Agenda item

[Report of the Deputy Chief Executive.To be introduced by the Cabinet Member for Health and Wellbeing]Consultation has been taking place, from 3^rd July – 1^st October, on proposals which affect Adult Social Care services. This report presents to Cabinet the feedback from consultation and other engagement with stakeholders and asks for decisions on the proposals.

The Cabinet Member for Health and Wellbeing introduced the report which set out proposals for, a number of current adult services to either change or close to enable best use of limited resources to create a more sustainable adult social care system in Haringey to deliver the best care possible for residents.

The changes would help to create an adult social care system in Haringey that does more to promote and support individual independence, dignity and choice. It will see some care shifted away from institutions, giving more people the opportunity to live healthily in their own homes and communities for longer.

The reduced budget of the Council was making the continuation of current Adult Services unsustainable. The Cabinet Member for Health and Wellbeing further outlined factors for the changes to provision at Osborne Grove, Haynes and Ermine road Centres and closures to day care services at the Haven, Roundways, Grange, Linden Road, Birkbeck Road, and Always Centre. This concerned changes to demographics, rising demand for services and changes to Government funding formulas which will see less funding for adult social care given to Councils in London.

These new proposals had been developed keeping in mind the responsibilities of the Council under the Care Act, and their increased role and responsibility for the broader social care market. A set of principles and values had been developed that the Council will be clear on which the services built and commissioned would be held to, and monitored against through contract management

The Cabinet Member for Health and Wellbeing reiterated that the Council were fully committed to safeguarding adults at risk, meeting statutory responsibilities and continuing to provide services that meet the assessed needs of adults. The Adult’s Service would be working with service users and their families and carers in the design of services going forward. There was continuing work into co –production and co design of Adult Services and the outcomes that would be focused on, this was set out from page 19 of the agenda pack.

Responses to the consultation had been fully set out in appendix 1 of the agenda pack along with actions to mitigate against the risks identified and summaries included of the financial position which would all be taken into account by the Cabinet.

The later budget monitoring report further exposed how continuing overspend by the Adult Services, in its current form, could not be sustained due to demographic change and increase in demand.

The Cabinet Member spoke of the depth of consultation undertaken  which had started late last year with consultation as part of the budget process , continuing with a further 3 month consultation between July and October before papers were brought forward to Cabinet.

Cabinet Members put forward the following questions which were responded to by the Cabinet Member for Health and Wellbeing.

·         Councillor Arthur continued to ask a question about the risks of alternative provision. In particular, the new provision for users of the Haynes and ensuring the right provider was chosen and monitored. Councillor Morton responded and spoke of the Council’s statutory monitoring and safeguarding role in the community. The Council was already working with the Care Quality Commission, other Councils and other borough providers on risks in social care and safeguarding. The Council will continue to work with these stakeholders as part of the Safeguarding Board .Also, where there were new contract management relationships, the Council would be ensuring that providers are working to commissioning for social value as required by the care act and duty to wellbeing.  There would continue to be independent scrutiny of the Adults services through the CQC and the SAB

·         Cllr Strickland spoke of continuing to use staff knowledge to transform services and ensuring their views were fed in to the process. Councillor Morton advised that there were already regular meetings with all staff affected by the changes. They had also been engaged in the consultation process so far. The Council would continue to work with staff and seek their views on the new target operating model.

In response to a question on the closure of the Roundways Centre and transfer of services to the Ermine road, Councillor Morton referred to page 38 of the report at 6.5.4 which further expanded on experience of a community based model to deliver autism services in the borough. There was a section on mitigation and changes that would be made to the Ermine Road Centre to make this Centre accessible and appropriate for the assessed needs of users. 

·          Cllr Waters spoke about the success of the shared lives scheme and residents continuing to know how and where to access services .The strengths of the current shared lives scheme was recognised but it could not meet demand in its current form.  The Council would be seeking a good alternative provider to grow the scheme and increase the carers involved. It would connect with the Council’s own Customer Transformation Programme to make it easier for residents: to get advice at Council offices, be better directed and correctly signposted to the appropriate services.

·         Cllr Vanier asked Cllr Morton to expand further on the mitigation measures being taken forward, following closure of the Haven and  changes to the re- ablement service  .She referred to page 58, paragraph 6.8.2 which indicated that service users were over 80 , with range of high level support needs. In regards to changes to the re- ablement services, assurance was  provided that there will be safeguards in place to mitigate concerns  that have been expressed in consultation Councillor Morton advised that there will be an implementation plan compiled with carers, service usurers, and assessments completed for individuals to enable the right alternative provision. This was coupled with support to services users with a sensitive transition plan to mitigate impact. A support officer with specific focus on transition was being recruited.

·         Cllr Goldberg referred to the EQIA findings page 44 and how the transitions for services users, at the Grange, who were mainly from the Afro Caribbean community would be handled. Cllr Morton outlined that the Council will look to commission and provide services to users at the Grange and ensure that the change is exceptionally and carefully completed. Representations on travel difficulties were well made, and would be taken forward as part of the mitigation action.  The Council will commission services across the community and will be aware of the ethnicity of Grange users and this change would be handled exceptionally carefully. There were other dementia providers in Tottenham and the Council would be talking to them and commissioning services appropriately and bearing in mind statutory responsibilities

·         The Cabinet Member for Health and Wellbeing and Adult Services thanked officers who had worked hard to find an alternative solution for Osborne Grove and transfer the Centre to a statutory NHS group.

The Leader invited Councillor Connor to address the Cabinet.

Councillor Connor had previously notified Cllr Morton of the Adults and Health Scrutiny’s Panel’s views on the consultation process. Cllr Morton outlined that Panel had put forward concerns about: how the responses were being taken forward, the overwhelming objections to the closures and changes to services, how alternatives for the closed provisions not yet developed and how meaningful responses could be provided to the responders. There were further concerns about the consultation process and how the co design process being taken forward. Clarity was sought on the role on the carers re-designing services and having as much input as [possible form carers and users in how the service changes are taken forward.

In response Councillor Morton outlined the expansive consultation process undertaken which had covered complex issues. There had been a range of meetings with service users, written responses collated, and the publicity methods used to elicit responses which had provided 300 written responses. Previous Scrutiny Panel points raised about access to the consultation had been reflected in a FAQ section of the consultation.

Cllr Connor also referred to the percentage of consultees, who were against the proposals by way of a question and this should be reflected in the minutes.

Cllr Morton explained that the consultation responses had been read by Cabinet colleagues and they were clear about what respondents were advising them in relation to the changed services and closures of Day Care Centres. Where possible proposals had changed, for example Osborne Grove staying open and working with the NHS . Also the issues raised in the responses  would be essential in, shaping  the way the Council will consider the risks and mitigation actions to be taken forward. The Cabinet Member made clear that the Council will not close services until an alternative provision has been found for the service users.

Councillor Gideon Bull was invited to come forward and address the Cabinet.

Cllr Gideon Bull began by criticising the Cabinet report which he felt was lacking in evidence base, had little information in future planning of the service, and the mitigation was weak. He spoke further of the high cost provision at Linden House where most of the users were aged over 80 with high special needs and questioned how alternative provision would be able to accommodate their needs. He felt that the proposals should be based on the prevention agenda and highlighted the good work of the Haven in supporting clients with high levels of physical needs including supporting clients who were recovering from a stroke.

He highlighted the importance of the Day Care Centres in reducing isolation and questioned how some elderly clients will be able to manage their personalised budgets without the support of the Day Care Centres. He queried what services these users can now buy without the support of the Grange and Haven. He suggested investing in one or more of the Day Care Centres to limit the future higher expenditure associated with residential care as he felt the Centres provided a key role in supporting clients to remain independent for longer. He also questioned why the report had not spoken further about an integrated service.

Councillor Gideon Bull, concluded by querying the local alternative provision available to service users, and asked for there to be more innovative solutions from existing structure. He asked Cabinet to pause taking forward the recommendations until alternatives were found.

Councillor Morton responded to the points raised by Councillor Bull by making clear that the proposals had a clear focus on prevention, re-ablement and responded to the Care Act.  The prevention example for Haven was set out from pages 27 of the agenda pack. The Council were taking these decisions to improve physical health and to enable physical re- ablement in the home so service users can continue to live in the community. The Haven was a more expensive service, per unit cost, per week, than local care at the Irish Centre This was not equitable and not sustainable as demand grows. Cllr Bull disputed this as he claimed the unit costs would go down if there were more users assigned to the Centre with the investment in additional transport.  Cllr Morton questioned why this issue had not previously been raised. It was clear last year that the Haven did not have the capacity to provide the kind of support as other Day Care Services. The Director for Adults further added that additional clients attending the Haven mean there would need to be more staff recruited to support them.

Cllr Morton re-iterated that there will be advocacy support for service users with personalised budgets and that service users will be provided with an assessment.

Clients with identified needs in Linden House will have a detailed assessment and the Council will seek to place these clients together, in the borough, in a proper supported residency with individual tenancies. They will continue to receive support, not just at home, but otherwise through a provider. The Council would continue to make sure their care is monitored and they continue to receive high level support.

Councillor Morton responded to the points on the combined impact of the closures .He was clear that services will not close until: alternatives are  provided, the Council is clear on safeguarding and mitigation points to be taken forward for each individual user .This will be done in a managed way working with Council Social Workers ,the Safeguarding Adults Board . The risk register will be used to manage and mitigate against the risks identified and this will be monitored by the Transformation Governance Board.

Cllr Morton reiterated that as part of the personalisation, clients will continue to receive support at home and there will be consideration given to new journeys and how they will be managed.

In summing up the Cabinet Member for Health and Wellbeing described the choices being made as difficult and challenging which was why a 3 month consultation had been carried out. The process had endeavoured to lay out what people told the Council in the consultation, the risks, and actions in response to them. There were risks with continuing to use reserves to sustain the current service. However, regardless of the financial position the demand for services was growing. Therefore, to have a sustainable future, meet the corporate plan objective for healthier and fulfilling lives, allow the Council to meet the requirements of individuals and statutory responsibilities the recommendations were put forward for agreement.

Following a vote of Cabinet Members  -

RESOLVED:

1.    Considered and taken into account the detailed feedback from the consultation undertaken.

2.    Considered and taken into account the equalities impact assessment of the proposals on protected groups.

3.    Considered and taken into acount actions proposed to mitigate the impact of the proposals on the protected group i.e. service users.

4.    To increase the Council’s capacity to provide re-ablement and intermediate care services by:

a)    The retention of Osborne Grove as a nursing and residential provision and developing re-ablement and intermediate care provision on site. This provision to be managed by an NHS provider through a statutory partnership arrangement.

b)    The closure of the Haven Day Centre and changing the use of the premises to a community re-ablement Centre delivered by an alternative provider. The commissioning of the new re-ablement service to be informed by the co-design principles and outcomes set out at 3.10 below and service users and carers to be involved in the production of the service specification. The new community re-ablement Centre to be commissioned as part of the Intermediate Care Strategy, being developed jointly by the Council and the Haringey Clinical Commissioning Group, as part of an overall approach which builds re-ablement capacity for individuals, services and communities

c)  The transfer of the Council in-house Re-ablement Service to an external provider following further engagement with staff and the Trade Unions in line with existing protocols, and a procurement process.  

5.    The closure of the Haven Day Centre to be subject to an implementation plan that includes a) engagement with all stakeholders including service users and carers, b) the re-assessment or review of the care and support needs of service users with a view to identifying suitable alternative provision to meet assessed needs, c) the assignment of a Personal Budget Support Co-ordinator to support service users to access other day opportunities and d) a transition plan that is sensitive to the needs of service users, mitigates the impact of the closure, ensures the process of change is safely handled and the care and support needs of the service users continue to be met. 

6.    To expand the Council’s capacity to ensure Supported Living Accommodation and Shared Lives schemes by:

a)      The closure of Linden Road Residential Care Home; and

b)      The delivery of the Council’s in-house Shared Lives Service through an alternative provider and following a procurement process. This is to ensure that the expansion of the scheme is delivered and that the benefits are felt throughout the system.

7.    The closure of Linden Road Residential Care Home to be subject to an implementation plan that includes a) engagement with all stakeholders including service users, families/carers and independent advocates (where necessary), b) the re-assessment or review of the care and support needs of service users with a view to identifying suitable supported living accommodation or other alternative provision to meet assessed needs and c) individual transition plans that are sensitive to the needs of service users, mitigate the impact of the closure, ensure the process of change is collaborative, safely handled, in the best interest of the service user and enable their care and support needs to continue to be met.

8.           To increase the flexibility and availability of day services within the borough by:

a)    The closure of the Roundways, Birkbeck Road and Always Day Centres for adults with a learning disability;

b)    The provision of a new and expanded day opportunities for adults with learning disabilities (including those with complex needs and autism) from Ermine Road Day Centre and through an alternative provider;

c)    The closure of The Grange Day Centre; and

d)    The provision of a new model of day opportunities for older people and those with dementia from The Haynes Day Centre through an alternative provider.

9.           The closure of the Roundways, Birkbeck Road, Always and The Grange Day Centres to be subject to an implementation plan that includes a) engagement with all stakeholders including service users and carers, b) the re-assessment or review of the care and support needs of service users with a view to identifying suitable alternative provision to meet assessed needs, c) the assignment of a Personal Budget Support Co-ordinator to support service users to access other day opportunities and d) a transition plan that is sensitive to and mitigates the impact of the closure and ensures the process of change is safely handled and that the care and support needs of the service user continue to be met.

10.         To adopt the following principles and outcomes developed through the co-design process for the delivery of the future service models for day opportunities for people with learning disabilities, older people and people with dementia:

Principles

a)         Quality monitoring of all activities and services in Haringey

b)         Accessible and up to date information  about activities and services

c)         Mobilising community volunteering and supporting this with infrastructure

d)         Working with providers so staff are well paid

e)         Working with providers to encourage staff development

f)          User, partner and staff involvement in the development and delivery of opportunities

g)         Enabling service users to lead a fulfilling life

h)         Working with the market to develop a breadth of opportunities that meet the needs of a range of individuals and provide choice

i)          Developing availability of sustainable opportunities

Outcomes

a)         Expanding out the availability of services in the wider community

b)         Information about services that are available

c)         Development of a travel programme to enable access to opportunities

d)         Help with personal assistants to provide help and support

e)         Enabling remaining Centres to work as hubs for needs of wider community

f)          Alternative methods of service delivery to be explored

g)         Support for people with Personal Budgets

11.         Using the principles and outcomes above, to develop with stakeholders including users and carers, a service model upon which officers will base the specification for day opportunities for adults with a learning disability to be delivered from Ermine Road Day Centre and for day opportunities for older people and those with dementia to be delivered from The Haynes.

12.         To tender the service for day opportunities for adults with learning disabilities based on the co-designed service model and specification, to achieve optimal outcomes for users and to achieve best value.

13.         To tender the service for day opportunities for older people and those with dementia based on the co-designed service model and specification to achieve optimal outcomes for users and to achieve best value.

14.         The implementation of the recommendations set out in 3.4 to 3.13 is delegated to the Director of Adult Social Services in consultation with the Cabinet Member for Health and Wellbeing.

15.       The implementation of the proposals to be monitored and overseen by the Healthy Lives Priority Board and the Transformation Group. (See Governance Section 4.30).

Alternative options considered 

Before the Council set its budget a consultation exercise was carried out on a wider set of proposals and savings proposals of £5.7 million set against care packages in Adult Social Services. This was considered but not taken forward.

The Council had also considered increasing Council Tax. It was decided that this was not the right thing to do as government funding rules suggest that overall the Council would only receive an additional £600,000 if it raised tax by 2%.  This would not be enough to make a substantial difference to the social care budget but would mean that people in Haringey would have to pay more tax which could be challenging for residents.

The Council also considered using its reserves and the Council’s Medium Term Financial Strategy does include some use of these reserves. However, the funding reductions are expected to continue for several years and are too high to be fully met from our reserves. 

As the Council has set its budget, not making the Adult Social Care savings would be likely to mean that the overall Council budget would fall into deficit (i.e. expenditure could exceed its available resources). This would result in serious financial difficulty for the Council as a whole and call into question the sustainability of services in the future.

Legislative changes, demographic pressures and budget challenge mean that to continue to provide care and support in the current manner is unsustainable. The way we currently deliver services cannot meet expected outcomes and will not provide equitable services to meet demand.

To increase the capacity to develop services run by the Council would require more resources.  The budget to provide adult social care has been reduced and, as such, there are no further resources therefore alternative ways of delivering services must be considered.

Responses to the consultation indicating the level of agreement/disagreement with the proposals have been considered in conjunction for the reasons stated for that view to understand the potential positive/negative impact of the proposal.  Where opposition to the proposals was raised, we have identified areas where we could mitigate the concerns/risks including further increasing communication, and collaborative working with service users/families and providers. These are considered in further detail in the paragraphs below.

Reasons for decision

The need for change

The traditional role of adult social care is changing. In the past, adult social services centred on assessing people’s care needs and providing services to meet those needs. This remains a very important part of what social workers do, but there is increasing recognition that adult social care must do more to support people before they need care. In an era where our population is ageing, investing in prevention is key to helping more people to stay healthy and live independently for longer - and it means scarce resources can be used more effectively to support those people who need them most.

Making the change from a system that reacts when people need acute help to one that supports more people to remain healthy and independent is not an easy task. It takes time and relies on close co-operation between organisations and individuals in health, social care and the wider community. But the benefits of this change are considerable. In Haringey it would help to increase people’s quality of life; improve people’s health and wellbeing, and develop stronger and more resilient communities.

The current model for adult social care in Haringey does not do enough to prevent care and support needs escalating, and is unsustainable in the long-term. Last year, for every £3 the Council spent, £1 went on adult social care. Without significant change in how social care is delivered, that figure would rise, resulting in difficulties for the Council in delivering other services such as refuse collections, libraries and parks.

In Haringey there was a 5.3 percent increase in residents aged over 65 years between 2011-2013. This is great news but there is no doubt that it also places an ever-growing demand on care services. And while demand for services continues to rise, the money available to fund them has reduced. Across the country, there is currently £3.5 billion less in Council social care budgets than there was in 2010. This means that there is a pressing need for Councils to deliver social care differently. The Care Act has widened the scope of statutory duties with an increased emphasis on wellbeing as part of any assessment process. It is therefore important that our approach focuses on prevention and early intervention whilst continuing to meet eligible needs.

In Haringey, we want to keep people healthy and living in their own homes and communities for longer.  We want to see a greater emphasis on promoting independence, dignity and choice - with care and support shifting away from institutional care towards community and home based support. 

This will mean an increase in services like supported living housing, which helps people to maintain their independence in a safe and supportive environment. It will also mean development of schemes like Shared Lives - where carers choose to look after people in their own homes - and community-led programmes like Neighbourhoods Connects, which supports local people to participate in social activities and play a more active role in their community.  It will also mean improving the work we do on prevention and early intervention so that more people are equipped with the information and advice they need to look after themselves and others better. This will help to delay and reduce the need for care in many circumstances, help people to remain independent for longer, and build more resilient communities.

Moving to this more sustainable model of adult social care would help us to reduce demand for services provided at traditional care institutions such as day centres and residential homes.

It would also mean that the Council would deliver fewer services directly, and would instead commission more services from the independent, community and voluntary sectors.

We know that care cannot be approached from a one-size-fits-all perspective, so we will ensure that specialist care services remain available for people with complex care needs. The recommended proposals enable the Council to continue to develop care and support which can be delivered within budget resources.

Proposal to increase the Council’s capacity to provide re-ablement and intermediate care services.

The Care Act requires the Council to provide or arrange for the provision of services, facilities or resources, or take other steps, which it considers will prevent, reduce or delay the need for care and support. The Care and Support Statutory Guidance provides that the care and support system must work to “actively promote wellbeing and independence, and does not just wait to respond when people reach a crisis point. To meet the challenges of the future, it will be vital that the care and support system intervenes early to support individuals, helps people retain or regain their skills and confidence, and prevents need or delays deterioration wherever possible”.

Re-ablement services are for people with poor physical or mental health to help them adjust to their illness by learning or re-learning the skills necessary for daily living. The Re-ablement Service works closely with an individual for up to six weeks to build up skills, confidence and increase the opportunity for them to care for themselves.  The service is for adults who have difficulty managing personal care or daily living tasks, perhaps as a result of illness or a period in hospital, following for example an accident, and have the potential to regain or maintain those independent living skills. This tailored support allows the individual to regain independence and stay in their own home for longer.

Intermediate care is short-term care for people who no longer need to be in hospital and do, however, require extra support to help them recover.  It increases the opportunity for individuals to care for themselves and access the support needed to gain independence. The type of support and the duration of support offered will vary according to the assessed needs of the individual.

We want to increase our capacity for re-ablement and intermediate care services to enable more people to live independently in their own homes. Supporting people to live as independently as possible, for as long as possible is a guiding principle of the care and support system.

Residential homes and hospitals provide valuable care for those in need of those services, but with the right support, it is clear that adults would like to be empowered to be healthy and independent in their own homes for as long as possible.  Evidence has shown that increasing the facilities and the opportunity for re-ablement services can potentially reduce the need for high cost social care packages in the future through supporting individuals to become independent. An increase in our capacity to provide re-ablement and intermediate care would allow us to support a greater number of people to have the support they need to prevent, reduce or delay the need for care and support.

Proposal to increase our capacity to provide suitable accommodation that promotes individual well being through expanding Supported Living Accommodation and Shared Lives schemes.

Under the Care Act, (2014), the Council must promote individual wellbeing; relating to ‘domestic, family and personal relationships’ and the ‘suitability of living accommodation’. The Care and Support Statutory Guidance provides that “Local authorities should encourage a genuine choice of service type, not only a selection of providers offering similar services, encouraging, for example, a variety of different living options such as shared lives, extra care housing, supported living, support provided at home, and live-in domiciliary care as alternatives to homes care, and low volume and specialist services for people with less common needs”.

In Haringey we have developed a range of provision for vulnerable people that has a greater emphasis on helping people to continue to live independently at home -  maximising their independence and reducing social isolation - and is less reliant on traditional institutions. Working closely with our partners we are increasing the availability of schemes such as Supported Living and Shared Lives – demonstrating how most needs, including complex needs, can be met in the community. Adult social care users in Haringey, including people with complex needs, have told us they would prefer to live as independently as possible in the community where they have the opportunity to exercise greater control over their lives.

Supported Living Accommodation enables adults, who are assessed as being able to live independently, to do so.  Individuals can have their own tenancy or choose to share with other eligible adults.  Support is tailored to the needs of the individual and supports them with daily living including personal care, taking medication and money management.

Shared Lives is a well established scheme within Haringey Council and nationally.  The scheme relies on the participation of the local community, where a family or an individual shares their family home with someone who needs support.  The scheme is open to adults with various disabilities that have been assessed as being able to live within the community.  It enables such adults to enjoy the independence and support of living with a local individual/family.

In consideration of feedback to the proposals, a broader spectrum of alternative providers will be appraised to ensure the best value for money option is identified to meet the needs of residents and benefit the whole community.

It is more important than ever that we get the most value from our public spending.  Commissioning for social value involves looking at the collective benefit to a community when a service is provided.  

Proposal to increase the availability and flexibility of day opportunities within the borough meeting the individual needs of residents.

The Care Act provides that “the local authority must promote the efficient and effective operation of a market in services for meeting care and support needs with a view to ensuring that any person in its area wishing to access services in the market” has a “variety of providers” and “variety of high quality services” to choose from.

Day services provide both respite for carers and opportunities for vulnerable adults to be active and socialise during the day. Haringey is continuing to develop new forms of day opportunities and move away from traditional buildings based services, supporting and increasing opportunities in the wider community. Working with the community and other businesses to develop services will promote more flexibility, availability and opportunity.

We are committed to the priorities set out in Valuing People Now[1], to improve outcomes for people with learning disabilities in employment, housing and health, through person Centred approaches and the promotion of personal budgets. All people with learning disabilities have the right to lead their lives like any others, with the same opportunities and responsibilities.  The shift from buildings based care to community led support will enable all adults to make informed choices to enable the best outcome for them.

We have to move away from segregated buildings based day opportunities within the borough for people with learning disabilities and to continue to develop access to mainstream activities – these include local leisure educational and employment opportunities.  We recognise, however, that people with specific needs will require a Centre to support them at particular times and we are proposing to retain the use of Ermine Road Centre as part of the delivery of Learning Disability Day Opportunities in Haringey.

The Consultation Feedback

Feedback received to the consultation demonstrated that respondents overwhelming opposed the proposals.  The value of the services currently received was reiterated throughout the consultation responses, with much accolade received for existing staff, facilities and the opportunities provided.  The desire to keep services in their current format and directly managed by the Council was repeatedly presented along with feedback of positive outcomes achieved through the existing service provisions.

Concerns raised demonstrated anxiety around the proposed changes and how they might affect individuals and their families/carers, a) mentally (through isolation) b) financially (having to obtain services elsewhere and/or families having to change working patterns to accommodate their loved one), and c) physically (assuring the safety of service users, with appropriately trained staff within alternative provisions).

Appendix 1, Analysis of the consultation process and results, summarises the key themes identified through a) responses to the consultation questionnaires, b) correspondence received (letters and emails) and c) staff engagement, to each proposal[2].  The document also provides the full responses received to the consultation.[3]

It is acknowledged that the recommendations will result in a reduction in services directed provided by the Council. The feedback received from the consultation demonstrates the concern for the continuation of high quality of services should services be delivered by an alternative provider.  We will select alternative providers to deliver services based on their ability to meet the specification and the commissioned service will be subject to ongoing monitoring as detailed in paragraph 4.29 below.

Also, there will be changes to the established daily patterns of service users and their families/carers. Service users may need to adjust to new environments, new staff and new routines.  We will work sensitively with each individual and plan with them, their families/carers, how best to manage any necessary changes.

Governance and monitoring

There will be monitoring and oversight of the implementation of the recommendations in Section 3 above, through: a) the Strategic Healthy Lives Priority Board (which has oversight of the strategic and operational delivery of the various service proposals); b) the Transformation Group (which provides scrutiny and challenge to the delivery of the Transformation proposals/plans and ongoing monitoring of quality and performance); and c) the Deputy Chief Executive, Director and Lead Member for Health and Wellbeing. This oversight will pay particular attention to the issues raised by consultees which includes potential loss of respite for carers, loss of experienced trained staff, perceived increase in safeguarding risk, lack of transitional support for people who find change difficult and lack of clarity about alternative provision. In addition the transformation is subject to scrutiny by the Council’s overview and Scrutiny Committee and the Adults and Health Scrutiny panel.