Agenda Item No. 7
The Vale of Glamorgan Council
Healthy Living and Social Care Scrutiny Committee: 16th May 2016
Report of the Director of Social Services
Accommodation with Care for Older People - Update
Purpose of the Report
- To inform Members of the progress made to date in providing a coherent strategy for the way in which the Council can help to ensure that the needs of older people for Accommodation with Care will be met.
1. That Members note the work that has been completed to date.
2. That Members request further updates on a six-monthly basis.
Reason for the Recommendations
1.& 2. To ensure that Members continue to exercise effective oversight of this important area of work.
- Across Wales and the rest of the UK, there are significant gaps in the range of accommodation options available to older people as they become increasingly frail, especially if they have significant needs for care and support. This position has multiple and complex causes, including:
- demographic factors;
- growing demand;
- limited housing stock;
- increasing co-morbidity and acuity in respect of the conditions that very old people characteristically suffer (including dementia);
- uncertainties about paying for care; and
- problems in ensuring that older people left on their own can live in close proximity with family members who can act as informal carers.
- As a consequence and despite increases in provision, older people do not have sufficient access to facilities such as step-up/step down accommodation which can help to avoid or shorten hospital stays. Extra Care and reablement provision has grown but not kept pace with demand. The properties owned by older people can be too big for them to manage or difficult to adapt.
- The Council's Commissioning Strategy for Older People's Services 2011-18 drew attention to the challenges involved in the provision of sufficient Accommodation with Care in a context where the market was not responding quickly enough to higher levels of need. It identified the need to put in place new service models which would provide increased support options at all stages of the older person's pathway. The Commissioning Strategy was designed to make best use of the resources available to social services by encouraging a reablement approach to care and reducing the pressure to accommodate growing numbers of older people in traditional residential settings. It involved developing further the use of assistive technology and a focus on partnership with other local authorities, the NHS, the third and private sectors to ensure that people are supported proportionately and in a way that maintains independence as long as possible.
- This work has involved providing an improved range of services, some of which are accessible to all and some of which are specialist, subject to eligibility criteria and cater for those with the most complex needs. Efforts to put in place the new service models have remained a priority for the Council. For example, recent proposals for use of the regional Intermediate Care Fund grant in 2016/17 contains a number of relevant schemes, as did previous versions of the Fund and also the Regional Collaboration Fund 2013-16. These matters are reported to the Scrutiny Committee on a regular basis. The strategy still aligns well with the objectives outlined in the Corporate Plan 2016-2020, especially Well-being Outcome 4: Objective 8 which has as its main action a review of accommodation with care options for older people and developing our commissioning strategy for future years (2016/17). .
- In 2013, a market position statement was produced which identified the principles that the Vale of Glamorgan would apply in redesigning services. "Our first priority is to support people to remain independent for as long as possible, delaying and in some cases avoiding the need for ongoing social care services. Supporting people to stay healthy and helping communities support each other is very important as we know that poor health and social isolation are factors that lead people to require social care services." This focus on a preventative agenda will be strengthened further as we implement the Social Services and Wellbeing Act 2014, which clearly articulates the need to support people at an earlier stage, before needs reach the point of crisis.
Relevant Issues and Options
- As indicated earlier in this report, some progress is being made in expanding the range of services providing accommodation with care. The Vale of Glamorgan's first Extra Care Scheme, Golau Caredig in Barry, has been a considerable success. Tenancies are quickly filled and there is a waiting list in operation. The scheme has demonstrated that, where suitable accommodation for older people exists, it is possible to maintain people in their own homes. We have accommodated tenants in Extra Care who were previously in residential and nursing homes or in their own homes with very high levels of care provided to them (to ensure their safety because their homes could not be adapted to their needs). Several people supported by the learning disabilities team have been very successful in managing tenancies in Extra Care, as well as individuals with complex mental health needs. As a consequence, there is a true community feel within the scheme.
- In 2011, a feasibility study was prepared regarding a site in Penarth that appeared suitable for creating an older people's village but this did not progress further at the time because of factors preventing access to the proposed site. More recently, the Council has been approached to facilitate further discussions in this matter. Some recent changes in assets mean that the Council is better placed to facilitate any proposal that may emerge. It has been able to sell two buildings (Bryneithin and Gardenhurst) that were in the Council's asset portfolio and managed by Social Services, which would allow funding to be reinvested. In addition, the Council has resumed direct management of two additional residential homes, Ty Dyfan and Ty Dewi Sant. The provision of funding through the Intermediate Care Fund grant is intended to ensure that additional capacity within Ty Dyfan residential home can be used to support people being discharged from hospital.
- However, significant challenges remain, given reducing financial resources available to the Council and rising demand for services for people aged over 65. Given the need for both capital and revenue investment, changes in legislation and policy need to be taken into account when planning service developments that will take some time to achieve,. For example, the impact of Welfare Reform is not fully understood for individuals in relation to access to benefits or the impact on registered social landlords (RSLs) regarding the social housing grant allocation and the effects on affordable rents. Social Services and Housing colleagues are working together to try to understand how these factors will influence any proposed developments.
- A workshop was held on 7th January this year, attended by a large number of stakeholders including elected Members, providers across the sector (including RSLs), local authority departments (social care and housing), the NHS and the Wales Co-operative centre. The aims of the workshop were to:
- gain an understanding of the issues connected to care, accommodation and wellbeing of older people in the Vale of Glamorgan;
- unlock the potential for alternative delivery models of care to support Older People with care needs;
- connect with others from the Sector to challenge perceptions and generate innovative ideas and solutions; and
- plan next steps to implement sustainable change.
- The workshop was well attended with good levels of interest and participation. Following the workshop, officers met with the Wales Co-operative Centre to identify themes resulting from the workshop and develop a plan to move the agenda forward. The themes identified in the workshop are attached at Appendix A.
- The meeting to develop an action plan has been delayed because of the need to prioritise implementing other aspects of the Social Services and Well-being Act. In the interim, discussions have taken place with Housing colleagues regarding other potential opportunities that need to be explored. In addition, organisations have approached us with proposals which should be considered carefully, given the scale of the challenges faced by the Council. We are encouraging a partnership approach and seeking to organise an event with providers to seek their views as to how they would meet the objectives set out in our Corporate Plan. A meeting is being held with relevant officers and Cabinet members, to discuss options further before embarking on the next phase of this workstream. Also, local authorities and Local Health Boards now have a statutory obligation to undertake a Population Needs Assessment which should contribute significantly to service planning in this area.
Resource Implications (Financial and Employment)
- Until the programme has been properly scoped, it is not possible to identify the resource implications or all the potential sources of funding. We are aware that, if an Older People's village is considered feasible, the Council has money available from the sale of buildings which may be attributed to this programme.
Sustainability and Climate Change Implications
- Effective delivery of commissioning responsibilities helps to ensure that the Council's assets are managed efficiently and effectively and that best use is made of the resources available for social care services, establishing sustainable models of assistance and support as well as contributing to the most appropriate ways of meeting the needs of vulnerable people. There are no climate change implications as a direct result of this Report.
Legal Implications (to Include Human Rights Implications)
- At this stage, there are no direct legal implications arising from the report.
Crime and Disorder Implications
- There are no direct crime and disorder implications as the result of this report.
Equal Opportunities Implications (to include Welsh Language issues)
- Commissioning of care services has to ensure that they are accessible to all those eligible to receive them and this will require Equalities Impact Assessments to be carried out, where appropriate.
- The work outlined in this report addresses the following corporate objectives outlined in the Corporate Plan 2016 - 2020:
- Well-being Outcome 4: An Active and healthy Vale
- Objective 8; Safeguarding those who are vulnerable and promoting independent living.
- Action: Review accommodation with care options for older people and develop our commissioning strategy for future years (2016/17); and
- Wellbeing Outcome 1: An Inclusive and Safe Vale
- Objective 2: Providing decent homes and safe communities
- Action : Provide appropriate accommodation and support services for particular vulnerable groups (2019/2020).
Policy Framework and Budget
- These are matters for Executive decision.
Consultation (including Ward Member Consultation)
- The issue potentially relates to all areas within the Vale of Glamorgan Council and so there has been no individual ward consultation.
Relevant Scrutiny Committee
- Healthy Living and Social Care.
Suzanne Clifton, Interim Head of Business Management and Innovation
Head of Finance
Head of Adult Services
Head of Housing Services
Philip Evans, Director of Social Services