Agenda Item No.
THE VALE OF GLAMORGAN COUNCIL
CABINET: 5TH NOVEMBER, 2012
REFERENCE FROM SCRUTINY COMMITTEE (SOCIAL CARE AND HEALTH): 8TH OCTOBER, 2012
"400 UPDATE REPORT ON BRYNEITHIN AND TY DYFAN (DSS) -
Ms. M. Farbrace of the 'Save Bryneithin' campaign was in attendance and was permitted to address the meeting.
Ms. Farbrace advised Committee that she was an advocate for Bryneithin and addressed the Committee on a number of issues, including:
· Regarding the second recommendation as contained within the report before the Committee, this was known in 2008. Since then, there was still no plan. People who require resources were not getting them.
· Bryneithin could be attracting much revenue to the Council.
· Bryneithin was not being used for respite care.
· Keeping this provision in-County was essential, but it was acknowledged that some people would have to receive treatment 'out of county' because of a lack of provision within the Vale.
· Ty Dyfan was not included in the earlier consultation exercise.
· The respite element of Bryneithin has been removed.
· Some of Bryneithin has been upgraded.
· Bryneithin was up and running and should be reconfigured.
· Why was Ty Dyfan not commissioned as an EMI?
· Ms. Farbrace was aware that the Vale were looking for a site for a 'Dementia Village', and asked if Bryneithin would be considered.
· Finally, Ms. Farbrace requested the Committee to reconsider its proposals to close Bryneithin.
Ms. Farbrace was thanked for her address.
Committee then received a report which provided an update on Bryneithin and Ty Dyfan which advised that, in May 2008, Cabinet had authorised the Director of Social Services to begin work to develop a strategy which would enable the Council to identify and put in place an appropriate range of accommodation options for older people needing care. As part of this work, Social Services conducted a review of the three Council-run residential care homes (Bryneithin, Southway and Cartref Porthceri). In December 2009, Cabinet agreed a plan to close Bryneithin and to transfer residents to other homes as appropriate. In coming to its decision, Cabinet recognised that officers would need to consider not only the needs of current residents within Bryneithin but also how best to reshape services for older people with mental ill health to meet current and projected demand. Hence, the plan included a proposal to re-designate Ty Dyfan as an EMI home for people with dementia related illnesses, thereby providing additional specialist beds within the Vale of Glamorgan and places for any residents from Bryneithin who wanted to move there.
Following representations on behalf of the resident's families, the Council accepted that it had previously entered into a contract with the residents to give them a 'home for life' within Bryneithin, provided that the home was able to meet their assessed needs. Consequently, Bryneithin had remained open, with a reducing number of residents. The Cabinet decision regarding closure has stood and no new residents had been accepted by the home since that time. Bryneithin currently provided for one resident.
Following the decision that Bryneithin should remain open for current residents, work was undertaken to mitigate any additional costs falling upon the Council as a result of the non-closure and the impact upon plans for changing the use made at Ty Dyfan. As part of this plan, the staffing establishment in Bryneithin had been adjusted continually to ensure that staffing levels were appropriate at all times for the reducing number of residents in the home.
Ty Dyfan was a 32 bed residential care home and was managed by the Council as part of a bigger contract with Hafod Care. The contract in relation to Ty Dyfan was agreed in 1991 for a 25 year period, which included the following terms of agreement:
· The building was leased to Hafod, for which the Council received a payment. For the duration of the contract, the maintenance of the property was the responsibility of Hafod.
· The staff group in the home was employed by the Council, and Hafod made a contribution to the staffing costs but did not meet the full costs.
· Any placements made by this Council were paid at the agreed contract rate for older people's independence at residential care placements.
In 2009, the contract for the home was re-negotiated as part of the plans to facilitate the closure of Bryneithin, to ensure that adequate alternative provision was available for those residents and to meet increasing needs for specialist 'Elderly Mentally Infirm (EMI)' provision.
Under the terms of the new agreement, the Council agreed:
· To block book the 32 beds so that only the Council could place individuals in the home.
· A reduced fee per bed.
· To pay for the increased staffing required for changing the status of the home.
The revised arrangements with Hafod remained in place. Most of the residents in Bryneithin did not move to Ty Dyfan. Partly for this reason, the provision of 20 places in Ty Dyfan had proved sufficient to meet the need. Another factor had been that, in both of the Council's own residential care homes and in the independent sector, there appeared to have been a shifting balance - away from placements for 'frail elderly' towards 'EMI' provision.
However, should there be evidence of further unmet need for EMI residential care home placements, the unoccupied unit at Ty Dyfan could be made available. This would be dependent upon being able to use staff currently employed elsewhere within Council run homes in order to minimise any additional costs. Additionally, the Council had approached Cardiff and Vale University Health Board (UHB) with a proposal to develop a 'step up/step down' provision within the unit, avoiding the need for an unplanned hospital admission or supporting a hospital discharge. There were also discussions with the UHB about whether the home could be used to meet the need for EMI nursing home placements.
Senior officers from the Council were pursuing discussions with Hafod Care about the terms of the current contract. Currently, these discussions were focussed on achieving an equitable share of the costs if Ty Dyfan were to make available an increased number of places. Negotiations also included the overall contract with Hafod Care and the Council was very concerned to bring these to a conclusion if possible.
In November 2011, Cabinet approved a Commissioning Strategy for Older Peoples Services 2011 - 2018. This strategy provided considerable detail about the context which the Council needed to consider in making arrangements for providing an appropriate range of care and support services. It included an analysis of the needs of the community and a strategy for managing increasing demand within an increasingly difficult economic environment. Production of the strategy was used as an opportunity to further the Council's overall programme for improving and modernising the social care services it provided for older people and their families.
The strategy needed to be informed by new evidence that emerged about needs, costs, preferences of older people and their families etc. Despite significant rises in the population of very old people, on a national basis the proportion of them who used places in care homes was reducing.
Last year, however, the Vale significantly increased the number of care home placements it made, with the biggest rise in older people's nursing home care and EMI residential care. The position was shown in Table 1 of the report.
Local data on placements made for older people in the Vale indicated that over 80% of required placements were made within county. As some service users wanted out of county placements in order to live closer to their relatives, this suggested that overall availability of placements was sufficient. The one area where there was a much lower ratio of in-county placements was EMI nursing. Through the Wyn Campaign, there were new services being put in place for older people which would have an impact on this position. This included provision of reablement services and an EMI crisis team.
As part of the Wyn Campaign, a task group was examining how the three organisations could collaboratively plan for and provide effective long term health and social care, including placements in residential care and nursing homes. Current work included the production of an agreed market position statement and a business case for a joint commissioning unit. One of the priorities for the group would be to consider the position in respect of EMI nursing placements, especially as this was having an adverse effect on the collective ability to maintain good Delayed Transfer of Care performance.
Following discussions on the contents of the report, it was
(1) T H A T the contents of the report be noted.
(2) T H A T a further report be brought to Scrutiny Committee once a plan had been developed with partner agencies who are using Ty Dyfan and other facilities to meet the overall need for residential care and nursing home placements for people with dementia related illnesses.
(3) T H A T Cabinet be requested to give consideration to the future use of Bryneithin as a site for social care, subject to ongoing contractual commitments.
Reasons for recommendations
(1) To ensure effective scrutiny of key developments in the delivery of these frontline services.
(2) To ensure that effective use is made of the Council's resources.
(3) To give consideration to the future use of Bryneithin."
Attached as Appendix - Report to Scrutiny Committee (Social Care and Health): 8th October, 2012