Agenda Item No
The Vale of Glamorgan Council
Scrutiny Committee (Social Care and Health): 8th October 2012
Report of the Director of Social Services
Update report on Bryneithin and Ty Dyfan
Purpose of the Report
1. To provide Scrutiny Committee with an update report, as requested.
1. That Scrutiny Committee notes the content of this report.
2. That a further report is brought to Scrutiny Committee once a plan has been developed with partner agencies for using Ty Dyfan and other facilities to meet the overall need for residential care and nursing home placements for people with dementia-related illnesses.
Reasons for the 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.
2. In May 2008, Cabinet 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 this 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 plans 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.
3. Following representations on behalf of the residents’ families, the Council accepted that it had previously entered into a contract with the residents to give them with a ‘home for life’ within Bryneithin, provided that the home is able to meet their assessed needs. Consequently, Bryneithin has remained open, with a reducing number of residents. The Cabinet decision regarding closure has stood and no new residents have been accepted by the home since that time. Bryneithin currently provides for one resident.
4. Following the decision that Bryneithin should remain open for current residents, work was undertaken to mitigate any additional costs falling on the Council as a result of the non-closure and the impact upon plans for changing the use made of Ty Dyfan. As part of this plan, the staffing establishment in Bryneithin has been adjusted continually, to ensure that staffing levels are appropriate at all times for the reducing number of residents in the home. For example, the home now shares a manager with another establishment. Only essential refurbishment has been completed, to ensure that the needs of residents and regulatory standards are met. Running costs have been reduced to ensure that the home is managed efficiently. Some areas have been closed to maintain a more homely environment for the number of residents who have a place in Bryneithin.
5. Ty Dyfan is a 32-bed residential care home. It is managed by the Council as part of a bigger contract with Hafod Care, which also includes the Ty Dewi Sant home in Penarth. Hafod Care is a charitable Housing Association that provides a wide range of housing, care and support services across South and West Wales. The contract in relation to Ty Dyfan was agreed in 1991 for a 25-year period, which includes the following terms of agreement.
- The building is leased to Hafod, for which the Council receives a payment. For the duration of the contract, the maintenance of the property is the responsibility of Hafod.
- The staff group in the home is employed by the Council and Hafod make a contribution to these staffing costs but this does not meet the full costs.
- Any placements made by this Council are paid at the agreed contract rate for older people’s independent sector residential care placements. Originally, placements could be made by other local authorities or privately by individuals or their family. The cost of these placements was not met by the Vale Council.
6. In 2009, the contract for the home was renegotiated 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 need for specialist "Elderly Mentally Infirm (EMI)" provision. The registration status of Ty Dyfan was changed to providing support and accommodation to older people with dementia-related illnesses. To facilitate this change, the home was upgraded by Hafod and they met the capital cost of ensuring that Ty Dyfan was fit for purpose.
7. 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. At the time the contract was renegotiated, it was envisaged that staff from Bryneithin might move to Ty Dyfan if the home were to close.
8. The discussions with Hafod were attended by officers from Social Services and Finance. Legal services were involved in the finalisation of the legal agreements between the two organisations. The work of upgrading the home was completed and the revised agreement became effective in May 2010. At that point, Hafod had incurred capital costs because of the internal upgrade undertaken within the home to make it suitable for EMI residents. Some staff from Bryneithin have transferred to Ty Dyfan and the staffing establishment has been changed to ensure that staffing levels are appropriate for the number of residents in the home (20).
Relevant Issues and Options
9. The revised arrangements with Hafod remain in place. Most of the residents in Bryneithin did not move to Ty Dyfan. Partly for this reason, the provision of twenty places in Ty Dyfan has proved sufficient to meet need. Another factor has been that, in both our own residential care homes and in the independent sector, there appears to have been a shifting balance - away from placements for "frail elderly" towards "EMI" provision. The Council's current fee structure for independent sector placements is to some extent designed to provide an additional incentive for this change, given rising numbers of older people who have been diagnosed with dementia-related illnesses.
10. However, if there is 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 has 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 are also discussions with the UHB about whether the home could be used to meet the need for EMI nursing home placements. As outlined later in this report, the Vale of Glamorgan appears to be experiencing a shortfall in available provision for people needing this level of care.
11. Senior officers from Social Services and Finance are pursuing discussions with Hafod Care about the terms of the current contract. Currently, these discussions are focused on achieving an equitable share of the costs if Ty Dyfan were to make available an increased number of places. Negotiations also include the overall contract with Hafod Care (i.e. Ty Dewi Sant and Ty Dyfan) and the Council is very concerned to bring these to a conclusion if possible.
12. There is a clear need to ensure that these discussions with Hafod Care and other providers are informed by evidence about the scale of need and the demand for places across all homes whether these are directly managed by the Council or commissioned from the Third and independent sectors. In November 2011, Cabinet approved a Commissioning Strategy for Older People’s Services 2011-2018. The strategy provides considerable detail about the context which the Council needs to consider when making arrangements for providing an appropriate range of care and support services. It includes an analysis of the needs of the community and a strategy for managing increasing demand within an increasingly difficult economic environment. The Strategy is attached at Appendix 1. Producing the strategy was used as an opportunity to further the Council’s overall programme for improving and modernising the social care services it provides for older people and their families.
13. The strategy needs to be informed by any new evidence that emerges about needs, costs, the 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 use places in care homes is reducing. In part, this can be attributed to the introduction of new service models such as reablement.
14. Last year, however, the Vale significantly increased the number of care home placements it makes, with the biggest rise in older people’s nursing home care and EMI residential care. The position is set out in Table 1 below.
Number of residents supported during year 2010-11
Number of residents supported in Vale placements
% in Vale
Number of residents supported during year 2011-12
Number of residents supported in Vale placements
% in Vale
15. These local data on placements made for older people in the Vale indicate, therefore, that over 80% of required placements are made within county. As some service users want out of county placements, in order to live closer to their relatives, this suggests that overall availability of placements is sufficient. As stated earlier in this report, the one area where there is a much lower ratio of in-county placements is EMI nursing. Through the Wyn Campaign (which the Council is delivering in partnership with Cardiff Council and the Cardiff and Vale University Health Board as part of the overall Integrating Health and Social Care Programme), there are new services being put in place for older people which should have an impact on this position. This includes provision of reablement services and an EMI crisis team. Moreover, the implications of introducing the £50 cap on charges for non-residential care services are becoming more apparent. There is now a significant cost difference for families when choosing between community and residential care which may affect demand for care home places.
16. As part of the Wyn Campaign, a task group is examining how the three organisations can collaboratively plan for and provide effective long-term health and social care, including placements in residential care and nursing homes. Current work includes production of an agreed market position statement and a business case for a joint commissioning unit. One of the priorities for the group is to consider the position in respect of EMI nursing placements, especially as this is having an adverse effect on our collective ability to maintain good Delayed Transfer of Care performance.
Resource Implications (Financial and Employment)
17. None as a direct result of this updating report.
18. The financial implications of the current contract with Hafod Care in respect of Ty Dyfan appear as a separate document under Part II of the Agenda,.
Legal Implications (to Include Human Rights Implications)
19. The powers and duties the of Social Services Department to provide residential accommodation are primarily dealt with in part 3 of the National Assistance Act (“NAA 1948”) and, in particular, in section 21. In addition there are provisions relating to accommodation services in other legislation including the NAA 1948 section 29(iv), the Mental Health Act 1993 section 117, the Local Government Act LGA 2000 and the Children Act 1989.
20. The National Assistance Act (Choice for Accommodation) directions 1993 places local authorities under an obligation to make arrangements for placing a person assessed as “in need” in accommodation of their preferred choice subject to certain conditions. The directions recognise that there will be cases in which prospective residents are unable to express a preference for themselves and that it would, in such circumstances, be reasonable to expect authorities to act on the preferences expressed by their advocate, carer or legal guardian unless that would, in the authority’s opinion, be against the best interest of the resident.
21. The Mental Capacity Act (“MCA”) provides that decisions in relation to individuals who lack capacity must be in the person’s best interest. The MCA provides a checklist of factors that decision makers must work through in deciding what is in the person’s best interest.
22. In making any decisions about the future of the residential care homes it provides, the Council needs to demonstrate that there has been due regard to the implications of section 149 of the Equalities Act 2010 which has replaced and incorporated the Race Relations Act 1976, Sex Discrimination Act 1975 and the Disability Discrimination Act 1975. A public authority in the exercise of its functions must give due regard to the requirements set out in this legislation.
Crime and Disorder Implications
23. There are no crime and disorder implications as a direct result of this report.
Equal Opportunities Implications (to include Welsh Language issues)
24. In developing proposals in respect of residential care homes for older people, the overall objective is to improve access to high quality and appropriate residential care service for older people with mental ill health and/or dementia across the Vale of Glamorgan.
Sustainability and Climate Change Implications
25. Part of the overall purpose of changes to residential services for older people with mental ill health is to ensure that current and future demand can be met and delivered in settings which are fit for purpose, sustainable and financially viable.
26. The development of proposals in respect of residential care and nursing home placements for people with dementia related illnesses will support the following corporate objectives:
- to make the Vale a safe, healthy and enjoyable place in which individuals can live their lives to the full; and
- to manage the Council's workforce, money and assets efficiently and effectively in order to maximise its ability to achieve its service aims.
Policy Framework and Budget
27. This is a matter for executive decision.
Consultation (including Ward Member Consultation)
28. Individual Ward members have not been consulted as these are services which cater for all the local authority area.
Relevant Scrutiny Committee
29. Social Care and Health
Cabinet Report 19.11.08 - Accommodation Strategy for Older People: Outcome of an appraisal exercise in respect of the Council's in-house residential care provision.
Cabinet Report 28.05.08 - Accommodation Strategy for Older People
Social Care and Health Scrutiny Committee 24.11.08 - Accommodation Strategy for Older People: Outcome of an appraisal exercise in respect of the Council's in-house residential care provision
Social Care and Health Scrutiny Committee 5.02.09 - Consultation in Relation to Bryneithin Residential Care Home
Social Care and Health Scrutiny Committee 22.06.09 - Outcome of Consultation on the Future of Bryneithin Residential Care Home
Minutes of Cabinet Meeting 15.07.09
Cabinet Report 2.12.09 - Bryneithin Residential Care Home, Dinas Powys
Cabinet Report 16.11.11 Social Services Commissioning Strategy for Older People’s Services
Lance Carver, Head of Adult Services
Carys Lord, Head of Business Management and Innovation
Carolyn Michael, Senior Group Accountant, Finance
Jodi Winter, Operational Manager, Legal Services
Philip Evans, Director of Social Services