Denbighshire County Council - Agenda item - THE FUTURE OF IN-HOUSE CARE SERVICES

To consider a joint report by the Chair of the In-house Social Care Task & Finish Group and Head of Community Support Services (copy enclosed) detailing the findings of the information gathering exercise and seeking approval of future actions.

RESOLVED that Cabinet –

(a) agree to publicly consult on the suggestions as detailed within the report and outlined below -

· Hafan Deg – to enter into a partnership with an external organisation and transfer the building to them, commission a day care service within the building and, in addition, enabling 3rd sector agencies to provide early intervention activities for older people that reduce social isolation, support independence and promote resilience;

· Dolwen – to enter into a partnership with an external organisation and transfer the whole service to them (residential and day care), while registering for Elderly Mental Health care

· Awelon – to stop new admissions and work with the individuals and their families at their own pace to explore, where appropriate, suitable alternatives and to enter into partnership with the owner of Llys Awelon to develop additional Extra Care apartments on the site

· Cysgod y Gaer – to enter into a partnership with relevant stakeholders (including BCU and the 3rd sector) to develop the site into a ‘support hub’ offering both residential and extra care type facilities as well as an outreach domiciliary care and support service to the tenants of local Sheltered Housing Schemes and the wider population of the Edeyrnion area;

(b) agree to enter into a tender for the provision of domiciliary care in Llys Awelon, Nant y Mor and Gorwel Newydd Extra Care Schemes as set out in paragraph 4.5.5 of the report;

(c) that any future provision must recognise the importance of delivering care services through the medium of Welsh, for those older people who require it, and maintain the capability to do so, and

(d) the Council engages with Welsh Government Ministers, Officials and Betsi Cadwaladr University Health Board in order to urge greater collaboration and partnership working between the Council and Betsi Cadwaladr University Health Board in the provision of services relating to the care of older people.

Councillor Bobby Feeley presented the In-house Social Care Task & Finish Group’s report detailing the findings of the information gathering exercise from reviews of individuals and families using the in-house care services and sought approval to publicly consult on suggestions for Awelon, Cysgod y Gaer, Dolwen and Hafan Deg and enter into a tender for the provision of domiciliary care in extra care schemes.

Councillor Feeley provided some context to the report highlighting the requirements of the Social Services and Wellbeing (Wales) Act and need to modernise services in response to changing demographics and needs of the public, whilst also bearing in mind the impact of significant budget cuts and ensuring sustainable services in the future. She took the opportunity to thank the Task & Finish Group and officers for their hard work in examining options for delivering high quality social care services taking into account local needs and elaborated upon the suggestions put forward for future in-house care services. Research showed demand for residential care was declining in favour of supported independent living and there was a need for Elderly Mental Health care and nursing beds. It was believed the current proposals would serve Denbighshire residents well in the future.

Cabinet noted the difference between the original and current proposals which demonstrated that the views of service users and their families had been taken into consideration. Debate focused on the following –

· clarification on the role of the Consultation Institute as a specialist in public consultation exercises was provided and their advice had been sought in order to safeguard against challenge and ensure the final outcome was deliverable

· the nature and type of partnerships suggested would differ depending on need in particular areas and would likely include partnerships with both private and voluntary sectors – if the suggestions were subsequently agreed it would be necessary to seek expressions of interest in order to deliver required outcomes which could include others delivering services on the Council’s behalf

· the importance of working collaboratively, particularly with Betsi Cadwaladr University Health Board, in the provision of local care services for older people was highlighted and it was felt that greater emphasis should be placed on progressing this element of partnership working in future – it was agreed that reference be made within the resolution in this regard

· it was noted that it was not currently cost effective for Denbighshire to admit residents into care homes from outside the county but this could change in future as a result of partnership working with other local authorities

· whilst assurances had been provided in terms of delivering care services through the medium of Welsh this aspect had not been specifically referenced within the report – it was agreed that this requirement be reflected within the resolution if Cabinet approved the proposals, and it be made clear within the consultation process that Welsh Language was a priority for future services

· in terms of Awelon it was recognised that it would not be appropriate to move some residents, hence the longer term vision for that site – it was agreed to reword the recommendation in this regard to better reflect that fact

· some indicative timescales were provided should the suggestions be approved for public consultation and realisation of future savings.

Councillor David Simmons, Chair of Performance Scrutiny Committee provided an overview of the scrutiny debate and comments which had been summarised in the report. The day care assessment process had also been raised as an issue and in terms of day care services, scrutiny had requested that provision be provided for individuals living alone and as respite for carers. Officers confirmed the intention to commission day care services at both Hafan Deg and Dolwen which would apply to any individual, regardless of their family situation. It was agreed to amend the wording in the recommendation for Dolwen to clarify that the service included both residential and day care provision. Councillor Ray Bartley added that in terms of day care assessments, officers had agreed to consult on whether the current six week provision should be increased to ten/twelve weeks. He also reported upon a positive outcome following a meeting with staff at Dolwen to explain the proposals.

[As an aside Councillor Eryl Williams reiterated the need for a full appraisal of scrutiny committee debates on matters submitted to Cabinet for decision.]

Councillor Jason McLellan raised concerns over the lack of detail about potential service providers and how services would be provided in future. Officers explained the need for a broad consultation on preferred options at this stage and be open to other suggestions – it was important not to pre-empt the outcome of the consultation as this would result in a risk of challenge. A report back to Cabinet in January/February would include the consultation results and more detailed proposals in that regard. It was agreed that the need for a procurement process to determine specific service providers be included within the consultation document.

Councillor Huw Hilditch-Roberts advocated a more evidence based approach to meet the care needs of the county’s residents which should be clearly set out in the consultation. Officers reported upon evidence considered by the Task & Finish Group which included data and statistics of past and current usage and future projections based on Denbighshire’s local population together with any additional information as requested. That analysis had identified the need for a mixed market provision which had been reflected within the proposals. Cabinet noted the work of the Task & Finish Group and Performance Scrutiny Committee within the process and was satisfied a decision could be made on the evidence provided. It was accepted there would be merit in ensuring that the evidence was sufficiently articulated within the consultation document. It was also agreed that a draft consultation document be tested on members prior to formal consultation.