Agenda Item 4 Report to Cabinet 19 April 2017 Subject: Presenting Cabinet Member: Day Services for Older People (Key Decision Ref. No. SMBC1621) Social Care 1. Summary Statement 1.1 On 18 May 2016, Cabinet approved the commencement of formal consultation on the future delivery of Day Services for Older People from council provided Extra Care Schemes; Holly Grange, Smethwick and Manifoldia Grange, West Bromwich (Minute No. 77/16 refers). The following options were presented to the public as part of the consultation: 1. Option 1 - For the services to remain open and stay as is 2 Option 2 - For service delivery to cease with existing users to be supported to suitable alternative placements within the Independent sector. 1.2 This report details the consultation process undertaken, feedback received and considerations and recommendations to inform Cabinet s decision on the future approach to the delivery of these services. 1.3 The Consultation process Formal consultation about the options took place during autumn 2016. During this period, views and comments were sought from; People who use the service and their families The Community Ambassadors Stakeholders The general public Effected staff and Trade unions
1.4 Consultation was through attendance at face to face meetings, forums and a stakeholder event. Information around the consultation was distributed via the internet and a council website survey (with paper alternatives) was made available to the residents of Sandwell. Please see Appendix 1 and 2 of this report for the full findings of the consultation. 1.5 Feedback from consultation As would be expected the as is option was the preferred option for service users, their families and staff. This was also supported by the majority of those completing the public survey. However 44% of the respondents to the public survey supported option 2. A number of issues were raised through the consultation process. The current attendees of day services stated a preference to retain their friendship groups which would be difficult to achieve within alternative independent sector services. Concerns were also raised about the availability and quality of these alternative day support options. It is also recognised that a significant number of the people attending day services at Holly and Manifoldia Grange have a degree of confusion/ dementia. 1.6 Current utilisation There has been a gradual decline in the number of people accessing the day services for several years. In total 7 people use the service at Manifoldia Grange and 10 at Holly Grange. Given the relatively small client base and the under-utilised capacity, the unit cost for these Day Services is significantly higher than the average locally commissioned rate. 1.7 Capacity in the independent sector Examination of the voluntary and independent sector Day Care provision showed a limited capacity and restricted choice options. The use of Direct Payment may provide service users with an alternative and more flexible approach to meet their individual needs.
1.8 Preferred Option Taking into account the feedback from consultation, the views of the current day service users and their families and the availability of alternative options within the independent sector an alternative option is recommended. This would involve maintaining day support for all current attendees but relocating the services from Manifoldia and Holly Granges to Walker Grange, Central Avenue, Tipton. Walker Grange is the Council s third extra care scheme which also provides a 7-day borough wide specialist day service for older people with dementia. This would enable current access to day services to be continued and support friendship groups to be maintained. This option recognises that the dependency of current users is increasing, in many instances due to the development of dementia. Walker Grange is well placed as a specialist dementia service to appropriately support these individuals. There are adequate facilities to accommodate the current users from Manifoldia and Holly Grange within this established day service. Minor capital investment would be required however to ensure that those without dementia have access to separate space and activities. The existing transport provision at Walker Grange will be used for the additional 17 service users. The travelling time spent on transport will remain within the recommended maximum of 45 minutes. Should current day services users not choose to relocate support will be provided for them to access suitable alternative placements. This option will improve value for money by consolidating services on one site, and provide current and future users with sustainable service options within in-house services. This option also supports the delivery of the Adult Social Care budget strategy realising annual savings of 128,000k. 1.9 Workforce implications Consolidation of the day service activity to Walker Grange will impact on the current staffing establishments. It is proposed to delete 7 vacant posts in the Day Care Services across all three Granges to deliver the required efficiency savings as detailed below:
Job Title Band No of Posts FTE Carer/Driver C 4 3.24 Day Care Assistant B 1 0.49 Day Care Assistant C 2 1.62 Total 7 5.35 To support the increased activity at Walker Grange it is proposed to transfer a carer/driver post from Holly Grange to Walker Grange. The remaining day care staff at Manifoldia and Holly Grange detailed below will be used to increase the care provision at both Granges thereby reducing the need for agency, temporary staff and overtime. This will also support the increased level of needs which are emerging at these schemes. Job Title Band No of Posts FTE Carer/Driver C 2 1.62 Day Care Assistant B 3 1.47 Total 6 3.09 No staff will be displaced by this proposal. 1.10 Should the proposal be approved a 30-day consultation period with staff directly affected and their trade union representatives will take place. A selection process will be developed to enable this proposal to be implemented. 1.11 An initial Equality Impact Assessment was produced in May 2016 and has been updated in line with the proposals contained in the report. The proposal will result in alternative day care placements continuing for the service users who currently access Manifoldia Grange and Holly Grange so there will be no loss of service. Following a review of their needs, support will be provided to service users to access suitable alternative placements for those who choose not to relocate to Walker Grange. The proposals will achieve savings through the deletion of vacant posts, there will be no staff displaced. The extra care service has operated with temporary staff throughout the period of this review. The reallocation of staff described in this report will reduce the on-going need for agency and temporary appointments and will provide a stable workforce to support those within the extra care schemes to maintain their independence within this community setting.
1.12 Consultation with Unions commenced in December 2016 and has continued throughout the consultation period with Trade Union representation at all staff face to face meetings. Updates have been provided during this time at JCC Direct Services sub group meetings including the meeting on 15 March 2017 and the contents of this report will be presented to the Adult Social Care, Health and Wellbeing JCC prior to Cabinet. 2. Recommendations 2.1 That Cabinet approves the consolidation of Day Services from Holly Grange, Smethwick and Manifoldia Grange, West Bromwich at Walker Grange, Tipton. 2.2 That in connection with 2.1 above, the Executive Director of Adult Social Care, Health and Wellbeing is authorised to: i. Engage residents and family members on the proposal to relocate services to Walker Grange, Tipton and complete individual community care assessments of need for current service users ii. Commence the statutory consultation process with all relevant employees and unions with regard to the selection process iii. Implement proposed changes should no significant issues arise from this consultation iv. Delete the vacant posts as set out below: Job Title Band No of Posts FTE Carer/Driver C 4 3.24 Day Care Assistant B 1 0.49 Day Care Assistant C 2 1.62 Total 7 5.35 David Stevens Executive Director - Adult Social Care, Health and Wellbeing Contact Officer Chris Guest, Divisional Manager 0121 569 5495
3. Strategic Resource Implications 3.1 Financial implications of the proposal. The recommendations involve the deletion of 7 (5.3 FTE) vacant posts and the reductions are anticipated to deliver annual savings of 128,000. The savings within day services for older people will contribute to the delivery of the 2017/18 budget strategy for Adult Social Care. 3.2 Implications for the workforce. The proposals will have an impact on the current staffing group. Subject to Cabinet approval of the proposal 7 (5.3 FTE) posts will be deleted. Existing day service staff will be deployed across the Granges to provide additional care and support to meet the increasing needs of tenants. The following vacant posts within Manifoldia Grange to be deleted: Job Title Band No of Posts Hours Care Assistant C 1 18 Carer/Driver C 2 60 The following vacant posts within Holly Grange be deleted: Job Title Band No of Posts Hours Carer/ Driver C 2 60 The following vacant posts at Walker Grange will be deleted in order to deliver the savings required: Job Title Band No of Posts Hours Care Assistant C 2 60 3.3 Implications for the Council s material assets (including the Asset Management Strategy). There are no implications for the Council s material assets (including the Asset Management Strategy.
3.4 Risk assessments The Corporate Risk Assessment has been complied with to identify and assess the significant risks associated with the proposal. This includes (but is not limited to) political, legislation, financial, environmental and reputation risks. No red risks have been identified. 4. Legal and Statutory Implications 4.1 Care Act Requirements The Care Act will have implications on the implementation of this proposal as Sandwell Metropolitan Borough Council must remain compliant with new legislation. The recommendations made, are fully compliant with the Care Act 2014, the Mental Health Act 1983, the Mental Capacity Act 2005, and the Health and Social Care Act 2008. The Report considers three day services which fall within the Extra Care Scheme. The report details a change in service delivery with regard to two day services for older people. The third day service will continue to be provided directly, as it is a specialist service supporting those with dementia. When making a decision involving adult care services the Care Act 2014 duty requires the Council to, promote the adult s wellbeing being, promote diversity and quality in the local care market and ensure there is cooperation between the Council and other relevant organisations. As the Council is considering a change which will affect adult social care services the Council must comply with and have due regard to its Public Sector Equality Duty under Section 149 of the Equality Act 2010. The Council must also undertake an effective consultation process in accordance with the Guidance published under Section 3 of the Local Government Act 1999. With regard to Care Act 2014 wellbeing and diversity/quality of care duty, this report has identified the need to retain a specialist local dementia service. Adult wellbeing has been further considered by the proposal of alternative options to those services subject to change. Diversity and quality in the local care market has been outlined in the report and detailed during the consultation process and the Equality Impact Assessments (EIA).
The two services subject to change have been publicly consulted upon in accordance with the Council s consultation duty. The consultation process was for 12 weeks and involved a range of relevant organisations and diverse population. The proposals were disseminated using diverse and accessible media, including face-to-face meetings. The common concerns identified during the consultation process must be carefully analysed throughout the decision making process. Members must consider whether a change in service as detailed in the report disproportionately disadvantages those with a disability and/or those whom share a protected characteristic as defined within the Equality Act 2010. The EIA s attached to the cabinet report provide sufficient information for elected members to analyse and consider the impact of the proposed changes in accordance with the Councils duty under the Equality Act 2010. Decisions involving a change or cut in service may have a higher risk of judicial review. Judicial review involves supervision of administrative decision making and involves a judge considering whether a public body acted in a lawful manner during the decision making process. Members must undertake robust consideration of the evidence supporting a decision and provide fair reasons for the final decision. Decisions must therefore be fair, lawful and proportionate. 4.2 Employment Legislation Under Section 188 of the Trade Union Labour Relations Act 1992 for the purposes of consultation the employer must satisfy and disclose in writing the following: a) The reasons for the proposal The reason for the restructure is contained in the report, namely to reduce budgets and secure value for money, which enables the Directorate to best respond to the Chief Executive s work priorities and the Scorecard priorities. b) The total number of employees of any such description employed by the employer at the establishment in question A structure chart setting out the current number and banding of posts across Day Services. c) The number of agency workers working temporarily for and under the supervision of the employer There are no agency employees who are affected by the proposals.
d) Those employees on fixed term contracts will be treated no less favourably than permanent employees pursuant to the Fixed Term Employees Prevention on Less Favourable Treatment] Regulations 2002 The principles of the Equality Act 2010 will be adhered to in respect of applying Council policies. 5. Implications for the Council's Scorecard Priorities The proposal supports the Scorecard Priority of Healthy Lifestyles and Getting the Resources Right and contributes directly to the scorecard priorities of Great People by: We will help people who need social care to live as independently as possible and to live in their own homes by: Listening to the voice of users/carers, and their families through our complaints system, specific consultation and by encouraging feedback; improving the care services we provide; allowing people to manage their own care budgets; and supporting those who care for them 6 Background Details 6.1 The Adult Social Care budget strategy includes a number of options for reducing the costs of delivering services that are currently provided inhouse. The SMBC review of services in Autumn 2015 was undertaken to appraise, identify and evaluate opportunities to secure better value for ASC Direct Services (those services which are provided by the council). 6.2 The council s Day Opportunities Service was included in the scope of the review. The review set out to determine: If the service provides a value for money offering; If the service can be procured within the market place more efficiently and cost-effectively whilst maintaining service quality; and If service is being delivered in an appropriate way for the future. 6.3 The Day Opportunities service at Manifoldia Grange and Holly Grange is operating significantly below the maximum capacity and does not provide value for money.
6.4 The council is seeking to make significant reductions in cost and, if savings are to be made in the operational (and other) costs associated with Direct Services, options may need to be considered. 6.5 Achieving these savings will not result from service specific changes alone, but will require Sandwell to re-think the way in which ASC Direct Services are delivered; characterised by a shift which places further emphasis on Sandwell s role as a commissioner of services. 6.6 Based upon current occupancy levels of 28%the average cost of day opportunities at Manifoldia Grange and Holly Grange are 95 & 113 per day respectively. This is more than twice the market rate for the average locally commissioned day service. 6.7 A consultation process with the 25 users of the day care service, their families, carers, staff and other stakeholders was undertaken for 12 weeks between 23 May 2016 and 14 August 2016. See Appendix 1 Day Care Consultation Framework. 6.8 This engagement process comprised of three meetings with service users (one which was attended by Councillor Taylor ), three meetings with staff and unions and two half day engagement sessions. 6.9 Consultation Feedback The main themes emerging from the consultation process were as follows: Although people would prefer the service go stay as is they acknowledged the costs and reduced capacity did not represent value for money Staff shared concern for the service users and their future service provision Questions were raised about alternative employment through the Job Promise. Staff said they had been kept informed and were aware of what to expect if the decision made was Option 2. Overwhelmingly positive feedback regarding day care service provided at Manifoldia and Holly Grange which was universally acknowledged. All stakeholders were extremely complimentary regarding the service provided. Questions were raised about choice and quality of services within the independent sector. There was a request to stay with friendship groups. 6.10 The Ambassador Group session attracted 12 people and at the Stakeholder event was attended by 18 people.
The main themes that emerged are as follows: Although participants did not necessarily agree with the proposals to change current service provision, there was acknowledgment that there are low numbers of people currently using the existing day services There was broad agreement that there should be more alternatives to traditional day care to meet with older people s growing expectations Make access to services easier: during discussion participants felt that there are similar services already in place in Sandwell. More awareness needed and signposting to ensure people can make informed choices. There was some positive feedback about potentially commissioning services out instead facilitate organisations coming together different providers to provide day services instead of the council providing them directly More awareness of prevention services, such as: Community Offer, Friends and Neighbours is required. These services prevent isolation and loneliness and enable people to re-connect with communities (if individuals wish) and would be useful for local older people 6.11 A public survey was made available on the Council s website on 23 June to seek the views of the residents of Sandwell on the best option for the future provision of Day Care services at the Granges and whether they provide value for money. There was a low response to the public survey with 34 completed forms received about value for money and 36 with regard to the options. Of the 36 the survey 56% supported Option 1 and 46% Option 2. See Appendix 3 for results of the public survey. 6.12 Two options were put forward for consultation. The analysis shows that the preference is for Option1 to remain as is. However, the service does not provide value for money in the current economic climate.
In order to find the savings for the Council and to ensure the service is delivered in an appropriate way an alternative option is recommended; for users of Day Services to be relocated to Walker Grange and to support those who do not wish to attend to identify suitable alternative placements in the voluntary or independent sector.