Letter Sent 27/08/2007
Dear Councillor,
I understand that you will be considering the attached report on 3
rd September 2007 . I would like to know if you will be accepting the
recommendations of the report at this meeting. In addition I would also
like to draw your attention to the points below & would appreciate
your comments.
Yours faithfully,
Sarah L.. Hemstock. Carer. Justice for Carers
1. Are you aware of the fact that Adult Social Care have recently increased
charges and implemented the use unsatisfactory Private Sector care companies
to provide care in people’s homes recently? Are you aware that
15 NCC care homes have already been closed since 1998 and only 60 beds
have been replaced?
2. What savings have be made by swapping from “Direct Services”
provided by NCC Social Services to private sector care companies? Has
this decision proved satisfactory?
3. What additional revenue has be raised by increasing charges to service
user’s? Has this increase proved satisfactory? Has any study been
carries out on the impact to service users? (i.e. Have you bothered
to find out how the additional financial burden affect carers &
those they care for – what are the health and social implications
for family carers when Social Service care hours have been reduced?)
4. What impact has the closure of 15 care homes had already? Has there
been any financial or other benefit of this action? Please justify the
proposed closures in terms of historical changes.
5. Although “Government Targets” have been set for the number
of care home places per 1000 people, have you considered that these
targets may be incorrect? Do you have the backbone to vote against further
changes?
6. Are you aware of the fact that Nottinghamshire’s OAP’s
are provided with free bus passes, but those elderly & infirm people
who are picked up by the NCC special need bus have to pay for the privilege?
7. If previous service changes have been successful, why hit this sector
with more cuts? Please look for budget cuts elsewhere.
8. If previous service changes have not been successful, why make more
cuts to cover up your mistakes? The changes made so far may be justifiable
in terms of budget, but are not justifiable in terms of service provision…
9. If the changes under discussion on 3 rd September 2007 take place,
what will be the level of future service provision – with particular
reference to Day Centres? What will happen to those currently in residential
care and those currently using day centre facilities? What alternatives
will be offered? For example, my Grandmother currently attends Kirkland
’s day Centre on Monday, Wednesday and Saturday. How will she
be affected by the proposed closures? If closures are transitional –
how will staff moral effect service users?
10. Have you considered emotional effects on service users?
11. Have you considered social, financial and employment impacts on
those that care for service users?
12. Why has there been no effective service user / carer consultation
during the preparation of the report? It is apparent (and backed up
by studies from organisations such as MIND , MenCap & Care UK) that
service users and their carers are only consulted as a means to put
a tick in the box and do not actually play any part in the real decision
making process. This is valid in terms of the “ CABINET COMMITTEE
TO REVIEW THE STRATEGIC DIRECTION FOR COUNCIL RESIDENTIAL HOMES FOR
OLDER PEOPLE AND FOR EXTRA CARE SERVICES” since there are many
service users and their carers, as well as local carers groups, who
have received no correspondence or notification of the committees existence
prior to the handout of Wednesday 22 nd August, 2007.
13. Why do you feel the need to hit the most vulnerable people in our
society by increasing charges and closing facilities? It is because
you feel that they are the least likely to fight back? Is it because
most of them are elderly and infirm so will probably not be around to
vote at the next election?
14. Social care is expensive – deal with it in a way that is most
beneficial to the service user – why not make budget savings elsewhere?
(Sandwiches & refreshments for council meetings at Ashfield District
Council have reportedly cost an average of £40,000 per year!!!
Also, Mansfield District Council holds many subsidised functions for
Councillors and council employees).
Re the report:
CABINET COMMITTEE TO REVIEW THE STRATEGIC DIRECTION FOR COUNCIL RESIDENTIAL
HOMES FOR OLDER PEOPLE AND FOR EXTRA CARE SERVICES
1. Under Recommendation (d) section 1.2 (page 5 of the report), how
much revenue is expected to be generated from the sale of land? What
guarantees are in place to ensure that revenue generated (£6.5
million from sale of land alone) is spent on day services and “extra
care”? What are community-based services?
2. Under Recommendation (h) section 1.2 (page 5 of the report), it states:
“ The aim of this should be to develop at least an additional
150 extra care places which are alternatives to residential care”.
What are these 150 “extra care places” additional to? Are
they additional to places which exist in all 15 homes listed at the
beginning of the report or are they “additional to” the
remaining places at the 8 homes once the 7 homes have been closed? In
which case they are not “additional” to anything.
3. Are care home beds and day centre places to be reduced from those
currently existing? Do you genuinely think that this is the right direction
to take? Government targets for bed numbers could be wrong.
4. Section 2, point 2.2 states: “ Several other organisations
have been invited to attend meetings and have made valuable contributions,
as well as members of the public. Comments on the issues before the
Committee have been widely sought including from the homes affected.”
There has been no effective consultation that I am aware of. I have
been informed by various care home staff that the letter from Terry
Pears delivered on Wednesday 22 August, 2007 with instructions to post
to service users that were not at the day centre was the first that
they had heard of it. In addition, I am a member of Nottinghamshire
based group “Justice for Carers” who were not asked to contribute.
Please could you list the “Other organisations” and numbers
of “members of the public” and also detail your methods
of how you “widely sought” comments… The handout of
August 22 nd 2007 has been the only correspondence received by a number
of Day Centre service users at Kirkland ’s day centre. Notices
on boards are not effective - Kirkland ’s has 2 sections –
residential & day care – there were no notices in the Day
Centre that I am aware of.
5. Section 3, point 3.2 (page 6): How many residential beds were lost
with the closure of 15 homes between 1998-2005? What impact did it have
on those who lost their homes? How many people/residents died within
3 months of the move?
6. Section 6, point 6.1 “The Local Context” – did
the committee consider the quality of care offered in the “independent
sector”? There are many reports dealing with abuse and low standards
of care in this sector. What strategies will be in place to ensure a
high standard of service provision from the “independent sector
providers”? Private sector care in the home is not up to standard
presently – a recent report looking at Home Care in Nottinghamshire
has indicated that care and time keeping is not up to standard and many
appointments have been missed. If this is not working, why do you think
changes to residential and day care will work? In order to follow your
strategic “All Together Better” plan, you should at least
get one thing correct before messing up something else! Another issue
that should be considered in terms of a “Local Context”
is the fact that less than a mile up the road care in the home is provided
for free in Derbyshire! If residents in Ashfield pay more council tax
than their counterparts in Bolsover, why do they get less from their
council?
7. Please explain the term “community based services”.
8. Page 10: Why isn’t the “Stay as Now” option consistent
with the Strategic Plan? Surely community based care has been “strengthened(!)”
by the use of private sector care providers? Government targets for
residential home places are not correct and day care seems to have been
ignored by these targets, closures will affect day care very badly.
In addition (page 30) there are currently only 566 vacancies in independent
sector care homes & 67 in local authority homes – this is
not enough to take up the slack that would arise from implementation
of strategy 3 as proposed.
9. Page 10: Financial implications of the “Stay as Now”
option has not been evaluated correctly and is confusing. There are
some fundamental errors here. It will cost 1.4 million over the next
5 years to maintain the care homes (is this for all 9 care homes in
the report (listed on page 37 of the report), or the 8 listed on the
NCC website, or just the 7 that are being closed re the letter of 22
nd August? This is confusing – if it is only 7 then maintenance
would be further reduced by £280,000 over 5 years and the cost
of Strategy 3 further increased). However, the value of land will increase
on average minimum of 10% per year (an estimated £650,000). If
the land is sold off under strategies 2 & 3 the council is asset
stripping itself. Additionally, the cost of “extra care”
has not been calculated fully (including rent & council tax &
level of care required etc) and could far exceed the cost of care currently
offered by local authorities (page 41). In addition, since Ashfield
District Council is reported to have spent tens of thousands per year
on sandwiches, £280,000 per year is a small price to pay for the
9 care homes.
More families will pay for home care
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/01/11/naged11.xml
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/01/11/naged211.xml
10. Performance Implications: current care at home private sector service
providers cannot deal effectively with the current situation –
check the records and reports, as a Councillor this is your responsibility.
Increasing this shambolic system will be a recipe for disaster.
11. Major Risks: Options 2 & 3 both reduce numbers of beds significantly
– the private sector is currently not capable of taking up the
slack. Risks here should also include: inability of private sector to
provide extra care (Options 2 & 3) and impact of closures on residents,
carers and staff (not included in option 3).
12. Point 7.2 (page 12): The financial impact of the Stay as Now option
is not significantly different from the Strategic Share option. Once
transitional cost are incorporated fully into the equation (which has
not been done) for the Strategic Share option it may turn out to be
more expensive than Stay as Now – and in addition, land for 7
existing homes will be sold off so reducing assets held. Therefore,
the financial justification for option 3 “Strategic Share”
is not valid. (also refer to 2.15.10 page 56). The table 2.15.16 shows
an actual difference of 0.1 million between strategy 1 – stay
as now (14.3 million) and strategy 3 – strategic share (14.4 million)
if the capital cost of land and buildings is included (18.8million).
For this reason, justifying option 3 over option 1 on financial grounds
is not correct.
13. Point 12.2 (page 13). Has there been any detailed impact assessment?
You could base this assessment on comparison of number of deaths in
care homes that remained open with number of deaths amongst those residents
who were moved from the homes closed between 1998 & 2005 over a
3 month period from the date they were moved or knew they were moving.
I think you might be shocked at the results. Obviously, this approach
doesn’t take into account effects on carers etc…
14. Point 12.5 – what are the indications that change is necessary?
Why is reducing bed numbers an advantage? Care in the home will increase
as the population continues to age, so I am sure you will be able to
meet your “targets”! In addition, your own findings demonstrate
that the Private Sector home care is currently failing to deliver the
same standard of care as the old system. Looks like “modernisation”
isn’t working well, so why continue with an unworkable strategy?
15. Point 12.6 – your report recognises the fact that there will
be an increasing number of older people, however, how can the reduction
in the number of beds and day centre spaces be justified as a means
“to ensure that services continue to develop to meet their needs”.
The proposals jus to not make sense – financially, socially or
morally.
16. Point 12.6 – “where possible, older people should be
supported at home”. This is true, however, the current private
home care providers do not provide the same quality and reliability
of social services (Direct Service) care. This situation should be dealt
with before making additional changes to the system.
17. Point 12.6 – What exactly is meant by “Extra Care”?
18. Point 12.6 – your report states:
“The unit cost for council care home places (£558) is significantly
higher than what we pay for purchased independent sector places (£315).”
Are you aware of the fact that many “independent sector”
homes are closing because they are in financial dia straights? They
provide a poor standard of care compared with local authority homes:
check out these links:
Starving on a spoonful of mash a day
http://www.telegraph.co.uk/health/main.jhtml?xml=/health/2007/01/26/nelderly23.xml
Care home elderly go hungry, says minister
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/01/22/nelderly22.xml
The commission's findings
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/01/11/naged111.xml
19. Point 12.6 – you recognise that each home has an associated
Day Centre. Places are difficult to get at these centres because they
are full. How will reducing the number of day centre places be helpful?
If the number of day a person can attend a day centre is reduced, how
will this effect the carers? Some carers work when those they care for
attend day centre – so reducing day centre places will have an
adverse social and economic effect.
20. The report is almost totally focused on residential care and does
not appear to have considered day care. Please provide information on
how day care will be affected by the proposed closures. Please justify
how drastic changes can be made with our considering the effects on
basic services such as day care.
21. Section 2: page 23 – with 1.2 million and 200,000 annually,
being paid out to independent sector care homes (over 5 years this would
total 2.2 million – 0.8 million more than the stay as now strategy),
the council could go a long way to paying for the improvements required
in the council homes due to be closed (only £280,000 annually
is required for 9 care homes – the 7 care homes listed in the
August 22 nd letter would be covered by the 1.2 million).
22. Section 2.6.5 & 2.6.6 – the local authority has a duty
of care. What is the legal situation if this duty is neglected?
23. Point 2.9.16 page 31. The report states: “ the clear message
is that there has to be growth in provision of appropriate services,
either non residential or residential, which reflect an increasing older
population”. How will this be achieved by reducing the number
of local authority beds without massive growth in the independent sector
which is currently failing?
24. Page 32 – what is meant by the term “self-directed care”?
25. Page 44 – “ promote greater choice and independence
through community care services” – given the choice I am
sure most current residents and day centre users would choose to stay
as they are….
26. Point 2.14.6 – page 46. It is very unlikely that long term
residents of the homes due to closure will live independently in their
own homes. Closing homes and kicking residents out of local authority
care homes is not a strategy for independent living. The report is fundamentally
flawed in this view.
27. Page 47. What guarantees are in place to state that the money raised
form sale of land/ care homes would be re-invested into caring for the
elderly?