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ITEM EX10

EXECUTIVE – 23 JULY 2002

SOCIAL SERVICES BUDGET PROPOSAL – REDUCTIONS IN HOME SUPPORT CONSULTATION ON WITHDRAWAL OF NIGHT CARE SERVICE

Report by Director of Social Services

Introduction

  1. In the budget proposal report presented to Executive on 19 March 2002 and confirmed by Council on 9 April 2002, reductions in Home Support for Older People amounting to £1.5m were agreed.

  2. The principal method proposed for achieving this reduction was through the application of the revised eligibility criteria agreed by Social Services Committee in October 2001.

  3. It was also proposed to cease to provide night care on the basis that:-

    • it was an expensive aspect of home support (up to 4 times as expensive as day services)

    • it was only available to a few people in limited areas of the County (namely Oxford City, Banbury, Witney, Wantage and Faringdon), thus making it a very inequitable service.

  1. A significant service change as proposed could only be achieved following formal consultation.

    2. Action to Date

  2. Following approval of the budget proposals, up to date information was compiled regarding current users of night care services. This showed the following:-

    3. Oxford City (Internal Service)

    Younger physically disabled people 6
    Older People 8
    Wantage and Faringdon
    Older People 9

    Witney

    Older People 10

    Banbury

    Older People 21

  3. Formal consultation letters were sent either directly to service users, or their carers (if recorded as acting on their behalf). Letters were sent during the week commencing 10 June 2002 with a reply date of 12 July 2002. Wherever possible letters have been followed up by a visit from a care manager, to discuss the night care service and consider possible alternative services.

  4. Letters were also sent to a range of stakeholders and the list of recipients is attached at Annex 1, together with a copy of the letter.

    5. Consultation

  5. Due to the timing of the consultation and the deadline for committee reports, at the time of writing the consultation period has a further week to run. The majority of replies have, however, been received and proactive work to gain the views of clients completed. Any additional information received will be reported orally.

  6. In general terms, users and stakeholders say that it is a valued service and have expressed concern over its possible withdrawal. A sample of responses included:

    7. " While we appreciate that costs have to be controlled, we ask that full consideration be given to continuing with the present service…."

    " Speaking personally I regard the Night Care Service as a vital and essential part of the care package for my wife…."

    " Currently….receives four visits every 24 hours….and one from night care. Every one of these visits is indispensable. If the financial pressure on you comes from central government, you may have my permission to inform those responsible that I, for one, am happy to pay increased taxes to improve care for the elderly…."

  7. A common theme in the replies was that the night visit was necessary due to the long time period between the last visit from day services and the first visit the next day. This is frequently 12 hours. Individual replies to the consultation have been placed in the Members’ Resource Centre.

  8. Particular concern was expressed by a number of respondents over the financial information in the letter. In an effort to simplify the content of the letter, the financial information it contained proved misleading, as it did not show why the night care service was considered to be expensive. In cost per client terms, in some instances, it is not. What the information did not show, however, is that for every person receiving night care, they receive, on average, between 1.5 and 3 hours per week. For an equivalent amount of money (per client), day services are providing an average of 7.5 hours per client per week.

  9. The contact with individual service users has resulted in the following:-

    10. Witney:

    Of the 10 current users, 1 is in hospital and unlikely to return home and 1 other could alter current arrangements to remove the need for a night visit. The remaining 8 have an ongoing need for service provision outside day services.

    Oxford:

    Of the 8 current users (older people), 1 person is awaiting residential care (by choice).

    The remaining 7 have needs which cannot be met by the current day services.

    Banbury:

    Of the 21 current users, all clients have a continuing need for services which cannot be met by current day services.

    Wantage and Faringdon:

    Of the 9 current users, all clients have a continuing need for services which cannot be met by current day services.

    Oxford City:

    Younger disabled clients of the 6 current users, all have a continuing need for services which cannot be met by current day services.

  10. In addition to providing a service to individual users, the Oxford City scheme has a link to the emergency warden scheme operated by Oxford City Council whose response was:

    11. "extremely concerned about the proposed cuts……….service enables many people to remain in their own homes……..demand for the service is high and likely to increase due to demographic trends……….fears that a cut to the service will result in the need for more residential beds".

  11. Between January and June this year, the service received around 10 calls per week that were appropriate referrals to the City Night Care Service. These included confusion at night, falls, medical emergencies. Although much valued by users, and the City Council, no similar service exists in other parts of the County, including the areas were Night Care services are provided for individual users. Alternative arrangements are made to manage night care emergencies and similar arrangements would need to be established for the City. The department’s Emergency Duty Team operates an emergency service across the County between 5.00 p.m. and 8.30 a.m. and Saturday and Sunday. This area of service is therefore inequitable across the County.

    12. Consultation with Staff (Oxford City Internal Service)

  12. At the point where the decision to consult was made there were 5 staff working in the service (3 permanent, 2 casual staff). They were all concerned about the impact on users without alternatives in place, but also that the service was expensive and inequitable. All staff were offered advice and assistance in considering their futures. One member of staff has gained employment elsewhere, the other staff have accepted redeployment to the day time Rapid Response and Reablement team, and posts will be held for them. At present, to cover the service, daytime staff have been seconded in on a temporary basis.

    13. Conclusions

  13. Clearly the night care service is a valued service which current users would find difficult to replace with alternatives e.g. special equipment to assist turning at night, pressure relieving mattresses. It is considered possible, however, to reduce the amount of service so as to provide a late evening service, rather than a full night care service.

  14. Many of the current users could continue to have their needs met by a reduction in the hours of operation of the schemes. This is due to the fact that the majority of service users require a single visit in order to reposition the individual in bed and/or assist with toileting. A late evening visit e.g midnight (it is difficult to get a day service visit after 8.30/9.00 p.m.) would ensure individuals were not left unsupported for an excessive period of time.

  15. Based on the information from the consultation exercise it is suggested that the external contracts could be re-negotiated to provide for existing clients based on a 12.00 or 2.00 a.m. finish. This would reduce costs but would clearly not achieve the full saving this year. This service would continue to meet the needs of current users. On this basis it is anticipated that this service would not be required in the longer term.

  16. For younger disabled adults it is recommended that current users of the Night Care Service are assisted by Care Managers to ensure alternative arrangements to the Night Care Service are in place, including the use of the Direct Payment Scheme if they wish. It is the opinion of the staff working in the scheme that alternatives are possible and greater distinction should be made between Social and Health Care Tasks under existing Shared Care Protocols. The existing arrangements will continue until this happens. This will therefore have a consequence for the identified savings, which cannot be quantified at the moment. There will be no new referrals to the Night Care Service. Any new referrals to the department where users may need assistance at night will be assessed and arrangements put in place, on an individual basis.

    17. Financial Implications

  17. The full year budget provision for the night care service was £300,000. As part of the £9m service reductions this was reduced to £125,000 to allow for the withdrawal of the service following consultation. Maintaining the service for existing clients is unlikely to provide any significant saving in 2002/03. Expenditure is currently projected to be £250,000, resulting in a shortfall of £125,000 in the savings target. This will need to be added to the savings target set against the re-assessment process.

    18. Staff Implications

  18. Staff employed by Oxfordshire County Council have been offered and accepted redeployment to day time services.

    19. RECOMMENDATIONS

  19. The Executive is RECOMMENDED to:

    1. request the Director of Social Services to:

(i) cease to commission or directly provide night care services and therefore no new referrals as the service will cease;

(ii) renegotiate current external night care contracts to provide a late evening service for current service users;

    1. work with individual service users to ensure that appropriate alternative services are available;

    1. agree that the planned savings for night care services will not be achieved in the financial year 2002/03 and the resulting overspend will be identified within the regular budget montitoring reports and funded either by alternative savings or considered as part of the overall budget shortfall for Social Services.

STEPHEN WILDS
Director of Social Services

Background Papers: Response to consultation

Contact Officers: Lorna Brown, Assistant Director, Community Care Tel. 01865 815828
Jean Carr, Assistant Director, Adult Service Provision Tel. 01865 815565
Alan Sinclair, Head of Disabilities Tel. 01865 815753

July 2002

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