refurbished home.

·        Residential placements made by the council in the independent sector make up 91% of the total funded placements by the council. Surrey is fortunate in having a diverse independent care sector offering quality services. The council has an ongoing relationship with the sector to ensure responsiveness to commissioning intentions. In the last year the council has placed 263 people in residential care and 857 in nursing care in independent sector provision. It has had high utilisation of its 905 block placement residential care beds. Investment in the council homes refurbishment does not compare favourably with commissioning existing alternative provision in the independent sector.

·        A phased approach, based on individual assessment and plans, enables time to ensure appropriate alternatives are identified for each individual and carers, and to work with the independent sector market in a managed way.

·        Employees within the homes are recognised as delivering a good quality of care in challenging environments. There has been investment in their training, and there is a wealth of skill and experience. The council will support staff to explore opportunities, seeking to retain skills and experience.

Should a decision be taken to close a home, any future use of that asset for Adult Social Care or the local community will need to be carefully assessed.

 

[The decisions on this item can be called in by Adult Social Care Select Committee]

 

On 21 October 2014 the Cabinet took a decision to consult on the future of six Surrey County Council residential care homes for older people. This followed a comprehensive review of the services provided, future commissioning requirements, and consideration whether Surrey County Council should continue to operate older people’s residential care homes.

The homes under consultation were:

·        Brockhurst in Ottershaw

·        Cobgates in Farnham

·        Domers in Caterham

·        Longfield in Cranleigh

·        Park Hall in Reigate

·        Pinehurst in Camberley

 

The Leader of the Council opened the debate on this item by inviting non-Cabinet County Councillors that wished to speak on the issue to present their views to the Cabinet.

 

Mrs Sally Marks, County Councillor for Caterham Valley, began by recognising the good care that existed in the six care homes but she pointed out that the environment needed work. She raised concerns around moving people and whether the re-provided care will be at least as good, if not better, than that should the homes be closed and wanted assurance that friendship groups and locations will be considered when placing people in alternative facilities. She particularly highlighted Dormers in Caterham and a specific concern around the position of the local hospice, St Catherine’s and services they delivered to the community. She urged the Cabinet Member for Adult Social Care to ensure that Surrey’s people, friends, neighbours and parents were at the centre of this decision.

 

Mr John Orrick, County Councillor for Caterham Hill, then spoke on this issue and expressed his sadness to see the recommendations set out in the submitted report. He talked about the Surrey brand and the value and trust within this and asked the Cabinet Member for Adult Social Care to ensure that the reablement provision and the hospice lease are fully considered in the plans for the future of Dormers in Caterham. He said that he would like to see the upmost care taken in re-providing care to residents and that staff are offered redeployment support.

 

Mr David Munro, County Councillor for Farnham South, spoke on the Cobgates care home and stated that he supported the recommendations reluctantly. He said that the care was excellent and it was a much loved facility that had served well but the building at Cobgates was not fit for the long term. He expressed concern that the site could be sold and care repositioned in the future. He acknowledged the extensive consultation that had taken place and said that there was good will in the town to ensure that Cobgates facilities would be available going forward.

 

The Leader of the Council thanked Members for their comments and asked the Cabinet Member for Adult Social Care to introduce the report and address the concerns raised by Members.

 

Mr Few stated that this was the most complex issue he had brought to a Cabinet meeting for decision since becoming a Cabinet Member. He said that the Cabinet needed to consider how best the Council could provide a quality and dignified care service to meet both the current and future needs of the elderly. He highlighted that Adult Social Care was responsible for the wellbeing and safeguarding of 23,648 of the County’s vulnerable adults and that 37% of these residents fell between the ages of 18-64. He said that 813 young adults were currently in transition who will most likely be users of the service for the remainder of their lives. This had led to the service re-examining its role in providing modern facilities which would cater for future demand. He explained that this had been taken into account with the comments received from the consultation and the original proposal had been modified and now included a specific recommendation to consider the future use of the existing six sites for the use by Adult Social Care.

 

He declared his appreciation for the hard work often under difficult circumstances that the team led by the Interim Assistant Director, Service Delivery, had put in to this exercise since the announcement of the consultation in November 2014.

 

He also thanked all respondents who had taken the trouble to reply to the consultation documents and for the many helpful suggestions that were made.

 

He asked Members to consider the separate paper entitled “Surrey County Council Older People’s homes: consultation Report dated 2 March 2015 which contained the full responses and replies made to the consultation.

 

He then made the following points:

 

·        The majority of responses received related to current users of the homes not agreeing with the proposed option 4 which was to exit the provision of residential care homes for the elderly in the six remaining old people’s residential homes.

·        Current best practice was to assist the elderly to remain in their own homes among friends, family and community for as long as practicable. Once their condition deteriorated to such an extent that living at home was no longer possible, the next move would generally be to a nursing home.

·        When the homes were first opened in the late 1960s and early 1970s the admission criteria required the presenting resident to be fully ambulant and continent, where the bedrooms were designed for residents who would only spend their nights in their bedrooms compared to residents today that spend the majority of their time in their bedrooms, which placed additional strain on the staff.

·        Many of the residents had complex needs and some had multiple complex needs which placed exceptional strain on the facilities and this was one of the main reasons that a decision was made some time ago to restrict the admissions to the homes.

·        When the decision to reduce capacity was made 8 years ago there was not a comparable reduction in the staff levels and this level had continued to be necessary to ensure the homes remain CQC compliant despite the obvious deficiencies in the accommodation.

·        Going forward it was widely recognised that future provision of adult services will be more specialised including dementia care, reablement services and extra care facilities.

·        It was well known that Adults services faced a continuing shortage in qualified staff. The service was currently running with a greater than 10 % vacancy factor and as a consequent it was expected that many of the staff would be transferred to other parts of the service where vacancies were still high.

·        Many comments were received on the quality of care provided by the staff, which were fully acknowledged and Mr Few expressed the Council’s thanks for their professionalism over this trying period.

 

The Deputy Leader stated that the decision was not easy and questioned whether the homes were not meeting needs and whether they were compliant with CQC standards and fit for the future particularly to those with mobility issues.

 

The Cabinet Member for Community Services challenged Mr Few and asked him to consider the significant impact on the residents and the impact moving them would have.

 

Mr Few replied that the level of renovations required would mean that residents would have to be moved twice and therefore it was not an option. In response to Mr Martin’s question he stated that the staff provided a great service in difficult circumstances but that the homes were well behind the average standard.

 

The Cabinet Member for Public Health and Health and Wellbeing said that he had visited all the homes in question and that they were built for a different time and place.

 

The Cabinet Member for Schools and Learning queried why option 3, to sell or lease the homes to another provider, was not viable. She also stressed the importance of respite and reablement care.

 

Mr Few responded by stating that the Council had been approached by other providers but that they had been interested in the care home sites not the current buildings.

 

The Cabinet Associate for Children, Schools and Families questioned whether there was sufficient capacity in the market in Surrey to accommodate people if the homes were closed, particularly in relation to Park Hall care home.

 

Mr Few said that Park Hall is in the fourth tranche of closing that that he was confident that alternative provision was available.

 

The Cabinet Member for Highways, Transport and Flooding commented on the combined experience that the Cabinet had with the Adult Social Care portfolio and that a number of the Cabinet had visited the homes and found the care to be extremely good and the residents happy. He raised concerns about the cost of refurbishment and the level of care if the service is provided elsewhere.

 

The Cabinet Member for Business Services raised concerns about the quality of care for respite, dementia and step down beds and urged further conversations with Clinical Commissioning Groups on this issue.

 

Mr Martin reflected that the service level was very good and that he had listened and read the report and annexes and it was clear that the condition of the homes meant they were not fit for purpose. He stated that he was reluctant to reject option 2 but if residents would have to be moved twice then this was not a good option and the same for option 3. He requested that should option 4 be approved then the next steps would have to be dealt with in a dignified and proper way.

 

Mr Few said that the Adult Social Care service would handle this with professionalism and that it would be phased over 3 years with each individual having had their wishes considered.

 

Mrs Clack stated that the buildings were letting the Council down and that much better could be provided. She recognised that the staff were highly valued and did a fantastic job and queried what would happen to them as a result of the homes closing.

 

He stated that there were huge opportunities for staff and that the Council would do everything possible to ensure that staff remained with Surrey County Council.

 

The Cabinet Member for Public Health and Health and Wellbeing referred to the Equalities Impact Assessments and that the impact on staff and residents had been fully assessed.

 

The Cabinet Associate for Adult Social Care said that he had worked closely with the Cabinet Member for Adult Social Care and looked at how the Council could best meet the care needs of the residents of Surrey and that he felt this was the best thing that could be done going forward.

 

The Cabinet Member for Schools and Learning also referred to the Equality Impact Assessments and in particular to Alzheimer’s respite requirements being specifically looked at. Mr Few replied that there was no option but to look at this.

 

The Cabinet Associate for Assets and Regeneration asked the Cabinet Member for Adult Social Care to confirm he was satisfied with the Equality Impact Assessments and to confirm that there were not any obvious gaps. Mr Few confirmed that he was.

 

The Leader highlighted the concerns that had been raised around St Catherine’s Hospice in Caterham and the ongoing work with the Clinical Commissioning Groups and voluntary sector and stated that the Council must not lose sight of these points. He said that this was about looking after people and not buildings and looking after the staff who were ambassadors for Surrey.

 

He went on to state that it was a complex and emotional issue where the care was good but the infrastructure was not.     

 

RESOLVED:

 

1.     That the decision to close residential care provision by Surrey County Council at Brockhurst be approved. 

2.     That the decision to close residential care provision by Surrey County Council at Cobgates be approved.

3.     That the decision to close residential care provision by Surrey County Council at Dormers be approved.

4.     That the decision to close residential care provision by Surrey County Council at Longfield be approved.

5.     That the decision to close residential care provision by Surrey County Council at Park Hall be approved.

6.     That the decision to close residential care provision by Surrey County Council at Pinehurst be approved.

7.     That a phased implementation programme to move people to alternative services be undertaken, which must take account of best practice and be guided by individual assessments of those affected, including carers.

8.     That suitable alternative services for each affected person in those homes closing be identified.

9.     That further work be undertaken for each property to fully evaluate potential alternative use to meet future needs for adult social care.

10.  That a full staff consultation begins, with the objective, where possible, of retaining existing staff skills and knowledge. 

 

Reasons for Decisions:

 

After analysing all the consultation responses received and comments made in the individual meetings during the consultation period, and the council’s review of services, the reasons for closure of the provision of in house residential care homes for older people are:

 

·        The physical environment of the homes is not fit for purpose and cannot easily or quickly be made so. The poor quality of the environment impacts on the quality of care that can be offered.

·        The demand for residential care for older people is changing as is their preference, with support, to continue living at home. Optimum occupancy cannot be achieved in any of Surrey County Council’s six older peoples residential care homes due to the building limitations, which in part leads to low occupancy and higher staffing levels. This makes the continued delivery of services unsustainable.

·        It will remain difficult to accept the range of referrals and complexity of need being presented unless the current facilities are significantly upgraded to the modern standards identified for dignified care delivery. To complete the required level of works, residents would need to temporarily relocate, potentially meaning two moves, at least if they were to return to the refurbished home.

·        Residential placements made by the council in the independent sector make up 91% of the total funded placements by the council. Surrey is fortunate in having a diverse independent care sector offering quality services. The council has an ongoing relationship with the sector to ensure responsiveness to commissioning intentions. In the last year the council has placed 263 people in residential care and 857 in nursing care in independent sector provision. It has had high utilisation of its 905 block placement residential care beds. Investment in the council homes refurbishment does not compare favourably with commissioning existing alternative provision in the independent sector.

·        A phased approach, based on individual assessment and plans, enables time to ensure appropriate alternatives are identified for each individual and carers, and to work with the independent sector market in a managed way.

·        Employees within the homes are recognised as delivering a good quality of care in challenging environments. There has been investment in their training, and there is a wealth of skill and experience. The council will support staff to explore opportunities, seeking to retain skills and experience.

Should a decision be taken to close a home, any future use of that asset for Adult Social Care or the local community will need to be carefully assessed.