To consider the report of the Portfolio Holder for Adult Social Care.
Minutes:
The Head of Adult Services gave a short history to this item. Some years ago it had been decided to reduce the funding for daytime activities for older people from £1.6million/year to £300k/year. By 2016 little progress had been made in identifying how this would be saved and the service embarked on a consultation period where it was looking to close the day centres. The results of the consultation found that the service was thought to be good by those who attended even if they had not enjoyed attending at first, and it was seen as a valuable opportunity for respite by carers. Cabinet decided to re-invest £1.1million in older people’s daycentre provision albeit with a reduced budget. Cabinet asked for an update in two years and it is this paper that is being considered.
There has been a decrease in the number of people attending daycentres partly due to a change in expectations with older people choosing not to attend daycentres and partly due to social workers offering alternative options.
The savings required in the first two years have been achieved:
For 2019-20 the savings target is £150k of which £117k has been found and work is ongoing to identify the remaining £33k.
Tanant Valley
This is a once a week day/luncheon club originally arranged by contract with the Royal Voluntary Service. The contract was too restrictive as only people with assessed needs could access the service and therefore the funding model was changed to grant funding. There is a review of grant funding but the Head of Service had requested that funding for this project was not included as it provide a service. This service cost £12k a year and is excellent value for money.
A short film on this service can be found at:
https://www.youtube.com/watch?v=BfnsPfXyayc
Ann Holloway Day Centre Welshpool
When the initial decision was taken to reduce funding of day centres the Council invited interested parties to express an interest in taking them over. Welshpool Town Council entered into a contract with the local authority to run the daycentre whereby the authority block purchase a certain number of places for people from Welshpool and the surrounding area with assessed needs. This costs £75k/year on top of which are transport costs in the region of £46k/year. The contract runs from 2015 to 2025 and whilst there is no review date it does contain an uplift for inflation.
Machynlleth Day Centre
This daycentre is run by Crossroads under a contract which has been extended to March 2020. Machynlleth also has a group (Dolen) which carers can attend. The funding for this contract has been confirmed until March 2020 at £75k/year which although less than a few years ago remains the same as the 2017/18 and 2018/19.
Park Centre Newtown
Consideration is being given to co-locating the daycentre in Newtown with the Library. Savings of £13,580 have been in 2018/90 now Meals on Wheels are no longer provided by the Park Centre.
Bethshan Dementia daycentre
This is specialist provision which is contracted to be provided by the third sector. The contract runs until 2020 and there are no plans to change this.
Maesywennol daycentre Llanidloes
This is a well-attended day centre with approximately 25 people attending each day. It is different to other daycentres as it is located within a care home. The Town Council support the funding of this by £12k/year to ensure its sustainability. This daycentre has been included as an option in the recommissioning of the Care Homes which is currently in progress.
Arlais day centre Llandrindod Wells
Changes here have seen the source of meals change which has saved £39k in 2018/19. Additionally savings of £17k are anticipated by a reduction of opening times from 5 to 3 days/week. The setting is also relocating to a smaller site in town which may produce further savings along with a capital receipt when the existing site is sold.
East Radnor daycentre
This centre is run by a charity that also provides home based support. Funding for the daycentre was cut in 2017 when the charity started to provide home based support. As a third sector provider this service can accept self funding older people from the local area including from England.
Crickhowell
There are very low attendance figures for the centre in Crickhowell and one of the options would be to provide transport to the daycentre in Brecon. This is already the choice of daycentre for older people in the surrounding area who may be closer to Crickhowell. There are other activities organised in Crickhowell and there may be the potential to provide support to a luncheon club in the town. Much work has taken place initially to see if there was local interest in taking over the daycentre but this did not materialise and stakeholder engagement continues.
Arosfa Brecon
The numbers attending this daycentre a decreasing and the service are looking to reduce opening days from 5 to 3 days/week although this is dependent on what is decided with the Crickhowell daycentre as if this is closed then a five day service would be needed in Brecon. It is 12 miles from Crickhowell to Brecon.
Canolfan Ystradgynlais
There has been a significant decline in attendance at Canolfan. In the New Year the number of days the centre is open will be reduced to 2 days/week. Work has been undertaken to identify is support can be given to a voluntary luncheon club in Coelbren but recently confirmation was received that this will not now take place. Canolfan is large and therefore it will be necessary with the reduced numbers to look for an alternative location. A short term and longer term solution maybe necessary as there are early stage plans for an extracare housing facility in Ystradgynlais.
Question |
Response |
|
|
There are other luncheon clubs in Powys. Why do they not receive grants like Tanant Valley? |
Tanant Valley was originally a voluntary run day centre which we purchased places from. The low numbers of people with assessed need to refer to the centre made it at risk of unviability and therefore the funding model was changed. The question of why other luncheon clubs are not similarly funded is valid and will be considered by the service |
|
|
This report needs to include the number of people accessing each day centre and for how many days together with transport costs for all daycentres to enable cost comparisons to be calculated. |
Transport costs together with other costs such as utility costs and property costs are already included. Information will be provided regarding numbers and attendance and will be included in the update to Cabinet |
|
|
What contributions do people make to access daytime activities? |
In the case of Tanant Valley people only pay for their meals and refreshments. In the case of Council run daycentres people with assessed needs pay £80/week. This covers their transport and attendance at the daycentre. An additional charge of £7.50/day is made for meals and refreshments. In daycentres run by voluntary organisations people who do not have assessed needs can pay to attend the daycentre. For example, Presteigne and Machynlleth both welcome self funding people. The rates for people accessing the service privately may vary depending on the support the daycentre receives for example if it is supported by a Town Council residents of that Town may pay a different rate to residents who reside outside the town area |
|
|
Access is limited by the size of the provision |
In Welshpool it has been the case that the number of places purchased has exceeded assessed need and the authority has not had to turn people away. If there were no places then the potential to purchase additional space at a spot rate would be considered. |
|
|
Welshpool took over the daycentre when daycentres were under the threat of closure. All daycentres should be operated on the same basis on the grounds of equity. |
The idea that all areas should have equity of access to daycentres is aspirational but not reality. There are areas of Powys which do not have any access to daycentres. The service are trying to provide equity of outcomes for older people and these aims are supported by Welsh Government. People should be supported to attend the pub, café, WI, chapel, a football match or whatever meets their needs rather than only having the option of attending a daycentre |
|
|
Is there an aim to decrease attendance at daycentres? |
The service is working under the Social Services and Well-Being act to try to find personalised solutions for each older person which may or may not include attendance at a daycentre. There is, and continues to be a decrease in the number of people accessing daycentres |
|
|
What obligation does the authority have to provide daycentres? |
There is no obligation for authorities to provide daycentres. The service assesses what matters to each older person and to best meet these needs through a strength based approach |
|
|
Why can other Town Councils no longer get the same package that was offered to Welshpool? |
This arrangement was put in place in 2015 and since then financial pressures have increased. Other Town Councils did approach the authority to investigate suitable local arrangements but no other Town Council felt able to proceed. Each Town will have differing needs |
|
|
In 2016 306 people were accessing daycentres. How many people are accessing daycentres today? |
Newtown 53 Llanidloes 41 Arlais 25 Arosfa 31 Crickhowell 17 Ystradgynlais 14 |
|
|
Newtown appears to be providing expensive provision. Has the potential to co-locate with the proposed developments being made by the Health Board been considered? |
Newtown does appear expensive however, it is the largest town and has the highest attendance of daycentres in Powys. The potential to relocate is being considered in the short term and longer term opportunities are also being explored |
|
|
Have the opportunities to work with the Health Board in Machynlleth been considered? |
The authority are working with the Health Board to explore opportunities in relation to the daycentre, provision for learning disability support and social worker office accommodation in any plans that are put forward in Machynlleth |
|
|
Has consultation been undertaken to ascertain what provision older people want? |
During 2016 considerable consultation was undertaken when it was proposed to drastically cut the budget for daycentres. This consultation won a national award for the way it was run. Consultation is not just about speaking to those who attend the daycentres (who largely enjoy their experience) but needs to also reflect the views of older people in the community who do not attend daycentres |
|
|
Is the service looking to use taxi transport instead of minibuses? |
No, the service are working with fleet to upgrade the vehicles |
|
|
From the data provided it appears that third sector provision is more cost effective than Council provided services. Has the potential for more settings to be run by the third sector been considered? |
Since the original reductions in the budget for this service were proposed the authority has been in conversation with various interested parties but there has been no recent proposals to take over a setting |
|
|
The data appears to show that this is an expensive service provided to a limited number of people. |
There has been a reduction in the number of people assessed to have needs that can be best met by attending a daycentre. As numbers fall fixed costs (buildings etc) remain and whilst it may be possible to reduce opening times by one or more days thereby saving on staff costs it may mean that by increasing attendance on those days the centre is open requires additional staff to be employed |
|
|
If provision in an area is expensive would it be more cost effective to offer older people direct payments to make their own arrangements? |
In 2016 the service looked at the alternative provision that would be needed for all the older people who were currently accessing the service. This showed that the alternative provision (domiciliary care) would cost £800k in 2016, if the care staff were available. |
|
|
Is the service able to refer older people with assessed needs to Llys Glan-yr-Afon in Newtown? |
Llys Glan yr Afon has some facilities but is not a daycentre. The service have been in discussion with Wales and West regarding the potential for referring older people to these facilities but there has been no conclusion to this discussion to date |
|
|
Have other options been explored to co-locate services in Llanidloes |
Some work was undertaken with the Powys Teaching Health Board to co-locate services but this did not progress |
|
|
Those older people that do attend day centres are more frail now than used to be the case. Can it be confirmed that older people who may benefit from daycentre care are not slipping through the net because daycentres are no longer routinely offered as an option by social workers? |
There has been a change of approach and it is correct that those people who attend daycentres are older because they have been supported at home for longer. It is not the case that the option is not given but is the case that other options are offered which are proving more attractive initially |
|
|
What is the average age of people attending daycentres? |
In 2016 the average age of Powys residents assessed as needing daycentre care was 73. This average age has risen since then.
|
|
|
Will parking be a problem at the new site in Llandrindod? |
Local consultation indicates that the new site is suitable |
|
|
Are direct payments evaluated? |
Direct payments are monitored and audited. Clawback of unused money does take place and in the previous year was in the region of £0.5mill. Further detail regarding Direct Payments could be provided to Members |
|
|
As the population ages who will be able to care for elderly people? |
The Health and Care Strategy and Vision 2025 outline the authorities longer term vision for supporting older people. A report on progress is with the Director for signoff. This shows that had demand for domiciliary care risen at the same rate as the Powys population then additional costs of £3million would have arisen but action taken to support people has diverted this need. |
|
|
The cost of transport and meals can mean that people in deprived areas cannot afford to attend daycentres |
The cost of transport and attending a daycentre is capped along with other social care charges at £80/week. Lunch and refreshment costs are additional. The Head of Adult Care had not received feedback that older people were unable to afford to attend a daycentre |
|
|
Could the authority work with neighbouring councils to improve the sustainability of Canolfan? |
Both Neath Port Talbot and Carmarthenshire have existing provision so it would be unlikely that they would need the additional capacity that could be provided by Canolfan. |
|
|
The aspiration to move from an institutional model to an individual model is understood. The cost of daycentres appears high. How does this compare to the cost of individual care? |
Supporting people to live independently in the community can be more expensive, but is the right thing to do in enabling people to not be dependent upon institutions where possible. Individual care may or may not cost more than daycentre care but at the Care and Wellbeing Act requires individual care to be prioritised |
|
|
How can equity of access be improved? |
Access is a real issue in a rural county. Not all residents will have easy access to a daycentre and the service, together with services across the council, are working towards ensuring there is equity of outcomes for people |
Findings
This is the first new style four page report that scrutiny have had sight of. The main content of the report covered no more than two pages and scrutiny found that they were hampered in their consideration of the paper by a lack of detailed information regarding attendance and cost per place information. This information was partly provided within the session and offered for circulation after the meeting. Whilst scrutiny welcome the new concise reporting instructions there will be occasions where appendices may be appropriate and the format of the report may need to be amended to ensure that the four pages are not disproportionally taken up with the corporate comments.
The opportunity for all Members to be briefed on Direct Payments in a Member Development Session be explored.
Detailed scrutiny observations will be provided to Cabinet.