The review of residential care services is one part of a broader review of all accommodation solutions for people with care needs, to help reshape accommodation services to better meet people’s needs now and in the future. As part of this review the future of the Council’s own residential care services was considered.
The Council has invested in two homes to provide dementia specific care, at Newton Abbott and Torrington. However there are few Council homes that lend themselves to the changes needed to meet best practice in dementia friendly buildings.
It is more effective to work with the independent sector, using our market intelligence, and to continue to invest in dementia care services to increase supply in identified geographic areas. Our approach to Extra Care Housing will also provide new options for some people in due course.
Intermediate care jointly provided with the NHS is being increasingly provided in people’s own homes when needed rather than in bed based care. This model is being used successfully in parts of the county and will be further developed.
However should short term bed based care be needed then there are schemes in place with the independent sector to provide places which the NHS rehabilitation staff then support.
We recognise the critical importance of respite and the role that our homes currently play in both planned and emergency respite services. This respite will be purchased from the independent sector, to provide the flexibility required, in order to supply the necessary provision in each area.
Devon County Council’s redundancy and redeployment policies and procedures are being applied with every effort being made to find suitable employment for the affected staff and to mitigate potential redundancies.
Some staff may not able to secure re-deployment to other services within the authority; this means these staff would be redundant and under Council policy would be offered voluntary redundancy.
These staff would have knowledge and skills valued in the independent residential care sector. Devon County Council has established links with employers from the independent residential care sector and those employing staff with skills similar to that of Devon County Council’s health and social care staff, with a view to highlighting vacancies within the independent sector to our employees.
Research has shown that the independent sector has some recruitment difficulties and therefore this liaison will be of benefit both to Devon County Council employees and the wider economy of Devon in retaining knowledge and skills.
Delivering a full range of accommodation based services to respond to people’s needs throughout their care journey is what the emerging Accommodation Strategy strives to achieve.
It is important to understand that demographic information shows growing demand. However the pattern of care is changing with more people wishing to stay independent in a home of their own for as long as it is safe to do so supported by community based services.
Devon County Council is responding to these changing needs increasingly in partnership with the NHS, other agencies and the independent sector.
The key challenges are to:
Everyone who is assessed for residential care and is eligible for public funding will continue to receive support from the County Council in arranging and purchasing their future care.
The consultation closed on 26th March 2014. The issues and concerns raised in feedback received together with the review findings have been carefully weighed against our ability to continue providing the same level of support, with the same eligibility criteria, for as many people as possible in the future.
Further questions and representations made at the extraordinary meeting of the Council on the 14th May 2014 were taken into account in the compilation of the recommendations.
The Impact Assessments for each home/centre consulted upon were updated during the consultation process where appropriate to do so and for recommendations and decision-making. All relevant Impact Assessments were provided to the decision maker alongside the recommendations.
A process of ratification followed with the matter examined further by County Council’s People Scrutiny Committee on 26 June 2014.
The decision to end provision of residential care services at 20 Devon County Council Care Homes was then final and could be acted upon.
There are currently three Extra Care Housing (ECH) schemes in operation in Devon – Okehampton (50 units), Ivybridge (32 units) and Newton Ferrers (25 units).
A further two ECH schemes are under construction in Bideford (59 units) and Newton Abbot (50 units – including 10 dementia care units) which are due for completion in spring/summer 2015 and will provide a further 109 units of housing with care.
Advanced design plans and funding packages are in place for a further two schemes in Totnes (60 units – including 10 dementia care units) and Exeter (50 units – including up to 20 dementia care units) which will deliver a further 110 units of housing with care. At this early stage, completion dates are estimated to be spring/summer 2016 for Totnes, and spring/summer 2016 for Exeter.
The Council launched a competitive tender in May 2014 to seek strategic development partners to develop a further 800 units of Extra Care Housing across market and coastal towns and the city of Exeter
units of Extra Care Housing across market and coastal towns and the city of Exeter
The Council is experiencing significant reductions in grants from Government. Having already reduced our staff level by over 3,000 across the Council we have to consider how we can still fund the same level of care we do now with a further reduction of £110m to come over the next three years.
It is more cost effective to invest in purchasing more care services in the independent sector, supporting development of the independent sector to meet our needs than to spend it on our homes.
There will be no changes to the eligibility for social care support and, for those in need of support, the process and threshold for access will remain the same.
Anyone currently using Devon County Council’s residential homes, including long stay residents and short stays for people currently receiving respite and rehabilitation services.
All public bodies, like Devon County Council, are getting less money from Government to provide services and need to make tough choices on how to reduce costs and save money.
This means Devon needs to look at everything it does, including adult social care and in particular whether it directly provides services when it is more cost efficient to purchase services from the independent sector.
Devon County Council is reviewing the Accommodation Strategy for older people in Devon to examine the range of accommodation options that will be needed in the county in the future, including the role of the Council as a direct provider of services.
A system change is needed as evidenced in the Government’s policy direction towards transforming community services and integration. This view was also supported recently by the Care Minister Norman Lamb. Answering a question from a Devon MP he said that he expected all local authorities to be commissioners of care, and not providers, implying working in the same way that the NHS commissions services.
Devon County Council already purchases around 90% of the care beds we need from the independent sector.
Devon County Council is committed to achieving these changes over a period of time with the minimum disruption as possible for residents. We have a lot of experience gained over many years of moving people to and from homes and will support a smooth transition of residents to new homes. There is also guidance available from ADASS (Association of Directors of Adult Social Care) that will be adopted.
Our information shows that the supply of residential care services exceeds demand in most areas for most types of care. We already purchase over 85% of funded residential care service from the independent sector.
We have been addressing the small pockets where there are a lower number of beds by providing grants and market information to providers so they can adjust their business model to meet our needs.
Each resident and their family will be contacted by an individual case worker to work with them to facilitate any change.
We will consider the full range of choices in any home that the family/ resident want us to consider. We wouldn’t see anyone being financially disadvantaged and will support individual choice.
There will also be a phased approach to the changes. See section 1.8.1 of the overall recommendation report for the phasing implementation.
In terms of quality the same regulator, the Care Quality Commission (CQC), oversees all homes whether they be DCC homes or other providers.
As our homes only provide around 10% of the beds we need, we could not care for the number of people we do if there were any quality issues with our providers. Our contracts stipulate quality requirements and we visit providers to check they are applied. Also our safeguarding procedures are robust and we respond to every alert.
We work with the CQC and our NHS partners facilitating networks of providers that work with health and social care specialists on quality assessment and improvement, including in specialist areas such as medicines management and access to NHS services.
We have had to reduce the number of beds we operate at the homes to maintain the level of staff to residents ratio required to meet Care Quality Commission regulations.
Many of the homes were not built to be care homes so the design and layout does meet the needs of residents in a cost effective way. So, for example, we have buildings with separate wings, separate floors, small numbers of bedrooms in any one area where we need to maintain good staffing levels. This leads to additional staffing costs – significantly so in a number of our homes.
We have tried to reduce costs in the past, however the CQC was critical of the staff to resident ratios, these did not reflect those achieved by the independent sector. So we have a choice, put more staff in or reduce the number of beds that can be supported.
We do not have more staff available within the budget for the homes to open more beds, and if we had then the staffing costs would also increase so our costs would stay high compared to the beds we can purchase in the independent sector.
We changed the number of operational beds in each home to one that we can safely support with the staff group of the home.
The single biggest differential between County Council run homes and the independent sector is staff costs. Our staff operate under Terms and Conditions that are mainly negotiated at national level with little that can be changed under local agreement.
DCC have an employer’s pension contribution approaching 27%, sickness is paid at full salary for six months; people are paid at the overtime rates if they are on holiday or are sick during Saturdays, Sundays or bank holidays if they would have otherwise been working.
None of this applies to the staff in the independent sector.
The Council seeks formal Nomination Rights to 100% of units developed with financial support from DCC. Referrals to these units will be made for people who have an assessed care need (under the national ‘Fair Access to Care’ policy) and a change to their accommodation needs.
We will seek to manage referrals into a scheme in line with the ‘dependency matrix’ below: