Agenda Item No. 7
THE VALE OF GLAMORGAN COUNCIL
HEALTHY LIVING AND SOCIAL CARE SCRUTINY COMMITTEE: 12 SEPTEMBER 2016
REFERENCE FROM CABINET: 25 JULY 2016
C3262 Reshaping Services - Review of Respite Care for Adults with Learning Disabilities (L&HSCH) (Scrutiny Committee - Healthy Living and Social Care) –
Approval was sought to undertake a review of the Council’s residential respite care service for adults with learning disabilities, including a programme of consultation on the way services were delivered.
The Vale of Glamorgan Council offered respite care to approximately 82 adults with learning disabilities and their carers in order to meet their presenting needs. On average service users had approximately 28 days respite service per year, which was used by them over a number of occasions.
Historically, the respite care needs of adults with learning disabilities in the Vale of Glamorgan were met through use of both the Council’s Respite Residential Care facility (based at Rhoose Road, Rhoose) and the spot purchasing of residential home placements where required. More recently, it had been recognised that there was a demand by service users and their families for increased flexibility in the way that respite care was provided. The spot purchasing of residential home placements for respite use by clients had reduced to single figures.
As part of the Reshaping Services Programme, all areas of Adult Social Services were being reviewed. As part of the first set of service reviews, Respite Care for adults with learning disabilities had been included in this work and (as with all Reshaping Services service review projects) a savings target had been assigned. This target had initially been set at £60k for the 2017/18 financial year.
The demand for Rhoose Road had decreased in recent years, which had an impact on the unit cost per occupied night of the facility. In 2015/16, the average unit cost per occupied night was approximately £391 (gross) and £343 (net of income). If the facility had been full to capacity the average unit cost per night would have been reduced to £301 (gross) and £265 (net of income).
The decrease in occupancy was mainly related to the usability and suitability of the premises compared with alternative provision. There was only one downstairs room for people with complex health and social care needs. This limited the amount of provision available at any one time. The floor space downstairs was extremely limited, particularly for those who were wheelchair users. The internal structure and general nature of the building also limited the ability to manage people who presented with challenging behaviour; as such the physical environment was not conducive to implementing strategies which supported positive behavioural management. The limited space also constrained the staff’s ability to provide person centred emotional support and care for people due to the lack of rooms available.
The report proposed to offer an alternative to the respite care provision that was offered at Rhoose Road in order to better meet presenting needs. This would be achieved in two ways as described below. Consultation with users of Rhoose Road and their families would therefore be on the basis of these two elements:
Consultation Element 1: Where an assessment showed that respite care services should be provided and service users chose not to receive direct payments, the Vale of Glamorgan’s Adult Placement Service was offered to people and their carers as a default option. As mentioned above, the service currently had capacity to host additional placements and offered greater flexibility and opportunities to people and their carers. 24 of the 36 existing users of Rhoose Road could have all of their respite care needs met by the Adult Placement Service. Eight of these people accessed Rhoose Road and the other 16 could access the Adult Placement service. The service had the capacity to accommodate this level of growth as it stood.
Consultation Element 2: For those who had particularly high level care needs (12 of the 36 current users of Rhoose Road) who had been assessed as requiring residential respite provision, the Council’s Adult Placement Service would not be suitable and the report proposed that the Council would look to provide the required 24 hour high level support to meet the needs of this client group through an external provider.
The project had clear equalities impacts. An initial scoping for equality impacts had been undertaken and a copy was attached at Appendix A to the report. The scoping identified that the proposals would impact upon service users, staff and carers and as such, a full Equality Impact Assessment would be undertaken and included as part of the development of the business case proposals for consideration by Cabinet following the programme of consultation with service users, carers and staff and trade unions.
The report stated that the outcome of the consultation and market sounding exercises would be evaluated and together would inform a business case. It was proposed that the report would initially be referred to the Healthy Living and Social Care Scrutiny Committee for pre-decision scrutiny and then to the Cabinet for a decision to be made.
After presenting this item, the Cabinet Member for Housing, Social Care and Health highlighted the falling occupancy levels and rising operating costs of Rhoose Road Residential Respite facility as detailed in paragraphs 9 and 10 of the report. She commented that this was a complex and sensitive issue with lots of work and consultation planned with service users, their families, staff and the Healthy Living and Social Care Scrutiny Committee. Although savings have to be achieved, it is hoped to do so not by a reduction in service but by ensuring the suitability and sustainability of placements through changes in the overall model of provision.
This was a matter for Executive decision
Cabinet, having considered the report and all the issues and implications contained therein
(1) T H A T the proposals contained in the report be approved as a basis for consultation with service users and their families and the engagement of trade unions and staff on the way in which services are provided.
(2) T H A T the report be referred to the Healthy Living and Social Care Scrutiny Committee for consideration as part of the planned consultation and the views of the Committee inform the development of subsequent proposals.
(3) T H A T subject to resolutions one and two above, proposals be prepared in the form of a business case for initial pre-decision scrutiny by the Healthy Living and Social Care Scrutiny Committee and that those proposals and the views of the Committee be brought to Cabinet in due course for a decision.
Reasons for decisions
(1) To enable a consultation exercise to be undertaken with service users and their families to inform proposals as to how the Council could best meet relevant respite care needs both now and in the future.
(2) To enable the consideration by Scrutiny Committee as part of the consultation process.
(3) To ensure that the process for progressing any changes was undertaken efficiently and effectively in accordance with the Council’s policies and procedures and that the views of the Scrutiny Committee were taken into account when reaching a decision as to how to progress.
Attached as Appendix – Report to Cabinet – 25 JULY 2016