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ITEM EX10

EXECUTIVE – 1 OCTOBER 2002

DRAFT CARE HOMES REDEVELOPMENT STRATEGY

Report by Interim Director of Social Services

1. The County Council transferred 19 operational residential care homes with 797 elderly residents and 784 staff to the Oxfordshire Care Partnership (OCP) in December 2001. Of the 19 homes, 10 did not meet, and could not effectively be made to meet, the new National Minimum Standards for Care Homes due to the size of resident bedrooms and the high proportion of shared double rooms. A key strategic objective of the County Council in transferring the care homes to a not for profit charitable trust was to improve the physical environment of the care homes such that they could better meet the changing and future needs of older people.
2. By undertaking this redevelopment programme the new homes will make a significant contribution to the social services purchasing strategy of increasing the availability of nursing and high dependency residential care beds, whilst also removing the requirement for a significant number of residents to share double rooms (currently 172 beds in OCP homes). These objectives cannot be achieved in the 10 existing homes where small room sizes restrict resident care and fail to meet not only the new National Minimum Standards but also the preceding regulations enacted in 1984.
3. The contract between the County Council and OCP contains requirements to produce a jointly agreed redevelopment strategy for the 10 homes subject to full, public consultation. Since April a group of senior County Council and OCP officers have examined proposals to redevelop the homes within an overall affordability framework so that they best meet local and county needs now and in the future. This report summarises their joint recommendations for the redevelopment of each home.

Redevelopment Objectives

4. The purpose of the redevelopment strategy and the resultant consultation process will be to achieve three broad objectives:

• Re-shape existing services so that they better meet the ‘modernisation’ agenda for older peoples’ services;
• Satisfy the broad contractual and financial requirements of the 25 year contract between OCC and OCP whilst still protecting current residents and workforce;
• Provide an opportunity for all stakeholders to contribute to the countywide redevelopment strategy and, by means of clear proposals, resolve the future development of each home.

5. Ten of the transferred homes fail to meet the recently introduced National Minimum Standards. Some rooms are as small as 6sqm (the new minimum requirements are 12sqm) which in practical terms mean they are wholly unsuitable for residents who use wheelchairs or require hoists and are too small to meet nursing care requirements. In addition, none of the resident bedrooms have ensuite bathroom facilities. These rooms will become increasingly difficult to fill as consumer expectations rise in the future.
6. When the homes were transferred, the new care standards had to be met in all existing homes by 2007. Since then the government has issued a consultation document indicating that these environmental and space standards may, potentially, be relaxed for existing care homes as will the 2007 deadline. Instead, only new care homes and extensions to existing homes will have to comply with the new standards and existing homes will instead have to provide information to users on those physical features that are ‘non-compliant’.
7. Despite the likely changes described above, both County Council and OCP remain committed to the service strategy and their contractual obligation to improve the quality of the homes so that they better meet the needs of older people over the next 25 years. The redevelopment programme offers a unique opportunity to create these new services. In doing so, the proposed redevelopment strategy has looked at how best to balance the context of the following, and sometimes competing, service aims:

• the need to redevelop some 400 beds but on fewer sites in order to achieve best value;
• the need to rebalance the number of beds from North to South, whereby the former has more than the latter;
• the need to replace 172 bed-spaces in shared rooms with single rooms;
• the need to provide greater levels of high dependency care and nursing care plus, where possible, specialist services for older people with serious mental health needs;
• to examine the contribution of ‘intermediate care’ services in providing alternatives to long stay care for a greater number of older people.
• to examine the contribution of Very Sheltered Housing as a preferred alternative to ‘lower dependency’ residential care;
• to develop services which comply with partnership objectives with health, housing and other independent services providers;
• to maintain some 400 care worker jobs and consider their potential re-training requirements;
• to provide minimum service disruption through carefully phased developments on appropriate new sites;
• to maintain the future viability and commerciality of any new service.

8. A specific and time-limited working group has been undertaking the detailed needs analysis and local service appraisal required for the production of the proposed redevelopment strategy. The group considered various data and opinion in reaching its conclusions, including:

• Needs analysis comprising current demands on service, and future demographic and policy trends
• Market analysis of current provision
• Agreement on definitions and models of care such as Intermediate Care, Very Sheltered Housing, Transitory/ Step Down Care, etc
• Analysis of local service and delivery pressures and area purchasing plans
• Recognition of other strategic purchasing and commissioning plans for Older People such as the pooled budget strategy, Primary Care Trust (PCT) and District Housing Authorities plans, etc.
• Examples of best practice elsewhere in the UK
• The involvement in preparing the strategy of other stakeholders concerned with Older People’s services

9. One of the key indicators used in forming the redevelopment strategy was an analysis of the local provision of care home beds per head of population (per capita) aged 75 plus. This information is summarised at Annex 1. The research clearly shows that Oxfordshire is relatively under supplied with residential and nursing care beds for older people, having 93 beds per 1,000 persons aged 75+ compared to 123 for England and Wales. In real terms this means that Oxfordshire is some 1,166 beds short of the ‘national average’. The per capita analysis also confirms that the North of the county is relatively well supplied compared to either the City or the South and that the latter two areas also have a shortage of nursing home beds. Detailed examination of local provision has therefore been used to determine the best mix of residential and nursing beds in the redeveloped homes.

   The Redevelopment Proposals

10. Each of the 19 homes has been considered as part of the redevelopment strategy. Recommendations for each home fall into one of the following four categories:

• No change, home meets new and acceptable care standards.
• Development of a new home, as previously consulted upon.
• Development of a new home, not previously consulted upon.
• Homes requiring further option appraisal or recommended for closure.

11. Proposals for each home (which are also summarised in Annex 2 (download as .rtf file) ) by each area are as follows:

No change
North
Lake House, Adderbury	Will continue as a 43 bed residential home and 15/20 place day centre.
Glebe House, Kidlington	Will continue as a 40 bed residential home.
City
Marston Court, Marston	Will continue as a 39 place residential home and 10-place day centre.
Townsend House, Headington	Will continue as a 45 place residential home.
Longlands, Blackbird Leys	Will continue as a 47 place residential home.
South
Mayott House, Abingdon	Will continue as a 43 bed residential home.
Chilterns End, Henley	Will continue as a 46 bed residential home with a 10-place day centre.
Stirlings, Wantage	Will continue as a 40 place residential home but with a proposal to build a further 8 bed extension.

Development of new care homes, previously consulted upon
These three homes have been the subject of earlier pre-transfer consultations and their redevelopment already forms a contractual requirement between OCC and OCP:
North
Lincoln House, Banbury	This home, currently providing 44 residential beds, will be redeveloped as a new, purpose-built 60 bed nursing home on the former Orchard Lodge site. Nursing care is proposed in order to meet contractual requirements and to meet a need across the Banbury area (nearby Lake House will continue to offer residential care).
South
Blue Mountains, Wallingford	This home, currently providing 44 residential beds, will be replaced with a new, purpose-built 60 bed nursing home at a nearby site. Building work is already under way. Nursing care is proposed in order to meet contractual requirements and to address the shortage of nursing beds in the South area. The new home, named Westgate House, will also provide a 28-place day centre to replace the current OCC provided service adjacent to Blue Mountains.
Ladygrove House, Didcot	This home, currently providing 39 residential beds, will be redeveloped as a new purpose built 60 bed residential home plus 20 very sheltered housing units all on the current site in Didcot. The new development is also planned to provide a 28-place day centre to replace the current OCC service on the Ladygrove site

Development of new care homes, not previously consulted upon
The homes listed below fail to meet the physical requirements of the new ’National Minimum Standards for Care Homes for Older People’ (or those of the 1984 Registered Homes Act) and originally had a contractual requirement to be re-developed by 2007, or face closure (closure will not apply if the government implements its revised standards). Nevertheless, for each one a positive decision is recommended to build a new home.
North:
St Edburgs, Bicester	This home, currently providing 40 residential beds, is proposed for redevelopment as a new, purpose built 60 bed residential home plus 20 very sheltered housing units. Subject to site acquisition, all services will be provided in one location in Bicester. Given the planned population growth in Bicester and the relative per capita shortfall of residential beds locally, an 80-bed development is considered sustainable.
Witan House, Witney	This home, currently providing 51 residential beds, is proposed for redevelopment as a new 60 bed residential home. Subject to site acquisition, the home will be provided at a new location in Witney. Although the Witney and district area has a relatively high per capita provision of registered care home beds, there is proportionally more nursing than residential beds. This, plus the fact that Witney is planned to undergo significant development and population growth, will make the new proposal sustainable.
City:
Iffley House, Rose Hill and Orchard House, Sandford on Thames	Currently provide 56 and 24 residential beds respectively. It is proposed that both these homes close upon the completion of a new, purpose-built care home at a new site in the City. A site has been identified adjacent to Donnington Health Centre on land currently occupied by Donnington Middle School. The new development is proposed to comprise 60 nursing beds, 20 residential beds and 20 very sheltered housing units. Overall, the new development will bring 20 additional beds to the City, whilst the provision of 60 nursing beds will exceed local contractual requirements and begin to address the severe shortage of local nursing homes. These three services together will offer the City a major resource for meeting the various and changing needs of older people on one site.
South:
Meadowcroft, Thame:	This home currently provides 45 residential care beds. It is proposed to close the home upon completion of a new purpose-built and dual-registered home comprising 40 nursing and 20 residential beds at a new site, subject to acquisition, in Thame. The proposal to provide nursing beds will help meet contractual requirements and address the shortage of such beds in the South area.

Homes requiring further option appraisal:

12. The proposed redevelopment of the 16 homes above will meet the minimum volume of block beds which OCP must contractually provide for OCC (currently 651 beds reducing to 559 by 2007) and also increase the overall capacity by a further 53 places (797 now, 852 proposed). In this respect the three homes considered below could be seen as ‘surplus to capacity’. However, for two homes at Woodstock and Chipping Norton a full option appraisal is recommended to see if they could provide additional or different services outside of the current contractual and financial limits.
13. Spencer Court, Woodstock This home currently provides 48 residential beds. In the past its occupancy levels have been below average but this has improved with recent initiatives such as short term ‘transitional care’ services at the home, mostly for clients who live beyond the Woodstock area. However, given the relatively small population of the town and its rural hinterland, it is not felt that the location requires the 48 ‘block’ beds potentially available in the OCP contract. Local social services placement managers have been consulted on this and estimate a requirement for between 15 to 20 beds for state supported residents.
14. The Woodstock catchment area currently has 75 residential beds per 1,000 older people aged 75 plus, against a county average of 52 such beds. Locally, there are two other registered care homes providing a combined total of 27 beds, although these are not often utilised by social services. However, the other redevelopment proposals described above would see the creation of 49 additional places at new OCP homes in Bicester and Witney, plus the continuation of 40 beds at nearby Glebe House, Kidlington. Whilst these are not ‘local’ homes they should be able to absorb any potential loss of beds at Spencer Court.
15. Notwithstanding this OCP have requested the opportunity to prepare a business case for a new care home on the Spencer Court site to be operated substantially outside of the Council’s block purchasing arrangement with OCP.
16. Therefore, it is the opinion of OCP and OCC that Spencer Court should be the subject of a detailed option appraisal to determine its future use. This appraisal will involve managers from the County Council (including their property consultants, W.S Atkins) and OCP, the home manager, plus local PCT and District Council managers. Whilst the actual site does have size limitations, the town’s location close to Oxfordshire’s main road networks and its major hospitals could lend itself to some form of specialist service. Alternatively, options for more local provision will be appraised, including a very sheltered housing scheme or a care home with a greater emphasis on private pay clients operated outside of the main County Council/OCP contract.
17. Consequently, it is recommended that no potential redevelopment of Spencer Court should be planned until after the completion of a comprehensive option appraisal. Any new plans will take time to develop and, therefore, existing care services at Spencer Court will continue for at least two more years.
18. Castle View, Chipping Norton This home currently provides 47 residential beds. Its occupancy has also been below average in the past but has recently improved by offering a variety of short stay and transitional places to residents, many of whom live out of the area. There are 47 contractual beds available to the County Council at Castle View. However, Chipping Norton is relatively well served by care homes, both residential and nursing. It has a per capita provision of 81 residential places, compared to a County average of 52, and a nursing home per capita of 63.5 places, compared to 41 for the County. The view of local social services placement managers is that between 25 to 30 residential beds would be an ideal requirement for state supported resident needs.
19. Given the above analysis, a new 60-bed care home would not be sustainable in Chipping Norton. OCP and most other independent sector care home operators see the 60-bed model as the minimum viable new development. Consequently a replacement home for Castle View cannot be recommended at this stage but a comprehensive option appraisal (using the same methods as for Spencer Court) is proposed to examine alternative models of service provision. A very sheltered housing development, providing an alternative to the good local supply of registered care homes, is worthy of serious consideration. Equally, the town has a community hospital which itself is subject to a review by the local PCT and this might provide options for a new joint social services / primary health care service.
20. As with Spencer Court, existing care services at Castle View will remain for at least a further two years whilst new options are being considered .
21. Langston House, Milton-under-Wychwood: This home currently provides 16 residential places and is the smallest of the 19 homes in the OCP portfolio. The home meets the new National Minimum Standards and is also acknowledged as a popular home with good occupancy.
22. However, the small size of the home is such that it cannot generate sufficient fee income to cover the costs of meeting the minimum care and operational standards expected of a registered home. The home currently operates at a deficit of approximately £125,000 per annum. Financial appraisals have been conducted to examine alternative solutions but, regrettably, none are sustainable. Whilst the home shares its site with 12 sheltered housing flats (provided by West Oxfordshire Housing Association) an appraisal has concluded that a combined care home / very sheltered housing development would still not be viable.
23. The contract between the County Council and OCP always envisaged that, in order to achieve and fund the redevelopment of seven new homes and some 224 new nursing beds within an affordability limit, not all 19 homes would be continued. It is therefore recommended that consultations begin with residents, relatives and staff of Langston House with regard to a decision on the future of the home including investigating options to transfer it as a going concern to a new operator.

Summary of Services provided by the Redevelopment Programme

24. Whilst most attention is rightly focused on decisions concerning the physical
    redevelopment of homes, the various new and continuing services they are planned to provide in aggregate should not be overlooked. These are summarised below.
25. Nursing care beds: By 2007 the re-developed homes will provide 220 such beds on four sites, in order to achieve economies of scale given the current national shortage of nurses. However, the exact number, location and method of delivering such nursing services will be kept under review as each new home development is considered in detail. The development of 220 new nursing beds is equivalent to a 14% increase in the current provision of such registered beds in the County.
26. Residential care beds: Given the above increase in nursing beds, OCP residential beds are planned to decrease by 165 to 632 (including 60 very sheltered housing units) However, this number could be expanded following the outcome of option appraisals at Woodstock and Chipping Norton. The majority of residential beds purchased by the social services department are currently supplied by OCP but this contractual obligation will reduce giving greater options for residents and other providers.
27. Intermediate care beds: Development of these services forms an important part of the Government agenda to modernise care for older people. Intermediate care aims to provide a range of intensive care and therapy services over a six-week period to help older people return home after recovering from an acute hospital admission. Its intention is to divert patients away from preventable long-term care admissions.
28. Plans have been agreed to pilot 20 intermediate care beds this year in registered care homes, including two OCP homes. After a full evaluation, more of these beds could be provided in self-contained units as new OCP homes are developed. The contract with OCP anticipates the provision of such services.
29. Respite and short stay care: The current OCP contract allows up to 60 beds for the provision of respite care. About 50 beds are used at present for this much-needed service and occupancy, in most areas, remains very high. The redevelopment proposals do not intend to diminish this service although the exact supply of such beds will be kept under review as local demand changes. Some long stay beds have already been temporarily converted to ‘transitional care’ beds (for medically stable clients who are waiting in hospital for a home of their choice to become available) which illustrates how the partnership with OCP can be used flexibly to meet the need for ‘short stay’ services.
30. Very Sheltered Housing: The contract with OCP identifies this service as an alternative to conventional residential care for some residents. Recent government guidance has also promised additional funding to further develop this service. The redevelopment strategy group considered a specification for these services and, in summary, concluded that they should comprise:

• Self-contained one or two bedroom flats with a tenancy for each occupant.
• The provision of an on-site care team to provide both ‘programmed’ and ‘response’ care, 24 hours a day.
• Provision of a dining room offering a main, lunchtime meal (residents will use, or be assisted to use, their own kitchens for breakfast and evening meals).
• On-site assisted bathing facilities, laundry room and other communal facilities.

31. Development of three 20 unit very sheltered housing schemes are proposed at new homes in Bicester, Oxford and Didcot, ideally on the same site as the actual care home. These developments will be subject to further negotiations with local housing authorities and associations. The procurement of Social Housing Grant will also be required to develop these services.
32. Day Care: Two types of day care services are currently provided in the OCP contract. One involves day care with ‘designated’ staff and space allocated to provide the service. Such day care provides 195 places a week at three homes. The other involves ‘non-designated’ day care where a limited number of clients attend the homes as ‘day guests’ and receive the same service as actual residents. The contract stipulates that 145 places per week should be provided for non-designated day care. Both forms of day care will continue under the contract but will be subject to occasional joint review in order to ensure operational efficiency.
33. In addition, two new purpose built day centres are to be provided at new OCP homes in Wallingford (35 places) and Didcot (28 places). These will replace current OCC managed day centres adjoining the Blue Mountains and Ladygrove homes. Each will have a separate entrance but will benefit from utilising communal services such as kitchen, laundry, hairdressing, etc from the new home. As new OCP homes are developed in other towns a review of local day care will be conducted to examine the cost and benefit of developing further purpose built centres.

Proposed Timetable for completing the Redevelopment Strategy

34. The current contract requires all new homes to be redeveloped by 2007. In part this was required to meet the new care standards deadline, which may now be relaxed. However, the financial model which funds the 25 year contract is geared to a 2007 deadline and this is still considered the earliest and best date to build the homes, introduce the required service improvements and avoid escalating maintenance costs on the older properties. With the practicality of two homes being built per year then the future of the redeveloped homes needs resolution early in 2003.
35. The proposed redevelopment timetable is, therefore, as follows:

• 1 October 2002

• October 2002 to 30^th November 2002

• December 2002

• January 2003 to March 2007

36. The proposed decision making structure within the County Council consists of a Social Services Board, comprising the Director and Executive Member plus the Head of Service Adult Care, an Assistant County Treasurer and the Service Manager (OCP Contract). The Board will in turn oversee the workings of a Project Group (including OCP) which will drive the delivery of the redevelopment programme and ensure appropriate links with other partners. A Member/Officer Working Group oversees the development programme, and considers issues regarding the performance under the contract. The Member/Officer Working Group advises the Executive on all aspects of the Development Programme and the contract with OCP. Any views on their part on the draft Redevelopment Strategy will be reported at the meeting.

Proposed Consultation Plan and Methods

37. A comprehensive and formal process of consultation regarding the redevelopment proposals is recommended starting in October and ending at the end of November 2002. The following consultation plan is proposed:

• Meetings in each of the homes for redevelopment or option appraisal: This will involve meetings in Thame, Oxford (both homes), Bicester, Witney, Woodstock, Chipping Norton and Milton-Under-Wychwood. Proposals to redevelop homes in Watlington, Didcot and Banbury have already been consulted upon prior to their transfer to OCP. For each home there will be a separate meeting with staff followed by another meeting with residents, relatives and supporters.
• In addition, a further public meeting will be held in each of the above communities in order to gather the views of the local public, voluntary agencies, district, town and parish councils and local PCTs.
• Distribution of the Redevelopment Strategy Consultation Report: Copies of this report will be circulated to all relevant public agencies and voluntary organisations in Oxfordshire and comments invited back to OCC.
• Distribution of Redevelopment Newsletter: A summary of the main redevelopment proposals will be prepared in a simple newsletter format. Copies will be available to all 19 OCP homes and distributed to other key agencies. The newsletter will also invite readers to send comments to OCP or OCC respectively and provide details of how to request further information.
• Dedicated Officer Time: In order to attend meetings, respond to information requests and collate responses, dedicated officer time will be set aside for the consultation process.
• Access to Advocacy Service: The County Council now has a Service Agreement with Age Concern Oxfordshire who provide an independent advocate in each OCP home. The Advocacy Service will be available to represent the voice of each individual resident throughout and beyond the consultation process.

38. It should also be noted that following approval of the eventual redevelopment strategy, plans for the detailed design, site and service mix for each new home will be subject to further local consultation with residents and their relatives/supporters plus staff prior to final approval by the County Council.

RECOMMENDATION

39. The Executive is RECOMMENDED to authorise consultation on the proposed Redevelopment Strategy and Programme as outlined in this report, with the outcome reported to the Executive in December 2002.

STEPHEN WILDS
Interim Director of Social Services

Background papers: Nil

Contact officer: Nick Welch, Assistant Director, Social Services Tel: 01865 815714

September 2002