Residential Services consultation

 We will be using this blog to provide weekly updates on the Residential Services consultation which started on December 1st 2011 and will close 29th February 2012. You can find out more about the consultation and read related documents on our consultation finder database.

Bristol has around 140 residential care homes, 11 of these are run by Bristol City Council. Our residential care homes for older people were reviewed in 2008 with recommendations to close all council-run services and replace them with a smaller number of resource centres and specialist dementia units. Work on this plan was put on hold in 2010 due to falling property prices and rising staff costs.

This consultation looks again at how services can be improved by developing alternatives to long-term residential care and making best use of all care homes in the city, including the independent sector.

We are asking for the views of residents, their families, friends and staff on the future of residential services in Bristol. This will help us decide how we can continue to improve services within the difficult financial environment that now exists.

Residential Services Consultation information leaflet

Have you filled out our residential services consultation questionnaire?

We are speaking directly to residents, their families, groups and organisations representing older people, staff and trade unions to find out their views at a series of meetings over the next few weeks.

Residential Services Consultation Timetable of events

This week we have been meeting with staff, residents and families at:

  • Coombe – a residential home in the North of the city specialising in the care of people with dementia.
  • Greville – a residential home in the South of the city specialising in the care of people with dementia.

Comments and issues raised this week include:

  • Concerns about people living in the community being isolated. Residential homes provide opportunities to make friends and socialise.
  • Concerns about negative press reports on independent sector care homes and a lack of trust in monitoring and inspections.
  • A comment that the quality of care in a residential home is more important than the physical environment.

We will keep you updated on the outcomes of the meetings on this page.

Please respond to the consultation using the questionnaire.

If you have comments or questions about the information in the weekly updates, please join the discussion.

29 thoughts on “Residential Services consultation

  1. Is it not a fact that no matter how much Ministers or Councillors from all parties bluster and prevaricate our NHS is being sold out to private financeers and profiteers. I am old enough to remember when both my brother and I suffered from whooping cough as children, because we could not afford the half crown to see the doctor we were treated with boiled lemonade. I have a dread feeling that we are due to return to that austere era again. And the truth is , who will give a damn. The wealthy have no need to care and the poor have no redress.
    So what’s new?

  2. Councillor Rogers

    Can you explain why Bristol City Council has
    been paying a sole Agency delivering on average between 1400-1800 placements per month filling residential home posts?
    Why has the Council paid more per placement per hour than what it pays its permanent staff eg BCC night care assistant £11.76 per hour with on-costs (actual hourly rate£7.79ph) Agency £17.02ph; BCC CA£10.75 ph with oncosts (actual hrate£6.83ph) agency £12.55; Domestic/Laundry Asst BCC £8.89 (actual hr ££6.29ph) agency £10.32; Gardner/HP BCC £9.98 ph with oncosts(actual hr £6.38ph) agency £10.32; BCC cook £10.75 hr with oncosts (actual hr £6.47ph) agency £10.32?
    Agency staff are meant to be reduced but in September 2011 BCC employed 1800 placements in addition to their permanent FTE of 1400 for the same month – on what basis is the council reducing agency staff when there are over 300 permanent FTE vacancies?
    Why has the underspend in managing vacancies (holding jobs vacant) paid for the use of agency workers?
    In 2009/10 H&SC paid £3.5m for agency workers; 2020/11 the cost was £3.3m and as at 2011/12 the amount is £2m with a further four months to go.
    Why has in excess of £8.8m over the last three years been spent to the private sector for agency workers – 90% have been working in the council’s residential homes?
    Why are council homes only two-thirds full?
    Why is the council paying for beds in private sector residential homes when your own homes have between five-ten beds empty per home?
    Why are agencies not promoting the council’s residential homes?
    why are you asking each residential home to put forward a business case to keep their home open?
    Why are so many permanent staff who wish to increase their hours not being allowed to and preference is given to agency workers?
    why are many staff still on 10, 15 and 20 hour contracts when there is clearly a case to increase permanent staff hours on a contractual basis enabling them to access proper paid annual leave, occupational sick pay and pension contributions?
    On what basis has an average redundancy payment of £13k per care worker been calculated?
    How does this amount compare with the ‘average’ council worker within the rest of H&SC eg the project team/commissioning team/STAR for example?

    all of the above information quoted has been supplied from your own department.

    I look foward to your response

    Rowena Hayward – GMB Full Time Organiser

    • Ms Hayward

      You ask a number of detailed questions. Staffing arrangements are an operational issue, so I will ask that officers respond to your specific points.

      Strategically, I understand that the Council has been holding vacancies in some of our care services to help with staff redeployment. The council wants to ensure that staff that want to continue to work in a caring role with Bristol City Council will have that opportunity, wherever possible.

      By using vacancy management the council have been able to minimise the risk of compulsory redundancies. Bristol has been more successful than many local authorities in achieving this.

      The council are also seeking to deliver the best possible service to residents, as well as offering choice and control to those residents, with the support of staff, carers and families.

      Best wishes

      Jon Rogers

    • 1) Can you explain why Bristol City Council has been paying a sole Agency delivering on average between 1400-1800 placements per month filling residential home posts?

      The Council has been holding vacancies within its residential care homes to enable the redeployment of staff from it’s home care service,  (Continuing to Care Service) which has been reducing gradually over financial year 11-12 whilst moving towards the new Dementia Service model to become operational from April 2012.

      During this period,

      • there have been staff movements out of Continuing to Care into EPHs and other services,
      • vacant posts in residential homes could not be filled until the outcomes of staff moves from CTC teams were finalised (this work is nearing completion),
      • agency staff have been hired to complement existing staffing levels so as not to breach statutory staffing levels required to meet Care Quality Commission standards.

      The Council uses a system of corporate procurement wherever possible and appropriate to gain optimum rates when contracting for services. This achieves better value for money. Agency staffing for the residential homes therefore comes from the agency that currently holds the contract.

      2) Why has the Council paid more per placement per hour than what it pays its permanent staff eg BCC night care assistant £11.76 per hour with on-costs (actual hourly rate £7.79ph) Agency £17.02ph; BCC CA £10.75 ph with oncosts (actual hrate £6.83ph) agency £12.55; Domestic/Laundry Asst BCC £8.89 (actual hr ££6.29ph) agency £10.32; Gardner/HP BCC £9.98 ph with oncosts(actual hr £6.38ph) agency £10.32; BCC cook £10.75 hr with oncosts (actual hr £6.47ph) agency £10.32?

      We acknowldege that agency staff are more expensive than BCC staff because agency rates include an element of charge for overheads and other costs incurred by the agency. Agency use is minimised as far as possible but has been used to ensure that vacancies were held for staff who needed redeployment opportunities, who would have otherwise faced redundancy.

      3) Agency staff are meant to be reduced but in September 2011 BCC employed 1800 placements in addition to their permanent FTE of 1400 for the same month – on what basis is the council reducing agency staff when there are over 300 permanent FTE vacancies?

      Levels of staffing are kept appropriate to the needs of the service. Each home must comply with minimum staffing levels as required by the Care Quality Commission. This relates to the number of residents within the home so can vary. The amount of agency use has reduced due to posts being taken up by staff transferring from the Continuing to Care Service and to the reduced numbers of residents in the homes.

      The 1,800 placements quoted in the question refers to the number of individual shifts worked by agency staff. The figure of 1,400 for BCC staff refers to Full Time Equivalent posts. These are two different things so wrongly give the impression that there are more agency staff than Council staff which is not the case. The figures should not be directly compared, as it is not a like for like comparison.

      4) Why has the underspend in managing vacancies (holding jobs vacant) paid for the use of agency workers?

      Each home is allocated a staffing budget for the financial year. The cost of all staffing comes from this and currently expenditure is within budget.

      5) In 2009/10 H&SC paid £3.5m for agency workers; 2020/11 the cost was £3.3m and as at 2011/12 the amount is £2m with a further four months to go. Why has in excess of £8.8m over the last three years been spent to the private sector for agency workers – 90% have been working in the council’s residential homes?

      These amounts show that the amount of agency staff being used is reducing. There will always be a need for temporary cover due to sickness, vacancies etc as minimum staffing levels must be maintained within a residential home.

      As explained previously, the need to keep posts available for redeployment during service changes has meant higher staff vacancy levels than would normally be the case however the approach taken avoided the use of compulsory redundancy when undertaking changes elsewhere in the department. This has reduced the impact on our staff, maintaining skills for the service, and saved an estimated minimum of £2.2m in redundancy costs.

      6) Why are council homes only two-thirds full?

      There are a number of reasons why the homes are not at full capacity.

      In the last 2 years the number of people without dementia placed in independent homes by the Council has fallen by 12%. This demonstrates the general shift that is occurring, with people receiving care and support for longer in their own homes. If they do enter residential care, they are doing so at a later stage with higher levels of need.

      This also reflects the move to a greater focus on reablement (as more people are supported to maximise their independence by community reablement services, in rehabilitation centres and in short term temporary residential care before returning home).

      It’s also possible that some people elect not to move into a Council home knowing that it has an uncertain future. This gives impetus to the need to agree the future strategy for residential services as quickly as possible.

      7) Why is the council paying for beds in private sector residential homes when your own homes have between five-ten beds empty per home?

      Under the “Choice Directive” people are able to express a preference for particular accommodation and can choose to receive residential or nursing care in a home of their choice provided:

      • the accommodation is suitable in relation to the individual’s assessed needs,
      • to do so would not cost the authority more than it would usually expect to pay for someone with the individual needs,
      • the accommodation is available,
      • the person providing the accommodation is willig to provide the accommodation to the authroity’s usual terms and conditions for such accommodation.

      Current changes to the way social care is delivered is aimed at strengthening and increasing the level of choice people have. The response to Q6 gives reasons for the reduced level of occupancy in all residential homes which has also impacted on the Council’s homes.

      8) Why are agencies not promoting the council’s residential homes?

      It’s unclear as to what ‘agencies’ this question is referring and clarification would be required to give a response.

      9) Why are you asking each residential home to put forward a business case to keep their home open?

      The Council’s residential homes have not been asked to provide business cases to keep them open. In November last year, Cabinet endorsed a proposal for the modernisation of health and social care services, with a formal period of consultation running from December to February on what  residential care may look like in the future. A report will return to Cabinet on the 29th March on the outcome of this consultation.  

      10) Why are so many permanent staff who wish to increase their hours not being allowed to and preference is given to agency workers?

      It should be possible for permanent staff to work extra hours to cover gaps if they wish to. Any examples where this has not happened should be forwarded to the relevant senior manager for the residential homes to look into.

      11) Why are many staff still on 10, 15 and 20 hour contracts when there is clearly a case to increase permanent staff hours on a contractual basis enabling them to access proper paid annual leave, occupational sick pay and pension contributions?

      As in Q10, overtime is offered to permanent staff. No permanent extensions to contracts would be offered at this time due to the review of the service.

      12) On what basis has an average redundancy payment of £13k per care worker been calculated? How does this amount compare with the ‘average’ council worker within the rest of H&SC eg the project team/commissioning team/STAR for example?

      The figure is based on the average payment made to BCC home care workers who chose to take voluntary redundancy during the recent service restructuring. All redundancy payments are calculated using the guidance in the Council’s redundancy policy as agreed by the Council’s HR Committee.

  3. Councillor Rogers
    It would be easier to judge any new proposals if we could have some information on past actions. So could I have answers to the following.
    How many service users were in the Bush Centre when it closed.
    How many were offered personal care packages and how many accepted.
    How was the level of remuneration calculated. What would it have been for the most severe cases of need.i.e. those who have to have 24 hour care.
    I can understand that some clients who have only minor learning difficulties may be glad to cope with the complexities of administring a care folio, but my experience of the Bush is that many have extreme learning difficulties and would not be able to decide for themselves. How are these cases resolved.
    James

    • Thanks James

      I will ask officers to respond on the specific questions.

      I understand that the needs assessment was updated for every person that attended the Bush before any changes were made to care arrangements.

      The “care folio” / “care plan” would follow from that needs assessment, and involve service user input where possible. Additionally, families, carers and of course staff would have input into that care plan.

      Finally, there would be a dialogue on how the plan would be managed. The majority are managed by the council still, or by the voluntary sector, but about 10% of service users or families manage their own budget (just over 600 when last I heard)

    • When the Bush closure was announced in September 2008 there were 107 service users. All services users were reviewed by a team of practitioners to determine their needs and interests and this was completed in May 2009. At this time the number of service users had reduced to 97. The reviews identified four groups of people:

      * People who require a building base and specialist facilities for complex and significant personal care needs although this is not intended on the whole to be a buildings base for activities. (20)

      * People who are able to lead relatively independent lives with minimal support and training (know as the Moving On Group) (16)

      * People who require dedicated support to access community activities and to plan their day-to-day programme. (20)

      * People who are in residential care and attended the Bush for day activities (37)

      During the process four moved to alternative services

      All service users received new care plans once alternative suitable services were identified to meet their needs. At the time none chose to take a direct payment but opted for a managed budget instead. The third group who access community activities have generally reported that they are very satisfied with their new service and many are reporting a greater range of community activities that are now accessible.

      As to the amount of budget this will depend on their assessed individual eligible needs and therefore it is not possible to specify as it depends on a number of different factors.

  4. Thanks Jon for some of the replies .
    1.Barbara Janke the leader of the council announced that £50 million will be borrowed to support Bristol will Social care Adults get a % of this ?

    2. Redfield lodge is a 40 bedded home for dementia services , a new dementia service is also been piloted in homecare .Why is Redfield lodge still running on agency staff since March 2010 even though Homecare staff have been relocated and the vacancies not filled . ( Should we not have a bank staff structure that we can use a pool of staff for both homecare , dementia and residential care like the NHS has .)

    3. Why cant residents be funded from central government (ie income support )like the poeple in the community , to take the burden off local governments where each local government has different prioriies and the elderly are been targeted .yet again ?

    4 Why cant all res homes, pwd’s and nursing facilities be non profit making and the standards not be compromised by profit hogging companies ?

    • 1.Barbara Janke the leader of the council announced that £50 million will be borrowed to support Bristol will Social care Adults get a % of this ?

      The £50m Capital investment in Bristol’s Future is one of the Liberal Democrat budget proposals. The budget debate is on 27th February.

      12% (£6m ) is earmarked for investment in Extra Care Housing and Aids and Adaptations to support people in their own homes.

      The remainder is for school places (£20m), improved transport and highways in Bristol (£16m), a new pool for East Bristol (£6m) and a recycling centre for South Bristol (£2m).

    • 2. Redfield lodge is a 40 bedded home for dementia services , a new dementia service is also been piloted in homecare .Why is Redfield lodge still running on agency staff since March 2010 even though Homecare staff have been relocated and the vacancies not filled . ( Should we not have a bank staff structure that we can use a pool of staff for both homecare , dementia and residential care like the NHS has .)

      My understanding is that the home care staff have not all been relocated.

      Last I heard was the majority of the 250 staff have agreed next steps, but some have not. We are determined to offer all our excellent home care staff the opportunity to continue to work in our care services if possible. We don’t want to lose their skills, experience and expertise.

      The review of day services and residential services may also lead to further changes, so it is possible that officers are trying to preserve further future flexibility.

      This might be a good topic for direct discussions on details between officers and the trade union representatives.

      • To add to Councillor Rogers response to Q2 30/1/12 asked by Charmaine, the last few members of staff that are moving from the Continuing To Care (CTC) service are currently being dealt with, after which other vacancies can be looked at for recruitment. Vacancies at supervisory levels have already been advertised as transfers of staff from CTC at this level have all been completed.

    • 3. Why cant residents be funded from central government (ie income support )like the poeple in the community , to take the burden off local governments where each local government has different prioriies and the elderly are been targeted .yet again ?

      We are certainly not “targetting the elderly”. We are trying very hard to protect front line services, and indeed we are expecting to deliver more services this year than last year, and more services next year than this year.

      We have a growing population of older people and we will need more services not less.

      On the specifics about income support, I don’t know the rules around this. I will ask officers to respond.

      • To add to Councillor Rogers response to Q3 30/1/12 asked by Charmaine, currently residents in care homes who are funded by their local authority are financially assessed to make a contribution to the cost. National benefits, state pensions and any private income they receive are taken into account in this assessment.
        The funding of long term care, is being considered by central government following the publication of the Dilnott Report.

    • 4 Why cant all res homes, pwd’s and nursing facilities be non profit making and the standards not be compromised by profit hogging companies ?

      I presume because people want choice.

      They choose what services they want. There are many excellent “not for profit” care services, and also many excellent private providers as well.

      • To add to Councillor Rogers response to Q4 30/1/12 asked by Charmaine, the local authority officers and staff work within the mixed market that exists, which includes our own provision, private profit making businesses and not for profit organisations. The focus when arranging services for people is to ensure apropriate, quality services that are value for money

  5. 1.What saving will the council be making by closing one of the 11 council run facilities in Bristol ?
    2.Why is adult care being used as a political football , at the 2008 residential futures we were told that the standards were not right ( but the economy took a dip and we fell into a receesion so the property market halted the sales of valuable property been sold !)?
    3.Hollybrook was shut with very littloe notice to all concerned with immediate effect as to refurbish the building and sell off the other two homes ie GREVILLE and Maesnoll , why is Hollybrook standing as a white elephant now that could have brought in revenue of _+ £4million a year and that would be a earnings of £12 mill in the time that it has stood vacant ?
    4 .How much has it cost in Senior management wages to run the residential futures projects since 2005 .Why do we need so many managers consulting on one project .
    5.Who commissions the admissions to residential/PWD’s for Bristol City Council , why in the last few months whilst home -care staff were been redeployed were the vacancies not filled in the EPH’s ?Most homes were running on 60% capacity why was theer not a need to cut back on vacancies(agency staff then .
    6.What is the breakdown that makes BCC £34 ph so much more expensive to run than the private sector £17 can we have a breakdown so that we can see where all the expenses are ?
    7.Which of the homes that the council currently use are owned by the council and which are rented property?
    8. What is the next 5 year strategy for the rest of the other homes that will be saved ?
    9.What support is there in place for the public to access if they have problems with getting info about Care services besides CQC ?

    We had drive about PUTTING PEOPLE first in BRISTOL but it obviously is now PUTTING money first then people after , because the vulnerable are been targeted first .

    • Thanks Charmaine. You raise a number of important issues.

      Below are my own, off the cuff, answers.

      I’ll answer the ones that I think I can, but will ask officers to respond to your more specific and technical questions 3. , 4. , 5. and 7..

      You conclude by saying, “We had drive about PUTTING PEOPLE first in BRISTOL but it obviously is now PUTTING money first then people after , because the vulnerable are been targeted first .

      I understand your concern, but we are definitely putting “people” before “money”. Not only is it the right thing to do, but is also required by law.

      Some councils have tried to limit care to those with “critical” needs. Bristol has chosen not to do that.

      In fact, we are putting money into prevention services, advice services, advocacy services and carers services as well as standard care services.

      We recognise that tackling problems early can save money later on. As a recently retired GP, this is second nature to me!

      Jon

    • 1.What saving will the council be making by closing one of the 11 council run facilities in Bristol ?

      That would vary from site to site. The condition of some of our buildings is poor, and may need new boilers, new windows, new rooves, redecoration etc. Also, not all are owned by the council, so there may be a rent charge.

      Feedback so far seems to indicate that having a base is important for many users, families and carers, but it is the people that are most important.

      People include regular, friendly, experienced, well trained staff, friendship groups, and open to carers and families.

      • To add to Councillor Rogers response to Q1 26/1/12 asked by Charmaine, the actual amount saved would also depend on other factors such as how many places the home provided, occupancy level, re-deployment of staff, saving from not needing to spend on refurbishment.

    • 6.What is the breakdown that makes BCC £34 ph so much more expensive to run than the private sector £17 can we have a breakdown so that we can see where all the expenses are ?

      The figures you refer to are the average costs of the discontinued Continuing To Care CTC in house/council run home care service (£34 per hour) compared to the average cost in the independent and voluntary sector.

      The huge difference in cost has been repeatedly investigated over the last 5 years, most recently at the cross party Resource Scrutiny on 16th December 2011. The report is here… http://bit.ly/bccctc1

    • 8. What is the next 5 year strategy for the rest of the other homes that will be saved ?

      Council officers will produce a report on residential care in Bristol for the March 29th Cabinet meeting. That will include information on how residential services could change and make one or more recommendations for Cabinet decision.

      I would expect those recommendations to cover all council run homes for at least 5 years. I would also expect some assessment of other current and future residential provision in the city, including Extra Care Housing ECH.

      The Liberal Democrat proposed budget for 2012/13 was confirmed yesterday, and includes £5.5m for ECH housing, as well as an additional £500K for aids and adaptations.

      The Full Council, with councillors from all four political parties, will vote on that budget on 28th February 2012. The Liberal Democrats do not have an overall majority although we are the largest party on the Council.

      • Adding to Councillor Rogers response to Q8 26/1/12 asked by Charmaine, in ensuring that the chosen strategy provides sufficient residential provision to meet people’s needs it will also take account of the level, type and cost of independent provision.

    • 9.What support is there in place for the public to access if they have problems with getting info about Care services besides CQC ?

      The best and easiest local source of help is Care Direct on 922 2700 or email adult.care@bristol.gov.uk

      Happy to hear other comments and try and answer any other questions.

      Jon

    • In response to your point 2, Charimaine: The strategy which was agreed through the Residential Futures project was designed to ensure the homes the Council ran would be of an acceptable standard and could be maintained as such. The decision to pause the work was made for financial reasons as the subsequent national financial crisis significantly reduced the value of the homes which were identified for closure and sale, in order to finance the refurbishment of the remaining homes. This meant the plan was no longer financially viable.

    • Response to point 3: The decision to close Hollybrook was taken in 30 July 2009 by Cabinet following a 3 month consultation. The home to close and reopen as a home for people with dementia, with residents from Greville moving there. However, the Residential Futures Programme was paused by Cabinet in June 2010 due to the economic downturn. A three year plan for residential services will return to Cabinet in March 2012 and this will include a decision on Hollybrook.

    • Response to point 4: Dedicated Council staff worked on the Residential Futures project for approximately 2 years; (approx cost £105k). Input from other senior managers occurred as part of their managerial role
      The programme of consultation meetings that is currently taking place is intended to act as a briefing and explanation of the whole change programme that is underway as well as consulting specifically about residential services and day opportunities. This is a major programme which covers all aspects of Bristol’s social care system. The involvement of all senior managers reflects this and also indicates it’s importance and significance.

    • Response to point 5: It is social workers who make the placements.
      Homes are encouraged to staff shifts according to the number of residents in place , however, an adequate number of staff is always needed. Bristol is working to reduce the number of agency staff employed.

  6. I have been trying to attend as many of the consultation meetings as possible.

    The meetings are happening right across the city concerning both residential care and day opportunities. The meetings have involved service users, families, carers, staff and interested residents and organisations. A number of ward councillors have also attended.

    All seem to have been well attended, even the meeting at the Bristol 600 club on Saturday morning!

    So far, I have had the pleasure of visiting Brentry House (9th), Bowmead (10th), Dovercourt Road (11th), Broomhill (12th), Coombe (16th), Hayleigh – ( 18th – wrong day, but shown around and met some staff and residents!), Bristol 600 on 21st and off to Maesknoll today.

    Every one has been friendly and welcoming. Each have their own character. Each have strengths and weaknesses, and I am impressed at how open staff are to possibilities.

    These reviews are looking at the total provision of care services across the city, not just our own council run services and officers will be bringing recommendations to Cabinet at end of March.

    Jon

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