Future of Devon County Council’s Adults Day services consultation

The question being considered in this consultation is should Devon County Council continue to operate the following in-house day services? 

Learning Disability Services 
Lyric, Okehampton  
Newholme, Honiton  
Rosalind House, Tiverton  
Silverhill, Barnstaple  
Tumbly Hill, Kingsbridge  

Older Persons Services 
Tumbly Hill, Kingsbridge  

1.1 Options

The current options identified for the in-house day services in this consultation, as listed in section 1.1 are as follows: 

Option	Description
1	To continue to operate all six in-house day services in five locations for five days per week.
2	To continue to operate all six in-house day services in five locations, and operate some, or all units, on a reduced number of days.
3	To continue to operate some of the six in-house day services in five locations for five days per week and cease providing services from the other units.
4	To continue to operate some of the six in-house day services in five locations and cease providing services from the others. Those that remain open, to operate some, or all units on a reduced number of days.
5	To cease providing day services from all six of the in-house day services in the five locations.

There may be additional options that the Council should consider, if you feel there are alternative options, please give your views on those in your response to this consultation. 

Whichever option is finally chosen, the Council will continue to comply with its obligation to meet a person’s eligible needs, following a Care Act assessment and support plan.  

1.2 Services out of scope of this consultation  

The Council is not proposing to consult on the future options for the following in-house day services or its respite centres at this time. This may be something the Council considers in the future and will be dependent on the ability and availability of the independent or voluntary sector to support the profile of people attending these services, or the remodelling of current services listed below. 

Learning Disability Day Services  
Abbey Rise, Tavistock 
Nichols Centre, Exeter 
Rushbrook, Totnes 

Older Persons Day Services 
Silverhill, Barnstaple   
Woodland Vale, Torrington 

Learning Disability Respite Services 
Greenfields, Barnstaple  
Pine Park, Honiton
Treetops, Exeter  

2.0 The in-house Day Services 

2.1 Current Provision 

Currently, Devon County Council operates ten in-house day care services over eight sites. 

The table below shows the current in-house day services and the occupancy within the services.  

Learning Disability Day Service	Current number of people using the service
Abbey Rise, Tavistock	Four people
Lyric, Okehampton	None
Newholme, Honiton	None
Nichols, Exeter	Three people
Rosalind House, Tiverton	One person
Rushbrook, Totnes	Five people
Silverhill, Barnstaple	None
Tumbly Hill, Kingsbridge	None
Older Persons Services	Current number of people using the service
Silverhill, Barnstaple	Thirty six people
Tumbly Hill, Kingsbridge	None

Six in-house day services currently have no people or one person using the service.  

All services that have more than one person currently using that service, currently operate five days a week. 

The learning disability in-house day centres mainly support people with profound and complex learning disabilities.  

Any person, or their carer, is free to privately purchase day opportunities from the independent market. Access to Devon County Council commissioned and in-house day opportunities are only available following a Care Act assessment, and where the support plan identifies an eligible care need which it is appropriate to meet through the provision of a day service. 

Day services offer many benefits to their users. They provide a social and stimulating environment to people, and a reason to get out of the house and engage with others. As with other services they aim to increase a person’s independence and ultimately to reduce and delay the need for current or future services.  

Day services also provide a replacement care function for a carer where there is an established eligible need under the Care Act.  The main reasons for accessing a day service are often a combination of both providing a social and stimulating environment for the person and fulfilling a need for replacement care.   

Transport is not provided as part of the current day services offer, however if transport is identified as an eligible need it will be provided in the most cost-efficient way to ensure travel to and from the service. 

In recent years, the support to disabled people has expanded with the Council’s Reaching for Independence offer, which promotes and enables more community inclusion through access to everyday community resources and employment opportunities. This may be a factor in why there are fewer people are accessing the in-house day services. 

The number of eligible people accessing the Councils in-house learning disability day services days has reduced in the last 8 years. From 116 in 2015, to 85 in 2020. Current attendance is now at 13 people, these 13 people are accessing 4 services (Abbey Rise, Nichols, Rosalind House, and Rushbrook), albeit the individual accessing Rosalind House is currently accessing another service. 

Some of the reasons for the reduction include:  

• People moving into supported living  
• People moving to alternative day opportunities, where peer groups are more suited to the individual 
• People accessing a Personal Assistant / Direct Payment 
• People moving into paid / voluntary employment 
• Deterioration in people’s health 
• People moving out of Devon 
• People dying 
• People seeking alternatives to day services e.g. enabling 

People who are in favour of retaining these services have in the past made a number of points, including the following. 

Some people have suggested that the reduced number of users is due to the service not being promoted widely, or to operational practice of sourcing care and support in the independent sector. It has also been suggested that the reduction in use of in-house day care has been engineered by the Council. 

Feedback received previously suggests that some people have sought alternative day opportunity as they were not satisfied with the stimulation provided at the Devon County Council services. 

There is also concern that the Council may be relying to too great an extent on the independent market to provide the required day care, rather than a greater mix of Council owned and run services.  

Concerns have also been expressed that, without a range of day services in various locations, people will have to travel further to access a day service.   

We have heard that some people really value the in-house day services and would like to see the numbers increase, and the range of activities increased, improving the experience of people accessing the services. 

Some people also hold the view that the service provided by the Council can manage a more complex level of need.    

We have received feedback that people believe a higher number of individuals are or should be eligible for these services. 

2.2 Buildings Descriptions 

All Devon County Council in-house day services buildings are compliant with legal requirements for facilities for disabled people. The following section details a physical description of the centres included in this consultation. 

Descriptions of the buildings in the scope of this consultation are detailed below: 

Newholme, Honiton 
The building is an extended domestic dwelling, The areas formerly used by the learning disability day services are configured as follows. The ground floor has 3 rooms for service delivery, sized 36m², 27m² and 10m² respectively. Additionally, there is 1 changing place, 3 toilets and bathroom. The lift to the first floor offers kitchen, dining room, toilet, and bathroom.  

Lyric, Okehampton 
The building is in the form of a domestic dwelling. The areas used by the learning disability day services are configured as follows. The ground floor has a lounge 14m², kitchen, conservatory 17m²  and toilet, steep and narrow staircase to the first-floor rooms sized 6m², 9m²  and 14m² respectively, plus a toilet.  

Tumbly Hill, Kingsbridge 
The specific area for the day service building is leased from Anchor Housing with shared access to the stairwell. The areas formerly used by the older people’s day services are configured as follows. The ground floor has 2 rooms for service delivery sized 79m² and13m², assisted bathroom, conventional toilet, kitchen, office and reception area. The internal square metreage is 125 m². The areas formerly used by the learning disability day services are configured as follows. Lift to the first floor, 4 rooms for service delivery, 34m², 23m², 12m², 11m² respectively and 3 assisted toilets plus 1 conventional toilet.  

Silverhill Learning Disability Service, Barnstaple 
The building was purpose-built for social care services. The areas formerly used by the learning disability services are configured as follows. There are 5 rooms for service delivery sized 43m², 27m², 34m², 9m², and 9m² respectively plus a small kitchen, shared toilet facilities, 3 separate toilets and 1 shower room.  

Rosalind, Tiverton 

The building was a former domestic dwelling which has been extended in the past. The areas currently identified for use by the learning disability day services are configured as follows. On the ground floor there are 3 rooms for service delivery sized 21m², 13m², and 38m² respectively.  Plus a small toilet, assisted changing room, and an office.  

3.0 Why change is being considered 

Devon County Council’s aim is to support all adults in Devon to have personalised care and support, that focuses on their strengths, the outcomes they want to achieve and gives choice and control.   

Day Services are only one of many services available to people through the Care Act eligibility. Having the right number of services, offering people the type of service they want, in the right place and at the best value is important to the people of Devon.  

There are several factors which have led the Council to consider its current day care service provision across these six services.  

3.1 The National Picture 

A brief scoping review to examine the extent, range, and nature of research activity on adult social care day service provision in the UK was conducted. The rationale was to identify key factors within the provision from 2011 to the present day. Data was collected from national and local engagement groups, academic research, and reports from the Local Government Association and the Association Directors of Adult Social Service (ADASS).  Academic research on the topic was found to be sparse. However, key factors found from within the data explored, demonstrate a changing pattern of day service provision. More specifically, a reduction in traditional day service provision is leading to new models of day care emerging. 

Research Background 

The Office of National Statistics (2020)^[i] state the UK population is projected to rise by 2.1 million over the decade to mid- 2030. Understanding the size and characteristics of the UK population is vital for planning and delivering services such as adult social care. Additionally, within this population data there are approximately 1.5 million with a learning disability in the UK and approximately 956,000 of the adults with a learning disability live in England. The World Health Organization maintain the best way to meet the needs of all adults is by ‘placing them at the centre of service delivery’ (World Health Organization 2015:99.  

Adult Day Centre – Impact 

Adult day centres can encourage healthy aging. An ADASS report in 2022 explained how councils have re-built their day service support after the pandemic but that their offer is now less reliant on these services. There are several factors for this, including the ‘long-standing desire to provide a more diverse and sustainable community-based offer’, which is vital ‘to support people in better, and in more personalised ways’, connecting them to their communities. The rationale within this report is to support people in need, with respite forming a less significant element.  

In line with the 2022 ADASS report findings, Orellana and colleagues (2021) found apparent value in the day centres’ collective provision which suggests this is not in direct conflict with the principles of the Care Act, yet must be subject to service quality. The findings of this study suggest an asset-based community development approach would focus on the benefits of a group setting for people.   

The Local Government Association’s Future of Adult Social Care web pages discuss day centres, along with other traditional care, as part of a much broader local offer. Suggesting the inclusion of smaller, more bespoke providers, micro-enterprises, a vibrant voluntary sector, and wider community assets, such as community-owned care, mutual aid and shared lives.  

Adult day centres can provide services that support active and healthy aging for older people but careful consideration and a clear strategy for the support of people with more complex needs, including the role and nature of day care is vital (LGA report,2016). 

Adult Day Centre – Complex needs 

In January 2023 the LGA published a report on bespoke support for people with learning difficulties and autistic people. The report explores ‘new, current, and emerging models of support for autistic people and people with a learning disability to assess efficiency and effectiveness in meeting individuals’ aspirations; that draw on care and support which upholds human rights, enables citizenship and empowers people to have choice and control over their lives and the impact this has on outcomes’. This report is narrative based and draws on lived experiences from people with learning disabilities and autism, their families and relevant support organisations to offer both best practice and potential long-term solutions. Key to potential positive change is stated in the findings: ‘Local authority areas are having to do their own exploration about what’s possible, what’s available and new ways of making things happen’. Additionally, the provider market seems to be willing to work in this bespoke way but needs support from commissioning in order to do things differently, demonstrating change is occurring away from traditional ways of day care.  

Adult Day Centre – New models  

Key considerations within proposals for change to adult day services are that provision should be community based, personalised, and include reablement. 

Hagan and Maktelow (2021) explain that to personalise care encourages service providers to think more creatively about their service to actively include relevance and be meaningful and must include older people’s views and active participation. This study maintains that service providers need to be conscious of the adequacy of follow-on strategies when adopting such a model, as well as ensuring that the experience at the day centre remains as inclusive and involving as possible for those attending.   

 Reablement is an intervention that is an individualised care provision supporting independent living. Focusing on helping clients relearn how to do things for themselves rather conventional home care. Aspinal and colleagues (2016) concluded their study on reablement, older people and independence by asserting different local and national services are trying to pioneer new and better responses to long standing policy challenges in adult social care. Finally, stating the emerging decisions about future services are being based on intuition, professional experience, and the lived experience of older people.  

3.2 Local Engagement  

The following views were taken from the Council’s previous consultation with people who use the services and their carers.  

• It has been alleged previously that ‘There has been limited promotion of the in-house day services’.  
• ‘Carers are critical to the wellbeing of the person they care for and make a significant contribution to the sustainability of the health and social care system. These services are important to them. 
• ‘Concerns over current usage within in-house services. Why are people not accessing these day services?’ 
• ‘The importance of consistency and quality of service’ 
• Transport is important to people 
• ‘Confidence in an alternative offer’ ‘An ability for any future provider to meet the care needs of individuals’.  
• ‘A need for a suitable transition plan for individuals if there were changes’ 
• What about people who need to access day services in the future, this needs consideration 

Responses below are taken from the Engagement Summary – Learning disability (December 2017).  

• For us to be in a safe environment, with people who understand us 
• To have purpose in activities we take part in 
• To have consistency and familiarity in what we do, who we are with, and where we are too. Change is difficult for some of us, so it needs to be taken at the right pace 
• Skilled staff who have the right training to be able to give us the best chance to thrive, whatever our level of need 
• Some people have stated that promoting independence is not a realistic proposition for everyone  
• If possible, we would like to access help and support locally, so we can reduce the time spent travelling and be closer to our families 
• Most of us consider our friendships with people we spend time with during day and overnight as very important. These relationships are with our family and loved ones as well as with carers and other people who use services which have taken a long time to build 

3.3 Local day care provision  

There are currently approximately 481 people receiving a day service in Devon (In-house and commissioned services). Of those receiving a day service approximately 253 people have a Learning disability, 169 people are aged 65+ and 69 people have other types of needs eg: they require mental health support or have a physical disability. 

The Council commissions 81 independent sector providers, to deliver day services in Devon, and 53 of these services support individuals with a Learning Disability.  

The number of people accessing learning disability day services in Devon decreased from 250 people in 2016 to 208 people in 2020. There was a further reduction during the pandemic.  Following the pandemic, the use of services increased and remains at approximately 250 people.  

As stated above, some people have suggested that the reduced number of users is due to the service not being promoted widely, or to the operational practice of sourcing care and support in the independent sector. They may also conclude that the reduction in use of in-house day care has been engineered by the Council. 

In line with the national picture and the ambitions for people with a disability, the Council invested in its Reaching for Independence service in 2018. This service works alongside people with a disability to enable them to access community services, such as transport, employment, and activities.  This type of service is an example of the changing nature of day opportunities.  

The model of day services in the independent and voluntary sector providers locally has changed over this time and is now more varied. For example, day opportunities include opportunities on farms or within a horticultural setting.   

People who receive their support through a direct payment, or using their own money, may directly access day opportunities within their local community. As these services are not purchased directly by the Council, the Council is not able to comment on the number of people accessing day opportunities in this way.  

The Council contacted the day services providers across Devon and surrounding areas in July 2023. In total 53 providers responded (some older people services, some learning disability services and some for people with other needs). 

Summary of Information collated from Day Service providers – July 2023 

• 38 providers of the 53 respondents, deliver services to individuals with a learning disability and 27 of these had vacancies. 
• Of the 15 providers who deliver services to older people, people with a physical disability and people with other needs, 4 had vacancies. 
• 68% of the 53 respondents said they would consider expanding in the future. 
• 5 services that support older people and people with a physical disability. 
• 31 learning disability day services. 
• 15 providers support older people, people with a physical disability and people with other needs. 
• 30 learning disability providers have full wheelchair access in communal areas  
• 19 learning disability providers have assisted bathrooms.  
• 25 learning disability providers have communal spaces and spaces to enable individuals to have quiet time. 
• 12 learning disability providers have hoist/tracking  
• 55% of respondents offer replacement care/respite for carers. 23 learning disability providers and 6 providers who support other needs offer replacement care/ respite for carers. 

3.4 Locations of day services 

The Council commissions 81 independent sector providers, to deliver day services in Devon, and 53 of these services support individuals with a Learning Disability.  

The table below shows the Devon County Council commissioned independent providers within an approximate 30-minute drive of the Devon County Council centres within the scope of this consultation. Source: Devon County Council Commissioning Data  

Name	Number of day care services within an approx 30-minute drive time  NB: providers could be included in more than one drive time zone
Lyric, Okehampton	10 (plus 2 Services for people with other needs)
Newholme, Honiton	12 (plus 8 Services for people with other needs )
Rosalind House, Tiverton	11 (plus 3 Services for people with other needs)
Silverhill, Barnstaple	8 (plus 4 Service for people with other needs )
Tumbly Hill,  Kingsbridge (Older people and LD services)	5 Learning disability services No service for people with other needs

Map 1 – Learning Disability Day Services 

Map 1 shows locations of all 53 commissioned learning disability independent sector day services and in-house learning disability day services in Devon and surrounding areas. This includes the services within an approximate 30-minute drive as displayed in the table as well as those further away. (Please note some of the blue circles represent more than 1 day service)

Map 2 – Service for people with other needs

There are no day services for older people within an approximate 30-minute drive of Tumbly Hill day service in Kingsbridge.

Map 2 shows locations of independent sector day services for people with other types of needs, and the in-house older person’s services in and out of scope. This shows the services within an approximate 30-minute drive as displayed in the table as well as those further away. (Please note some of the blue circles represent more than 1 day service)

3.5 Needs assessment and potential future demand  

It has been raised that young people with a learning disability transitioning from Children’s services, may need day services in the future.  

The Council has recently undertaken a needs assessment and supply mapping of day services in Devon and the findings indicate that the number of people with autism, and emotional and mental health needs, and needs associated with their speech and language will increase.  

The future requirement for day services for people (18 – 64 years) with a learning disability has been calculated using activity data from the recent past. It shows that approximately 204 to 246 individuals with a learning disability are likely to require day opportunities support in the next few years. 

When reviewing young people with an Education Health and Care Plan (EHCP), those people with the area of need of severe or profound learning disability is predicted to remain consistent over future years. There is greater growth in the moderate learning disability area of need. This area encompasses a broad spectrum of needs.  

When tracking young people with an Education Health and Care Plan (EHCP) for moderate learning disability (MLD) into adult day services, we found few individuals’ needed day services.  Specifically, in 2016, of 47 people with a moderate learning disability, 2 people went on to receive a day service. In 2023, of the 152 with a moderate learning disability, 8 people went on to receive a day service from adult social care. Therefore, historically, most young people within this Education Health and Care Plan area of need have not required a day service on transitioning from children’s into adult’s services.  This data suggests that the numbers of people with a learning disability who require a day service are not likely to increase significantly.   

The PANSI (Predicting Adult Needs and Service Information system) methodology for predicting population growth, suggests that numbers of all individuals with a moderate to severe learning disability in Devon will increase from a baseline of 2499 in 2020, to 2567 in 2025, and up to 2674 in 2040 (age range 18 to 64 years).  

3.6 Financial Considerations and Best Value 

This is a time of significant change for English local government. Despite the government increasing funding for councils over recent years, a combination of high inflation and rising demand has left local authorities facing some of their toughest budgetary decisions to date. 

Growing demand, increasing complexity of need and higher than anticipated inflationary pressures have imposed huge pressures on public services. This is resulting in an unprecedented and increasing number of local authorities facing deep financial distress. 

Devon County Council has a best value duty; the requirement of which is set out in the Local Government Act 1999 to “secure continuous improvement in the way in which its functions are exercised, having regard to a combination of economy, efficiency and effectiveness.”.  

One aspect of best value is the price the Council pays for its services. In reviewing the average costs of day services, and those day services within this consultation, the costs of providing the service in-house is is generally more than the independent and voluntary sector. A Council’s terms and conditions, for example provision of a local government pension scheme, is one reason behind the higher cost for services, which any Council provides. 

References 

• Office For National Statistics. Population Data (2020).
• Mencap (2023) How Common is a learning Disability. Online accessed 29^th September 2023. 
• World Health Organization. (‎2015)‎. World report on ageing and health.
• The Commissioning or Providing Day Services – March 2022.  Association of Directors of Adult Social Services 18 Smith Square, Westminster, London. SW1P 3HZ.
• Orellana et al (2021) Choice, control and person-centredness in day centres for older people.  
• The future of adult social care (2019) online accessed 20/07/23
• Learning Disability Services Efficiency Project Interim position report. (2011)
• Bespoke support for people with learning disabilities and autistic people | Local Government Association (2023)   
• Hagan, R., & Manktelow, R. (2021). ‘I shall miss the company’: Participants’ reflections on time-limited day centre programming. Ageing & Society, 41(12), 2933-2952. doi:10.1017/S0144686X20000689 
• Fiona Aspinal and others (2016) New horizons: Reablement – supporting older people towards independence, Age and Ageing, Volume 45, Issue 5, September 2016, Pages 574–578
• National Institute of Health and Care Research (2023). Funding Call.
• Lunt et al (2021) Outcomes for older people with long-term conditions attending day care services delivered by paid staff or volunteers: a comparative study. Palliative Care & Social Practice 2021, Vol. 15: 1–15 DOI: 10.1177/ 26323524211030283

4.0 Glossary of terms 

Care Act Assessment: Gathering and discussing information to develop an understanding of the needs of someone who appears to require care and support. 

Commissioned service: Care, support or supervision that has been arranged and paid for on an individual’s behalf by a public authority, like a council. 

Day Services: Adult day services or opportunities, often referred to as adult day care, are programs and facilities that provide a range of social, recreational, and supportive activities for adults who require supervision and assistance during the day. These services are designed to support older adults, individuals with disabilities, and/or those with cognitive impairments. They also provide respite for carers. Activities may include social interaction, meals, practice of independent living tasks, readiness for employment, among other things. The activities may be indoors in a purpose-built centre, outdoors or within a person’s home, or a combination of these. This support enables people to remain in the community. 

Education, Health and Care Plan (EHCP) – Schools in England must provide support to children with special educational needs (SEN) as part of their standard offer to children. This is called SEN support. Where a child requires additional support that goes beyond what a school, college, or nursery can typically deliver from their own budgets or staffing then they may need an Education Health and Care Plan (EHCP). An EHC plan is a legally binding document outlining a child or teenager’s special educational, health, and social care needs. Parents and carers can apply to the local authority for an EHCP needs assessment.

Equality Impact Assessment (EIA): Assessments carried out by council officers to help understand the impact of proposed changes on people with protected characteristics. These are: age, disability, sex, gender identity, race, religion / belief or none, sexual orientation, pregnancy and maternity, and marriage and civil partnership.  

Government: The offices, departments, and groups of people that control the country. 

Legislation: A law or a set of laws that have been passed by Parliament. 

Local Authorities / Authorities:  An organisation that is officially responsible for all the public services and facilities in a particular area.  

Personal Budget: – A personal budget is the amount of money the local council will pay towards any social care and support the individual needs. 

Protected characteristics:  There are things we need to consider when we think about making changes, such as the impact on people because of age, sex, gender identity, disability, race, religion or belief, sexual orientation, pregnancy or maternity, marriage and civil partnership and carer’s responsibilities. 

Reaching for Independence (RFI) service: This is a short-term offer, it is focussed on supporting people within the community, to connect to their community. The service supports individuals to identify specific and achievable goals that enable them to become more independent or completely independent.  

Replacement care: This is a term that is broader than respite and covers needs wider than offering a break from caring, plus it is the term used in the Care Act 2014. Replacement Care relates to the provision of a one-off or recurrent service that specifically addresses the need of a carer for a break from caring responsibilities, or allows other carer needs such as access to employment or education to be met, by providing a service to the person requiring care. 

Stakeholder: A person with an interest or concern in the service. 

Statutory Duties: Functions that the council has a legal obligation to provide.  

Statutory responsibility: Something that the council has to do or provide because the government regulations say that all Councils must do.  

The Council: Devon County Council, DCC 

5.0 How to have your say

Full details about this consultation including any supporting documents are available online.  

We would be very grateful if you could take the time to respond to the questions outlined below. If you would prefer to provide your answers verbally instead, you are welcome to attend one of the face-to-face sessions set out below. 

You are welcome to complete the questionnaire even if you have attended one of the face-to-face sessions. 

5.1 Face-to-face and online consultation meetings  

Location	Date and time of the meeting
Tiverton Hotel, Tiverton	Monday 20 November 10:30am – 12:30pm Book your space
The Beehive, Honiton	Tuesday 21 November 10.30am – 12.30pm Book your space
Barnstaple Library	Monday 27 November, 11am – 1pm, Book your space
Kingsbridge Library	Monday 4 December, 1.30pm – 3.30pm Book your space
Ockment Centre, Okehampton	Tuesday 5 December, 10.30am – 12.30pm Book your space
Online consultation meeting	Tuesday 5 December, 6.30pm – 8.30pm Book your space
Online consultation meeting	Monday 15 January, 1.00pm – 2.30pm Book your space for 15 January

5.2 Other ways to have your say 

Please complete this online questionnaire.

6.0 What happens next? 

The consultation ends on 16 January 2024. The final decision will be based on the requirements of the County Council’s Strategic Aims, the completed Equality Impact Assessments and other factors as well as the outcome of this consultation process. 

We will notify you of the decision and this will also be made available via the Devon County Council website.

If you have any queries relating to this consultation please email APSConsultation@devon.gov.uk.