Purpose: For Approval

Committee Date Title


Report of

EXECUTIVE SUMMARY 1. This paper updates cabinet members on the outcome of community engagement work undertaken in July and August this year, as previously discussed and approved by Cabinet on 10 May 2011. It contains a summary of the feedback from the engagement work including views about future commissioning of support for older people and more specifically about the future for services delivered at The Adelaide and The Gouldings. In the plan set out before cabinet on 10 May 2011 the intention was to present options relating to the future of The Adelaide and The Gouldings alongside the report from the initial consultation phase. It was proposed that there would be a further 90 day consultation following cabinet’s decision. Feedback from the initial consultation has highlighted a range of possibilities which would have an impact on other council services not previously included. This paper seeks the approval of cabinet to allow further time for officers to develop a clearer picture of the potential business models and delivery options which would take into account the feedback received thus far, whilst also delivering efficiency savings and realising the council intention to move away from direct service provision in a managed way. At its meeting on 10 May 2011, Cabinet considered and approved proposals for a consultation exercise which would include a period of engagement prior to making more detailed proposals which would then be subject to a further 90 day consultation period. The paper reflected on the need to consider the future of The Adelaide and The Gouldings Resource Centres in the broader context of care for older people on the Island. D-1



4. 5.




This was also set within the context of firstly the council moving to being a commissioning body (as outlined in the Chief executive’s paper The Council Organisation: future shape and direction, 7 December 2010); and secondly the immediate requirement to reduce our financial commitments whilst making sure that the most vulnerable people on the Island continue to have access to the support they need. The review of care for older people on the Island is directly relevant to the Eco Island vision to develop a healthy and supportive Island as well as impacting on the corporate priority to support older and vulnerable residents and deliver budget savings through changed service provision. A full report on the community engagement is attached at Appendix I, which includes information about who was consulted and how, together with an analysis of the comments received. The work undertaken in July and August was shaped and supported by a range of organisations with an interest in the needs of older people including Age Concern, Older Voices, Quay Carers, Isle of Wight Advocacy Trust, Carers UK, Alzheimer’s Society, Isle of Wight LINk and NHS Isle of Wight. We are grateful to these organisations for their advice and support in undertaking this work. The community engagement involved the production of what was termed a “market report” describing the population of the Island and its likely changes over the coming years. The range of services that are currently available on the Island, services that are available elsewhere but not well developed here and the current investment and services delivered by the Adelaide and the Gouldings. A survey form was developed and made available both online and through a range of outlets and was heavily advertised. In addition the Advocacy Trust was commissioned to facilitate people who currently use the services of the Adelaide and the Gouldings expressing their views through individual interviews and six public sessions were held in Newport, Freshwater and Ryde. Senior managers also held separate briefing sessions for both staff groups at the Adelaide and the Gouldings. This process resulted in 237 individual survey responses with a further 15 people writing separately and the views of an additional 35 people being summarised through 4 responses representing discussion groups led by either the LINk or Older Voices. There was also a written response representing the views of 60 staff and the League of Friends of the Gouldings and 21 people attended the public events. The following paragraphs summarise the key messages from this community engagement. They are considered in terms of: (a) The range of services that the Council should look to develop (b) The particular contribution of the Adelaide and the Gouldings (c) The future organisational arrangements for the Adelaide and the Gouldings









In terms of the range of services that the Council should look to develop the key messages were as follows: (i) (ii) Separate and specialist support for people with dementia Separate and specialist support for people at the end of life, available quickly and with minimum “bureaucracy” D-2

(iii) Homecare provision with increased capacity delivering a more prompt response when required and with a greater consistency of individual carers (iv) Preventive work addressing growing problems such as diabetes, dementia, obesity, smoking, hypertension/stress and depression (v) More positive involvement of older people in shaping services (vi) An updated Carers’ Strategy and delivery plan (vii) Effective self assessment and direct access to services (viii) One Stop Shop/information – feedback highlighted the need for improved access to information, including developing a directory of services available both in print and online (either through joint funding or advertising). 17. In considering the future contributions of the Adelaide and the Gouldings there was very strong support for the residential respite and day care services being provided. Both people who use these services and their carers expressed great appreciation of them and the difference that they make to their lives. In addition there was strong support for developing the range of services provided from these centres including: (i) (ii) (iii) Broadening the resource centre concept so that they become more of a focus for the community Reaching out into the community to identify and support more vulnerable people Widening the range of activities available at the centres so that they are not just focussed on “care” but on a range of wellbeing activities that promote social interaction, intellectual stimulation and healthy living Streamlining approaches with NHS services particularly in relation to crisis response and reablement services Streamlining approaches with the council’s homecare and Wightcare services Being accessible for people wishing to purchase directly from their own resources without the need for assessment by adult social care. This view was particularly expressed in relation to residential respite care and day care services.

(iv) (v) (vi)


Finally, there was considerable concern in terms of the future organisational arrangements for direct services. This focussed on the concern about externalising the services to a private provider. It was felt that such providers would be driven by profit rather than quality motives. The strength of this view might be considered surprising given that the vast majority of the Island’s nursing and residential care home services and homecare services are delivered by private sector providers and are, generally, well regarded. However, this engagement exercise took place against the horrific disclosures of abuse of learning disabled people at the Castlebeck facility near Bristol and the financial crisis of Southern Cross that potentially placed thousands of vulnerable older people at risk of losing their care home placement. The overriding view was that the future of these services should rest in some form of “not for profit” arrangement where the focus was on quality services meeting the community’s needs albeit delivered at competitive prices. To support this approach, there was also considerable feedback from members of staff themselves who identified the opportunity to manage these services at arms D-3




length of the council, and ultimately completely independently. However, the staff recognised that they would want to prepare thoroughly to be able to ensure that the business would be successful in the longer term. Therefore they would value a period of time where they could develop the necessary skills and insight. During that time they would be in a position to shape the business in terms of the range of services provided and ensure that they delivered high quality at a price that would enable them to compete in the open marketplace. HUMAN RESOURCES 22. There are no Human Resources issues at this stage other than recognising the importance of continuing to fully involve members of staff in the process. We will fully assess the impact of any future proposals on members of staff as part of the Equalities Impact Assessment. There are no costs at this stage, but a detailed financial assessment will be included in future proposals. There are some implications associated with developing local resource centres which may minimise the need for people to travel distances for support and thereby reduce carbon emissions. Consideration of this will be included alongside more detailed proposals in future. The legal duties relating to social care for older people placed on local authorities include: (a) carrying out assessments of people’s needs (NHS & Community Care Act 1990, Disabled Persons Act 1986, Chronically Sick & Disabled Persons [CSDP] Act 1970) (b) access to social work advice (National Assistance Act 1948) (c) access to support service and facilities for rehabilitation, adjustment to disability, occupational, social, cultural and recreational activities (National Assistance Act 1948) (d) ensuring access to information about relevant services (CSDP Act 1970) (e) a joint duty with Health to provide after care services for people with mental health needs (Mental Health Act 1983) (f) safeguarding vulnerable adults (Mental Capacity Act 2005) 26. The Equalities Act 2010 created a unified and extended public sector duty. In the exercise of its public functions and provisions of services to the public, a public authority, including a local authority, must have due regard to the need to eliminate discrimination, harassment, victimisation and to advance equality of opportunity between persons who share a relevant protected characteristic and persons that do not. The local authority will consider the impact that any future proposals may have on individuals who may be affected and, in particular, those with a protected characteristic under the Equalities Act 2010. The duty covers all the following protected characteristics: age, disability, gender, gender reassignment, pregnancy and maternity, race, religion or belief and sexual






orientation. It also covers marriage or civil partnerships, but not for all aims of the duty. EQUALITY AND DIVERSITY 28. The initial Equality Impact Assessment has been revised to include specific information resulting from the first consultation phase. There are no property implications at this stage. Option One: doing nothing would present a high risk to the council both in terms of being unable to make the necessary savings as well as failing to respond to public feedback once requested, which would have a detrimental impact on the council’s reputation Option Two: Do some limited work to enhance services at The Adelaide and The Gouldings in isolation. This approach may deliver a level of savings but this is likely to be limited given the high costs of corporate overheads and running costs. Such an approach would also not deliver the customer benefits envisaged by those feeding back in terms of streamlining community-based services. Option Three: Undertake a wider piece of work covering all directly provided services within the Community Wellbeing and Social Care Directorate including Westminster House, The Adelaide, The Gouldings and Wightcare (community alarm) as identified in the Budget Paper presented to Full Council on 21 September 2011. This would allow officers a further period of time to prepare a more detailed report, considering all directly provided services within the Community Wellbeing Directorate, including No Barriers, Beaulieu, Homecare/Reablement and Mental Health Day Services. This work would result in specific proposals being brought to Cabinet describing how services could be enhanced while delivering financial savings and for the programme of work to be undertaken to test and deliver the provision of these services outside the councils’ direct control and management. Option Four: That officers take into account the broader feedback in terms of priorities for service development in considering the future commissioning of care and support services for older people and that these are brought together into a strategy that integrates both council and NHS provision. Those risks identified by respondents to the initial consultation phase will be incorporated as part of the risk assessment of proposals which emerge. There are significant risks associated with not taking additional time at this stage to take full account of feedback and develop a sufficiently detailed proposal, namely the potential: (a) (b) (c) Failure to realise the optimum proposal capable of delivering increased capacity to support older people in future Failure to realise optimum efficiency in the longer term and council savings in the immediate future For the value and quality of consultation to be minimised should insufficient information be available to fully inform the process







RECOMMENDATION 36. That Cabinet receives the attached report and approves Option Three, to allow a further period of time for officers to prepare a more detailed report which will then come before Cabinet in December. That Cabinet also approves Option Four, that officers take account of the feedback received in developing an integrated strategy for future commissioning of care and support services for older people across the council and the NHS.


APPENDICES ATTACHED 38. APPENDIX - Care for Older People on the isle of Wight including the role of The Adelaide and The Gouldings – Engagement Report (including the updated Equalities Impact Assessment)

Contact Point - Kim Ball, Operations Manager, 01983 814675 e-mail

IAN ANDERSON Strategic Director Community Wellbeing and Social Care

COUNCILLOR ROGER MAZILLIUS Cabinet Member Adult Social Care, Housing and Community Safety


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