9(2)

North Somerset Council

REPORT TO THE Executive

Date of Meeting: 15 December 2009

Subject of Report: Ebdon Court

Town or parish: all

member presenting: nigel Ashton, leader & executive member for adult social care

Key Decision: yes

RECOMMENDATIONS

The Executive is recommended to:

· Approve the mutual termination of the proposed development with Housing 21 for dementia care services at Ebdon Court

· Initiate a three month consultation process on the intention to close Poppyfields Residential Care Home, and

· Endorse the outline proposals for alternative use of the site as:

o Retention of Severn Day & Birnbeck Day Centres

o Technical Centre

o Community Meals kitchen

o Training facility for the Council, Independent Providers and Voluntary Sector

1. Summary of Report

The report explains the rationale for not progressing the proposed development with Housing 21 of a flagship dementia care service on the Ebdon Court site and how these services will be delivered alternatively.

The report provides the basis for initiating consultation to potentially close Poppyfields Care Home and considers the opportunities to utilise the Ebdon Court site for alternative purposes.

2. Policy

National Guidance

The White Paper Our Health, Our Care, Our Say (2006) illustrates that demographic change to the population through ageing is one of the greatest strategic challenges facing the UK today. It affects all policy areas and all Government levels, nationally, regionally and locally. A change in approach to meeting both health and social care needs is therefore regarded as necessary by national policy-makers, unless a far larger proportion of Government income at all levels is to be spent on these services for older people.

Adult Social Care Strategic Review

The Adult Social Care Strategic Review, echoed by the Joint Strategic Needs Analysis (JSNA), recommended redistribution of resources on preventative services in order to achieve more effective use of the overall budget across health and social care and to meet the personal care needs of older people. The following outcomes capture the essence of the proposed way forward:

· A range of preventative service and good quality housing in the community to meet the needs and sustain the changes

· Reduced numbers of older people entering care homes for personal care

· Reduced numbers of older people entering care homes for nursing care

The new prevention-focused service design will help prevent older people from having to go into residential or nursing care, and will help them back into their own homes after short stays in hospital, residential or nursing care. The services will:

· Enable older people to lead full, active and healthy lives for as long as possible.

· Enable older people to live independently in their own homes for as long as possible.

3. Details

3.1 Background

The services provided on the Ebdon Court site at present include the Poppyfields care home (18 bed, 15 permanent, 3 respite), 2 day services for people with organic mental health problems, principally dementia (Severn Day) and for people with functional mental health problems, like depression (Birnbeck) and also voluntary sector services for the same care groups run by the Alzheimers Society and Brunel Care. The site is also used to provide limited office accommodation for approximately 12 staff.

3.2 Housing 21

The process of identifying Housing 21 as a preferred partner for development via the competitive dialogue process was outlined in the October 2006 and June 08 Executive Reports.

The proposed development, in line with those reported in October 2006, included:

· 24 units of Extra Care Housing specifically designed for people with dementia and their partners/carers. This is proposed to be funded via Housing Corporation, and will include mixed tenure

· 6 outright sale Extra Care bungalows (sale proceeds to offset capital costs)

· 36 residential care, including provision for respite care, care following hospital discharge or other major changes in care needs

· Day services for people with dementia

· A range of carer and service user support services run by the voluntary sector organisations which are currently based at Ebdon Court

· TUPE transfer of approx 43 staff

In total this proposal would have a development cost of £3m, with on-going revenue costs of approx £700k per annum. Their preferred option for financing the development was:

· Contract length of 30 years for care services on the site

· Scheme passed back to the Council at the contract end

· Capital costs and cost of financing to be met within existing resources, achieved by the ability to flex the number of residential care beds available for self-funders. The number of commissioned beds was anticipated to be 27.

Key factors in this development was its ability to be delivered within the existing budget envelope and to be completed by mid 2011.

The Steering Group were established to outline proposals for the development of dementia services at Ebdon Court was retained to oversee implementation plans. This group represented a wide variety of stakeholders including service users, carers, Executive Member, Voluntary Sector, Avon & Wilts Mental Health Partnership and PCT. The group has operated on the basis of achieving a consensual view of the proposed service developments taking into account the views of all parties. They were involved in short-listing partners and working with Housing 21 on the development of plans for Ebdon Court.

3.3 Service Continuity

At an early stage Housing 21’s Construction Partners identified that given the spatial constraints of the site, a phased building development would not be practicable without additional time and substantial cost in excess of £500k which was deemed unaffordable. A phased development would have presented considerable challenges which would have included disruption to service users, their families and staff.

Discussions with Housing 21 focused on the identification of decantment facilities to ensure continuity of service for residents and staff. This would also require an alternative location for the day services. The only alternative to a decantment of the service would be to close Poppyfields and the Day Care on a temporary basis during building works. This was anticipated to take 14 months and would require redeployment of all staff or extended period of paid leave which was also deemed unaffordable.

Decantment options were explored with sites such as Diamond Court, however, after exhausting all options that didn’t result in significant cost, time delay or potential TUPE implications, the only alternative the Council were left with would be closure and reprovision of the day services elsewhere.

3.4 Extra Care

Housing 21 identified that Diamond Court, whilst not being a decantment option, would offer long term affordable extra care units for the area and were successful in securing £4.64m Homes & Communities Agency grant funding as well as £100k social housing grant to purchase Diamond Court.

In accordance with the Adult Social Care Strategic Review, affordable extra care will play a vital part of fulfilling the strategic objective of reducing reliance on care homes.

As a result of the Diamond Court development 52 units (mixture of 1 and 2 beds) of affordable extra care were made available from October 2009 for all service categories, including with the assistance of Telecare, units for older people with learning disabilities and dementia. The number of units is more than twice the original proposed allocation that would have been delivered in Ebdon Court, although recognise that Diamond Court is not a specialist centre for dementia care.

The Council is also aware of two significant (60 bed) independent sector dementia specialist care home developments in the Weston and Worle area, which will increase dementia bed capacity and question the capacity requirements for the additional 18 beds proposed at Ebdon Court.

3.5 TUPE

Without a readily available decantment location, detailed discussions with Housing 21 explored options for transferring service users out of Ebdon Court and utilising existing staff. This proved impractical in operational terms given the potential implications of TUPE and when it would apply.

The definition of TUPE is the Transfer of Undertakings (Protection of Employment) Regulations to preserve employees' terms and conditions when a business or undertaking, or part of one, is transferred to a new employer.

It is clear from other TUPE contract arrangements that providers are more adverse to accepting risks associated with TUPE and the impact on pension investment streams has substantially raised these risk levels.

In addition to the Council accepting liability associated with a fully funded scheme on entry (as per other transfer agreements), Housing 21 tabled in September 2008 three further TUPE principals that they expected the Council to comply with. They were:

· Capped Pension Contributions

· Indemnity for Ill Health & Early Retirement

· Bullet Payment

These indemnities could not be accepted by the Council, due to the additional cost and risk associated with them.

3.6 Financial Viability of Redevelopment

In addition to the TUPE issues, the Council highlighted some areas requiring clarification in the financial model to ensure that the services could be delivered within the budget envelope. The Council updated the budget information provided to Housing 21 for 2009/10 and asked Housing 21 to refresh their data.

On scrutinising their revised information, there remained some inconsistencies in their modelling which have additional cost implications to the Council. These are outlined in the table below.

	£
Housing 21 revised revenue price	811,115
Existing budget provision	752,300
Shortfall	58,815
Adjustments identified by NSC
Reprovision of Birnbeck Day Centre	136,600
Fee Income ‘gap’ on provision	70,905
Reprovision of day care transport	72,000
Ongoing Revenue Shortfall	338,320

The Housing 21 resubmission of costs implies an ongoing revenue deficit in the region of £338k.

The financial model was also reliant on the extra care units, particularly the 6 outright sale bungalows, to offset some of the capital costs associated with the build. The current market for private sales has significantly declined. Given the wider availability of extra care in the Worle area, Housing 21 were requested to consider the financial model excluding extra care, however, this further extended the financial deficit.

It was intended that the number of beds commissioned by the local authority could be flexed and minor adjustments of the capital financing options could be made in order to balance the budget. However, the size of the ongoing revenue deficit shared with Housing 21, coupled with the impact of the recession for capital financing, has led to Housing 21’s confirmation that the redevelopment is not viable within the budget envelope.

We would recognise that Housing 21 have made best endeavours to deliver the vision for the flagship dementia care facility and have tried to resolve financial and TUPE issues, however, the economic downturn and lack of a viable decantment facility has made the current proposal untenable.

Housing 21 now provide the care support to both Diamond Court and Lakeside extra care schemes and the Council remains committed to working with Housing 21 and other partners to improve services for people with dementia and their families.

3.7 Poppyfields Care Home

In the light of the above it is necessary to re-examine the issues that led to the 2005/6 proposal to close Poppyfields in order to reduce the Council’s expenditure, aligned with the strategic direction for the future development of services for Older People, as outlined in the Adult Social Care review and the Transforming Social Care agenda.

The weekly cost of a bed in Poppyfields Care Home is £772.90 per week. This is 74.3% higher than the cost of an equivalent 2* care home in the independent sector at £443.46. This difference in cost is not related to a commensurate difference in quality as both costs are for 2* rated homes. It is not therefore possible to demonstrate that Poppyfields delivers value for money.

The available resources for funding social care services are reducing as demand and demographics increase in North Somerset. As a result there is a need to ensure that expenditure is contained within the reduced resources available. North Somerset has a chronic over supply of residential and nursing care. Our commissioning strategies outlined in the Adult Social Care Review are based on reducing reliance on care home provision. Given the need to contract supply in the general market the justification for retaining an in house service that costs more than equivalent independent sector provision cannot be made.

There are currently 12 out of 15 permanent placements occupied in Poppyfields and approximately usage of the 3 respite beds is 65%. This under-utilisation will in the short term generate additional savings from reducing the reprovision costs, however, the fairest comparison between the existing provision at Poppyfields and equivalent independent sector provision is to assume that all 18 beds are available for permanent placement (e.g. respite provision generates variable income levels).

3.7.1 Savings Comparison

Notes		£
1	Expenditure	723,430
2	Income	(159,510)
	Poppyfields Net Budget	563,920
3	18 independent sector placements in a 2* home	415,079
4	Average income	(101,182)
	Net Cost of Reprovision	313,897
5	Net Budget Saving	250,023

1. This reflects the gross cost of providing the 18 bed unit. All costs relating to the delivery of other services at Ebdon Court have been excluded on an agreed apportionment basis. Notional central overheads (c£28k) are excluded from this exercise.

2. The income figure is the estimated income from fee recovery. This represents an average of £170.42 per week; however, given an income shortfall of c£47k, the true weekly contribution is £120.20. This is higher than the typical contribution of clients in the independent sector due to the higher charge; however, the difference is mitigated as the actual income includes respite provision which is lower and variable.

3. This cost reflects the authority’s standard fee for an EMI 2 star home for all 18 beds. It does not assume any level of vacancy in the reprovision cost which would reduce the cost, however, the standard fee takes no account of any exceptional needs payments nor does it include for the possibility that following care assessment service user needs may have changed.

4. The average contribution per week in the independent sector is £108.10; this is offset against the costs of reprovision as per Note 3.

5. The net budget saving represents the minimum annual revenue saving by reproviding 18 dementia care placements in the independent sector. The actual reprovision cost given vacancies and existing shortfalls may be higher. Furthermore anticipated future cost pressures, particularly in relation to staff pension contributions, will exacerbate the price differentials. Similarly potential cost pressures in the independent sector e.g. the threat posed by arbitration, could diminish these savings.

The above revenue savings exclude any costs associated with any potential redeployment, severance or redundancy for staff.

Poppyfields Care Home was built 1975. The fabric of the building has not changed for some considerable time and looks ‘tired’ and in need of investment for upgrading. The building is single storey and does not in its present structure make good use of the land available. There have been ongoing issues over the years mainly with the timber windows, timber cladding and the flat roof sections. The stock condition reports highlighted that at some stage in the future the wiring and heating systems will need to be renewed, replacement of which would involve extensive Asbestos works.

Poppyfields also does not meet the physical space standards set out in the National Minimum Standards, established by legislation. These standards (relating to room size and en-suite facilities) are currently only applied to new homes and those where the terms of registration are being varied. There is consequently no immediate requirement for Poppyfields to meet these standards, but the intention is for this legislation to apply to all care homes in the future.

If no requirement is introduced, expenditure on such alterations can only be avoided if the home remains unchanged for the foreseeable future. This would mean that the home would be unable to respond to the changing needs and expectations of current and future service users. If work were undertaken to achieve increased room sizes (for example) within the current building, this would reduce the number of beds available and increase the unit cost to an unviable level.

3.8 Alternative Usage of Ebdon Court

Subject to the outcome of the consultation stage, consideration has been given to alternative usage of the site to deliver Council objectives. A more detailed feasibility study will be undertaken to explore the potential cost and benefit of the alternative options for the site and will be subject to necessary planning approval.

· Retention of Severn & Birnbeck Day Centres and Voluntary Sector support services

The Council is committed to maintaining delivery of the specialist day care services and to enable the range of carer and service user support services to continue from the site.

· Technical Centre

Initial preferences would be to be a ‘centre of excellence’ for key prevention services outlined in the Adult Social Care Review.

The technical centre would be responsible for assessing, arranging and in some cases fitting, telecare and tele-medicine devices in the homes of individuals, in accordance with care plans. It would attempt to oversee all equipment and adaptation to individual homes.

The review considered this one of the most important components of the new vision and the biggest gap in existing services.

Invest to save funding has been identified via the review, £50k in 2010/11 and £50k in 2011/12, to develop this centre based on the Telecare Project findings due to complete in September 2010. No funding from Health partners has been secured, but will be revisited.

It is envisaged that this service will directly contribute to the concept of enabling people to remain in their own homes or sheltered/extra care housing and will help prevent people from having to be admitted to hospital.

· Community Meals Kitchen

The relocation and consolidation of two of the three existing community meals kitchen facilities, at William Knowles and Winscombe, to Ebdon Court. By utilising the existing kitchen, with minimal set up costs, this would offer greater accessibility, resilience to the service and a modest reduction in cost. There would be the potential to continue offer hot meals via community meals to service users attending the day care centres, which would further reduce costs.

· Training Facility for the Council, Independent Providers and Voluntary Sector

Relocating the training suite from Partnership House to Ebdon Court, a previous location for this service, will offer an excellent location to deliver training to the social care community, including council, independent and voluntary sector staff, the vast majority of whom are located in the Weston / Worle area.

The space vacated at Partnership House will allow the co-location of the first of the four new integrated care teams which had been developed under the Partnership for Older People Projects (POPP) initiative to deliver care to their local communities. The development and co-location of these teams was another key objective of the Adult Social Care Review focusing on helping people to resolve both health and social care problems and will have the specific brief to help them function well and safely in their own homes. The teams will be critical to establishing close working links with GP practices to help achieve the new service outcomes. Care plans will be outcomes focused in order to measure their impact.

The use of the vacated space as a training facility will significantly reduce the conversion costs on site for ICT and will allow greater use of the existing layout, for example, practical demonstration of manual handling, telecare equipment etc, than utilising the space directly for the locality teams.

4. Consultation

Poppyfields was considered for closure in the 2005/6 budget setting process and significant opposition was raised by carers and families which prompted the exploration of developing the site.

The decision to consult on closure will be shared with the Steering Group and staff groups including Unison on 7 December 2009. Each service user and their carer, and all stakeholders via the Steering Group, will be engaged in this detailed consultation. The wider Medium Term Financial Plan consultation on the budget will include the savings proposal to close Poppyfields.

The consultation process will seek to address some of the natural concerns and anxieties raised about the potential closure by ensuring that each service user and their carer will be provided with support and information on the availability of places in other homes in North Somerset, including visits prior to making a decision.

A current snapshot of available dementia residential care provision in North Somerset indicates that there is sufficient capacity to offer real choice for service users and their carers, at higher or equivalent care quality standard, as assessed by the Care Quality Commission. In the Weston area there are 6 homes of equivalent or above quality with sufficient vacancies to meet the needs of all existing residents.

Area	3 Star	2 Star	1*, 0* & NYR	Capacity	Vacancies
Weston-s-M	1	5		194	21
Clevedon	1	2		91	2
Portishead			1	81	0
Sandford		1		71	12
Nailsea			1	60	10
Winscombe			1	39	9
Backwell	1			23	1
	3	8	3	559	55

Of the above in 1*, 0* & NYR (Not Yet Registered) there is 1 home in each category.

Where necessary advocates will be provided and the service user, and their carers, will be fully engaged in the process of their move, paying particular attention to their wishes, feelings and anxieties.

There are 20.98 budgeted FTE’s at Poppyfields made up of 48 members of staff. Every attempt will be made to minimise compulsory redundancies, by offering redeployment, support into gainful employment with the independent sector, natural termination of extensions to contracts and casual arrangements and voluntary redundancies. If these prove unsuccessful compulsory redundancy may need to be invoked.

5. Financial Implications

The redevelopment of Ebdon Court cannot be delivered within the budget envelope and Housing 21 has confirmed their withdrawal from the project.

The provision of beds at Poppyfields costs the Council c£250k more than equivalent beds commissioned from the independent sector. This revenue saving excludes one-off redundancy costs.

Alternative usage is likely to have minimal set up costs, however, these could be mitigated by opportunity cost savings or avoidance of additional costs, e.g. solution for co-location of locality teams by freeing up Partnership House space.

6. RISK MANAGEMENT

The key risk of the proposals above is the lost opportunity of delivering a flagship dementia service at Ebdon Court. A transfer of service users in any circumstance is less than ideal and will need to be managed sensitively.

The future demand for dementia care services will not be met by existing provision alone, however, we are aware of two substantial new developments for dementia care services and potential re-registration of existing older people services to specialist dementia care.

7. Equality Implications

Equalities Impact assessments carried out to date suggest that older people with mental health problems encounter significant difficulties in terms of equal access to care services which promote independence.

Equality Impact Assessments will be undertaken which will identify the need to reduce the impact of closure on service users by ensuring that careful, individualised care planning is undertaken for each resident to minimise any distress and disruption caused in moving to another establishment.

8. Corporate Implications

The potential closure of Poppyfields and / or alternative usage, contribute to the following priority areas:

· ensuring older people are adequately supported

· addressing environmental concerns

· improved customer services

· maintain an affordable and sustainable level of council tax increase

9. Options considered

9.1 Redevelopment

The competitive dialogue process enabled potential partners to identify innovative means to develop the site within existing resources. As outlined above, Housing 21 has been unable to meet this fundamental requirement and have withdrawn from the project.

9.2 Retention

Long Term

Poppyfields unit cost has been consistently above the rate the Council commissions from the Independent Sector. The cost of in-house provision is consistently referred to the Council by the Care Home Associations when setting fee levels and forms part of their evidence in the current arbitration case although the reality is that Poppyfields represents 0.59% of the market.

By retaining Poppyfields, the Council would forego the opportunity to make significant savings and obtain better value for money through the provision of alternative placements.

There are unknown future costs associated with making Poppyfields meet the new space standards, which will involve substantial expenditure and will impact on capacity and value for money.

Short Term

Retention of Poppyfields for the lifetime of existing residents, with vacancies arising being used only for short term respite, would ultimately achieve the eventual closure of the home without the requirement to move permanent residents on. However, potential savings would be delayed by a number of years and the unit costs would increase substantially due to the inevitable drop in capacity. This solution is unlikely to deliver a safe, nor satisfactory, outcome for service users and their carers.

9.3 Closure

This would deliver savings, while still providing a service to residents and is in line with the strategic direction for older people’s services, but recognise this will cause distress to current service users, their families and staff.

9.4 Disposal

As a Going Concern

Disposal of the home as a going concern to an external provider. However, the new provider would still face the same issues with space standards and would need to develop the site. It would also be unlikely to be able to compete with the current fee rates as existing staff would transfer under TUPE to the new provider at their existing terms and conditions. There would also be the same risk and unknown cost of TUPE liability. Given the current economic climate it is unlikely that a prospective purchaser would be forthcoming.

Outright Disposal

This would generate a sizeable capital receipt; however, the challenges would be the reprovision of the day care centres and foregoing the opportunities to deliver the technical centre, address the co-location of locality teams, and the rationalisation and improvements for community meals.

9.5 Alternative Usage

The options outlined above for alternative usage are recommended based on the ability to deliver quick wins with minimal cost and potential opportunity savings, given the challenging financial context of the MTFP for both revenue and capital investment. They also recognise that with forthcoming increase in residential and nursing capacity in dementia care, the availability of 52 extra care units at Diamond Court as well as the retention of the day care services on site, much of the vision for dementia care services will have already been achieved.

In addition to the options outlined above, longer term consideration could include further investigation of the scope to deliver a small specialist care unit for service users with complex learning and/or physical disabilities as an alternative to expensive out of county placements. A similar case could be made for developing a centre for looked after children. There is little provision in North Somerset and costs for placing out of the area can be expensive.

Both of these options would need pump priming in order to undertake feasibility studies to determine the investment required to make the building fit for purpose and consider whether it would be suitable to continue to run the day centres from the site.

Author

Gerald Hunt, Assistant Director Finance, Resources & Strategic Commissioning

01934 634803

Background Papers

Executive Report Ebdon Court Review, 24 October 2006

Executive Report Ebdon Court Review Update, 3 June 2008

Executive Report Review of Adult Social Care – Services for Older People, December 2008.