Agenda item
Adult Social Care Direct Services review
The reason for the call-in is:-
· To give full consideration to the alternative proposal submitted by Brent LD Carers.
The Executive report is attached. The Lead Member and Lead Officer are invited to the meeting to respond to Members’ questions.
Minutes:
The reason for the call in is:-
· To give full consideration to the alternative proposal submitted by Brent LD Carers.
Councillor Lorber, one of the councillors who had call in this item, explained that it had been because he wished that the committee consider the alternative proposals that had been made by Brent carers. He stated that the carers had felt that their views had not been sufficiently considered and neither had the item been considered in the detail they felt was necessary at the Executive meeting held on 13 December 2010.
With the approval of the Chair, Anjna Manek, a Brent carer, addressed the committee and circulated a document detailing the Brent LD carers’ alternative proposals. Anjna Manek explained to Members that she had asked some carers to volunteer information about their particular cases and the sample used was representative of the various situations that they faced. The questionnaire she had used had asked for information on the service user profile and the carer’s situation. It was usual for there to be one primary carer per household and the paper circulated provided a synopsis of their response. Members heard that there were 138 users for the Stonebridge Centre and 100 for Strathcona. The level of disability amongst users varied, however nearly all also had underlying health issues and the average age of users was 49 years for the Stonebridge Centre and 46 years for Strathcona. Anjna Manek explained that most users had little connection with the community at large and many had difficulty in building relationships. Members noted that any user over 40 years of age were not likely to have been through the education system and the day centres provided users with the opportunity to meet with their friends and around 200 families in Brent were affected by the proposals. Anjana Manek drew Members’ attention to comments with regard to costs for the personal budget, day centre costs and transition to care home costs, the figures of which were calculated using a number of different sources, including voluntary, public and private sector providers. With regard to option four in the report that was agreed by the Executive, she queried the accuracy of the financial costings and sought a further explanation of these. Anjna Manek also sought further details of how personalisation for users and carers would work for them, such as how could users maintain friendships where their interests differed. She suggested that she could identify six users for the council to create personalisation plans from Monday to Friday to see how it would work.
Turning to Brent carers’ alternative proposals, Anjna Manek stated that of the Special Educational Needs teachers she knew, none had been consulted over the council’s proposals. She acknowledged that those users on both the older and younger age of the spectrum were less likely to use day centres, however there was a sizeable number in between who wished for a building based service. She felt that even if one building had to be released as a day centre, two alternative locations in both the north and south of the borough should be sought. Anjna Manek stressed the importance the day centres played in providing a safety net for its users who had built trusting relationships with the staff and each other and would be resistant to change. The day centres also provided some respite for the carers, especially as some carers were also in employment. Anjna Makek suggested that a small group of trustees should be formed to include carers and a senior council officer and it be given a capped fund to distribute funding as it best saw fit to use. The group of trustees would offer the additional advantage of being able to react to needs more quickly and would seek to use services from both the public and private sector and she asked that Members consider these proposals.
With the approval of the Chair, Councillor Colwill addressed the committee. Councillor Colwill commented that although the intention was to provide users with choice, in effect the proposals were dictating what users were going to do. He queried how users could use mainstream services where they had conditions that could render this impractical, such as those who were incontinent. Councillor Colwill stated that the proposals needed to be re-considered from afresh, including a review of costings for personalisation, whilst also more needed to be done to assist carers and he suggested that officers see what it is like to be a carer. He also sought an update with regard to the John Billam site.
Members then discussed the item. Councillor Denselow enquired to what extent the Brent LD carers had been involved in the consultation process. He acknowledged the frustration felt by the carers and he sought assurances that feedback from the consultation was properly considered before the decisions that were made by the Executive. Councillor Mashari enquired whether the practical implications of the proposals had been discussed with users and carers during the consultation and had there been consideration of how personalisation would work in view that many users had little connection with the community as a whole and may also have limiting health conditions. She asked whether it was possible to describe a typical day for a user and what their plan may be under personalisation. Councillor Mistry enquired what other local authorities were doing in respect of adult social care services.
Councillor Lorber expressed concern about the timing and speed of which the proposals were to be undertaken, which was also of particular concern to older carers, whilst many users were very attached to the services they currently used. With regard to the consultation, he stated that the carers had challenged the analysis of the first consultation and still had concerns that they had not been listened to in the second consultation. Stonebridge Day Centre users faced the prospect of two moves within the next year which was of serious concern to both carers and users and Councillor Lorber enquired about the possibility of keeping this centre open for the next 12 months until all the users’ assessments had been undertaken. With regard to the New Millennium building, Councillor Lorber enquired about the possibility of this building accommodating 30 to 40 users during the assessment period. He asked why other locations had not been considered to accommodate disability users, such as Bridge Park which had sufficient space and was close to the Stonebridge Day Centre. Details were sought with regard to risk assessments undertaken and what alternative measures would be in place should a user be unable to manage a personalisation budget and their carers were not able to care for them during the day. Councillor Lorber added that such a situation could result in higher costs to the council as a user could be placed in residential care. He asked what a typical direct payment amount with regard to personalisation would be. Councillor Lorber also queried whether other services would be able to provide for users’ interests in view of the savings measures, such as the proposed closure of some libraries and had a joined-up approach to it been taken.
The Chair asked for Councillor R Moher’s response to the issues raised and the alternative proposals suggested by Anjna Manek.
In reply to the issues raised, Councillor R Moher (Lead Member for Adults, Health and Social Care) advised that there had been an extensive consultation as part of the review which had included a series of meetings with service users, carers and staff and relevant organisations were aware of the options that were being considered. Members noted that there had been 42 meetings that had taken place over the three months that the consultation had taken place. Issues that had been raised at earlier consultation rounds had been addressed in time for subsequent rounds. Councillor R Moher stated that costings had not been raised as an issue during the consultation. She acknowledged that although service users tended to want to continue to attend places they knew, a number of then had expressed interest in personal budgets and these would empower users and their carers to pursue what they wished to do and provide them with greater flexibility. However, the council may still have a role in helping users to be able to pursue these activities. Councillor R Moher stressed that the assessment of service users would be thorough before deciding on those who could participate in the community and access mainstream services. With regard to the Stonebridge Day Centre, Councillor R Moher advised that its closure had been proposed for over two years, whilst the use of the New Millennium building for service users had been suggested as a possibility by staff working there, although other buildings in the borough may be available for this purpose.
Councillor R Moher acknowledged that the carers had raised a number of issues, of which there were already answers to some. She appreciated the concerns raised by carers, including such situations where providers may not turn up. However, the personal budget would empower service users and their carers to pursue preferred choices and ensure they received what they needed. Social workers would also be finding out what networks there were to support service users. Councillor R Moher asserted that there would not be any less care to users than what was being provided now but rather that it was being provided in a different way. Where the assessment had deemed that service users were in need of building-based services, appropriate options would be considered. Councillor R Moher confirmed that proposals for the John Billam site were proceeding as planned.
Councillor John (Leader of the Council) added that the views of the carers and service users were valued and there would be difficulties and challenges encountered because of the changes, however issues that had previously been raised in the consultation prior to 2010/11 had been addressed and there would be provision for all users irrespective of their level of disability. She advised that the council was obliged to pursue a programme of personalisation as set by the Government.
Alison Elliott (Assistant Director – Community Care, Housing and Community Care) advised that the consultation had shown there was broad support for the principles, but not necessarily a full appreciation of the practical implications. She advised that carers had been presented with possible day and night scenarios and those carers with users who already had personalisation plans in place had been invited to provide information to carers on their experience. Personalisation plans were difficult to generalise because of their individual nature depending on the users’ interests and needs, however these would be progressed through the assessment process and carers would be fully involved in this. The opinions of other professionals, such as health visitors and speech and language therapists would also be sought during the assessment and a holistic approach would be taken. A range of activities, including those related to education, work and leisure would be considered to see which best suited each users’ needs and it may be possible for group-based activities to be arranged, such as going to college or even work-related activities. Alison Elliott acknowledged the role day centres played in giving carers respite and there would be no reduction in such provision. There had been an assumption that around 30% of users assessed could undertake a degree of independent living, however if this was shown to not be the case, then the proposals would need to be reconsidered by the Executive.
With regard to the New Millennium Centre, up to 20 users could be accommodated although some improvements to the building would be needed. It was acknowledged that users valued being with their friends and community facilities such as Bridge Park could also be used as a meeting place for them. The personalisation programme was in line with the Department of Health’s strategy of putting users first and giving them more choice, independence and control. Other local authorities were moving in the same direction and each faced the challenge of calculating the budgets required for direct payments. An indicative budget had been presented and this would be continually updated as the assessments were being completed. The Executive had considered all the options presented to them including the level of support for each and the views of the carers, users and staff.
Members then decided not to agree to recommendations put forward by the Chair and Councillor Lorber that in view of the concerns and the alternative proposals put forward by carers, that the proposals be re-considered and that updates on this item regarding the user assessments be presented to the One Council Overview and Scrutiny Committee to identify what centre-based options should be considered.
RESOLVED:-
that upon considering the report from the Director of Housing and Community Care on the Adult Social Care Direct Services Review, the decisions made by the Executive be noted.
Supporting documents:
- hcc-direct-services v10, item 3a PDF 145 KB
- hcc-direct-services-appa, item 3a PDF 137 KB
- hcc-direct-services-appb, item 3a PDF 429 KB
- hcc-direct-services-appc, item 3a PDF 382 KB
- hcc-direct-services-appd, item 3a PDF 198 KB