North Yorkshire Council
Executive
20th June 2023
Developing care services in the Craven area
Report of the Corporate Director – Health & Adult Services
1.0 PURPOSE OF REPORT
1.1 To update the Executive on ongoing work to support the development of the care market in Craven to ensure it can continue to meet the emerging needs of the locality, and strategic intentions to develop new accommodation-based services in Craven.
1.2 In light of the above, to seek approval for the replacement of Neville House Elderly Person’s Home with new accommodation-based services
2.0 SUMMARY
2.1 This report provides an update on the Council’s intentions to develop new accommodation-based care services in the Craven area, in particular in Gargrave, alongside ongoing work being undertaken to develop the care market in Craven to embed a home first approach that enables people to remain independent in their own homes for longer and to reduce reliance on residential care.
2.2 Home first has been a fundamental part of social care policy in England since the 1990s and is intended to support people in their existing home or in a location where they have their own front door. More recently, this model has been reinforced as part of the NHS Discharge to Assess programme, where going home is the default pathway for people leaving hospital, with alternative pathways for those people who cannot go straight home. In North Yorkshire, the Council is committed to reducing reliance on short-term residential stays and growing sustainable home-based and community-based support. Most people achieve better outcomes and the Council and the tax-payer also get better value for money, if more people can be supported in their own homes with the least restrictive option that maximises their independence. This report also outlines the recent and planned market growth in Craven in home-based care, extra care and supported housing.
2.3 The Council has now invested in excess of £2.5m in capital and/or grant funding to establish four Extra Care Housing schemes in Craven and has also delivered four new units of Supported Living in the locality. This investment, alongside the re-procurement of the Approved Provider Lists (the funding and contracting arrangements for the care market in the County) and targeted work with home-based and community-based support providers has started to create a more sustainable care market in the Craven area.
2.4 Given the significant investment in new services and support to the care market, as set out above, to enable more people to remain in their own home, alongside proposed new developments, the report addresses the impact on the Council’s in-house Care Provider Services, particularly the future of Neville House Elderly Person’s Home (EPH) in Gargrave in response to the changing needs of the local community in Craven. The report confirms the proposal to:
i. Replace Neville House with an Extra Care Housing scheme at Eshton Road, Gargrave, comprising approximately 30 residential units for older people, subject to successful procurement.
ii. Undertake further work to deliver an as yet undefined number of supported accommodation units for people with a range of care and support needs including younger adults across Craven.
3.0 BACKGROUND
3.1 In August 2021, it was agreed at the former County Council’s Executive that further feasibility studies would be undertaken into the future use of Council-run Neville House care home whilst continuing to deliver services from the site. Since that decision, further work has been completed to determine options for the future use of Neville House. This has been undertaken alongside targeted work to ensure that the wider care market can respond to the changing needs of the local community in Craven.
3.2 Needs analysis commissioned through Housing Research indicates a shortfall of 32 units of supported accommodation for older people in the Gargrave catchment area by 2030. Housing Research are an external consultancy organisation who specialise in market analysis for specialist and supported housing. Evidence also shows that there is significant demand in the Craven area for supported accommodation for working age adults with a range of care and support needs, as well as residential care for people with more complex needs including people living with dementia and, also, for bed-based provision to support hospital discharge and hospital admission avoidance.
3.3 Developments in the local care market in Craven, alongside further committed developments outlined in this report, offer models of care for people that enable them to remain in their own home for longer, rather than having to move to Neville House or other residential establishments.
4.0 ISSUES FOR CONSIDERATION
4.1 Extra Care Housing Development
4.1.1 The Council has invested in excess of £2.5m in capital and/or grant funding to establish four Extra Care Housing schemes in the Craven area. There are 211 units to date which are fully occupied, with an additional 57 people across Craven having expressed an interest in Extra Care, of which 27 are in the wider Skipton/Gargrave areas. There is good geographical spread of Extra Care provision across the Craven locality, with two schemes in Skipton, one in Settle and one in Bentham. This is a significant increase in provision over the last few years and demonstrates an increase in excess of potential places to be lost at Neville House. The Council’s investment in Extra Care responds to the emerging needs and wishes of the community to live as independently as possible in their own homes into later life and is also in line with our strategic ambitions to reduce reliance on residential care and deliver on a true home first approach across North Yorkshire.
4.1.2 There are now 24.7 Extra Care units per 1,000 residents aged 75 and over in Craven. This compares to 10.8 units in 2020. It also exceeds the current North Yorkshire average of 8.9 units per 1,000.
4.1.3 A fifth Extra Care Housing development is proposed in Gargrave. Whilst the site at Neville House is too small to be developed for Extra Care, the North Yorkshire Council-owned site at Eshton Road in Gargrave has been earmarked for Extra Care for a number of years, although a procurement process in 2016 was unsuccessful in delivering a scheme through the Extra Care framework. Further needs analysis was commissioned in 2020 through Housing Research, who have completed similar work for all proposed schemes on the Extra Care procurement framework. This research indicated a potential shortfall of 32 units of supported accommodation for older people in the Gargrave catchment by 2030. At the point this research was commissioned, the view of potential providers was that a scheme of this size may not be viable and such delivery of Extra Care either at Eshton Road or Neville House would not be a realistic proposition.
4.1.4 Extra Care development has continued to evolve nationally and engagement with providers in 2022 indicated that a new generation of smaller (~30 unit) Extra Care schemes were beginning to emerge with a model which could work in Gargrave. Subsequent formal framework provider engagement in late 2022 confirmed an interest amongst providers to fully explore the opportunity. This makes the likelihood of a successful procurement more realistic.
4.1.5 The development of Extra Care would be beneficial to Gargrave. This development would also complete the current Craven chapter of the Extra Care programme and would confirm Craven as the locality with the most Extra Care per head of population anywhere in the county.
4.1.6 Extra Care development is currently very challenging, with construction sector inflation running at high levels which is affecting some of the built-in assumptions around development which often involves significant investment from developers, local authorities and other funders such as Homes England. Whilst provider engagement has been positive and levels of demand would support a scheme in the area, until this is tested through a procurement exercise it is not possible to fully confirm whether a scheme can be delivered.
4.1.7 A full suite of procurement documents has been completed following the market engagement - and public engagement activity has been planned. Subject to Member approval, a procurement could be delivered within six months. If the procurement is successful and subject to further consideration by Executive, the new Extra Care Housing scheme in Gargrave could be operational during the calendar year 2026.
4.2 Supported Housing Development
4.2.1 The Craven area has a very limited stock of Supported Living properties for working age adults, with only 10 properties supporting 28 people in this type of support, the lowest of any locality in the county. Demand is high with 34 people awaiting supported living across Craven of whom approximately 22 would consider accommodation in the Gargrave and surrounding areas. This is a consistent pattern, established across many years which mirrors levels of demand and activity across North Yorkshire.
4.2.2 The Local Government Reorganisation (LGR) in North Yorkshire has created new opportunities to deliver housing through existing partnership and framework agreements which have been inherited from Craven District Council and Harrogate Borough Council. Under these arrangements it would be possible to commission a number of supported accommodation units on the Neville House site, or other available sites locally across Craven, for the use of supporting people with a range of care and support needs. Work between the Council’s Health and Adult Services Housing, Technology & Sustainability team and the new Community Development directorate’s Housing and Planning teams is ongoing but there is confidence that suitable accommodation could be delivered in Gargrave, hopefully on the Neville House site once it becomes available.
4.2.3 These developments will be in addition to the four new units of supported living in Skipton implemented in early 2021. An exercise has also been undertaken with the Council’s Housing service to match development sites to the needs of people requiring supported housing. This has brought forward two sites due to complete this year which will provide approximately 10 additional units of supported accommodation in Craven. Further units are planned as sites are granted planning permission. Details of the types of properties required to meet the needs of people looking for supported accommodation have been factored into this programme.
4.2.4 The availability of sites and potential delivery vehicles in Craven is somewhat unique in the recent experience of delivering housing schemes across North Yorkshire. Availability of land is a continual challenge and prior to LGR there was no direct vehicle by which the Council could commission bespoke supported accommodation. Whilst cost pressures continue to be a significant challenge across the sector and this may constrict the willingness of providers to engage with the sites, there is a clear and deliverable pathway to significantly upgrading capacity in the area through:
i. Delivery of an approximately 30-unit Extra Care Housing scheme at Eshton Road, Gargrave for older people, subject to successful procurement.
ii. Undertaking further work to deliver an, as yet undefined number of supported accommodation units for people with a range of care and support needs including younger adults across Craven.
4.3 Other Care Market Developments
4.3.1 The Council has also recently re-procured the Adult Social Care Approved Provider Lists. These are pre-approved lists of providers who have demonstrated their ability to meet the minimum required standards, as defined by new outcomes-focussed service specifications and a standards and outcomes framework, to deliver adult social care services, across four service areas; Residential & Nursing Care, Home-Based Support, Community-Based Support and Supported Living.
4.3.2 The procurement supported the sustainability of the care market through the ability to provide new rates for the delivery of care, and has also attracted new providers into the area, as well as supported existing providers to expand their services. The Council has injected an additional £14 million into the Adult Social Care budget to fund the increased costs of care within the care market. Craven now has a more resilient and diverse home-based support market, having seen seven new providers expand or set up services in the area over the last two years. Despite having had two providers exit the market in the same period, the expansion of the provider market in the area has meant that the local care market has been in a position to respond to support those people impacted by this.
4.3.3 The Council has also undertaken targeted work with home based and community support providers in the locality to develop collaborative and more sustainable approaches to meeting needs in the more rural communities within the locality. Work by Service Development teams has ensured that growth and expansion of the provider market in Craven is targeted on rural communities, and at supporting those people whose needs may be more difficult to meet through existing services. Other examples of work with the market include support to home-based support providers to work collaboratively on resilience and contingency planning, and start to share office-based facilities, work with voluntary and community sector organisations to expand delivery to support people with care and support needs and targeted local recruitment support to achieve a new Shared Lives service offer in Craven.
4.3.4 Over the last six months, unsourced packages of care in Craven have remained at an all-time low with only one unsourced package of care at any one time. Recognising that adult social care can be a fast-changing market, this does demonstrate the positive impact of such market interventions, and the market’s ability to meet the current social care needs in the locality.
4.3.5 There is demand in the Craven area for residential care for people with more complex residential needs including people living with dementia, including bed-based provision to support hospital discharge and admission avoidance. The current staffing model and capacity, alongside the site and property condition at Neville House is not able to support this level of need. Ashfield EPH in Skipton is currently responding to this need through the delivery of intermediate care in collaboration with community health teams and new funding from the West Yorkshire NHS Integrated Care Board. Intermediate care services provide a range of integrated services to promote faster recovery from illness, prevent unnecessary hospital admission and/or premature admission to long-term residential care, support timely discharge from hospital and maximise independent living. Intermediate care services are usually time-limited and can be bed-based or home-based. The development of a Care and Support Hub in Skipton is proposed to further meet demand in this area. The Care and Support Hub model is based on learning from Station View EPH in Harrogate; another of the Council’s in-house care settings, which has established itself as a core part of the local system, focussed on prevention – adding short-term capacity through rehabilitation and respite that has been proven to have a positive effect on people’s long term care needs.
4.4 Neville House Issues
4.4.1 Demand & Capacity
Neville House has been closed to new permanent admissions since March 2022, in anticipation of plans to replace the service with Extra Care Housing in Skipton and supported housing in Gargrave. Since March 2022, the service has only been accepting short stay admissions. As of 1 June 2023, there were seven remaining permanent residents within the home.
4.4.2 Analysis of referral and admission data for Neville House shows limited demand for the service over the last three years. Between January 2020 – March 2022, there were a total of 33 admissions to the service. Only eight of these admissions were permanent admissions.
4.4.3 Since March 2022 when new permanent admissions were suspended, there have been only nine short stay admissions. Admissions have undoubtedly been further impacted by staffing capacity (due to the highly competitive labour market and wider national and local challenges around care sector recruitment), and also the COVID pandemic and associated outbreak management responses. Admissions to Ashfield EPH in Skipton, by comparison, are double those for Neville House for the same period, across both permanent and short stay placements.
4.4.4 Neville House has historically provided care to people with relatively less severe needs. A well-embedded home first approach in the locality, further supported by Extra Care Housing developments locally means that more favourable and personalised models of care for people with this level of care need are available which enable people to remain at home and more independent for longer.
4.4.5 Property Condition
The Neville House site would require significant investment to support the continued safe delivery of social care services from the site if it is to remain open. Average annual maintenance costs over the last five years at Neville House are £70,954.54 per annum, and it is anticipated that this will continue to escalate with a significant failure of some part of the building or infrastructure increasingly likely over time which would potentially necessitate a less planned conclusion to the use of the building. Emergency and unplanned responsive maintenance orders represent over 75% of maintenance spend for the last two years.
4.4.6 The latest Condition Report for Neville House was undertaken in January 2023. This indicated that maintenance work to the value of £469,338 would be required over the next three years to maintain safe standards.
4.5 Impact on people
4.5.1 If the proposals outlined in this report are approved, Neville House will stop providing current services from Autumn 2023 with remaining residents supported to move to alternative residential care homes. The assessment of residential care provision in the locality indicates that there would be capacity to meet the needs of the remaining residents, including within the Council’s in-house provision at Ashfield EPH in Skipton, if appropriate. A collaborative approach will be taken to understand people’s needs and preferences to ensure suitable alternative homes are identified for the seven residents at Neville House, promoting choice and taking account of friendships alongside personal and social needs. Counselling and/or advocacy and additional support will be made available to people demonstrating signs and symptoms of stress related to the closure.
5.0 CONSULTATION UNDERTAKEN AND RESPONSES
5.1 It is recognised that changes to services for the current residents of Neville House has the potential to cause distress to people and their families and/or carers. Subject to Executive approval, sensitive consultation will be undertaken with people and their families prior to the closure, working closely with Locality Care and Support Teams to ensure alternative care and support is identified that meets people’s needs and wishes. Consultation will also take place with Neville House staff and their union representatives.
5.2 It is also recognised that there will need to be sensitive communication with the local community. A clear Communication Strategy will be developed and implemented. This will include communication and engagement with the local Parish Councils, and a local public information and engagement event(s).
5.3 Formal market and public consultation will also be undertaken as part of the procurement exercise for the new Extra Care Housing scheme in Gargrave, and as part of the wider development work to deliver supported accommodation.
6.0 CONTRIBUTION TO COUNCIL PRIORITIES
6.1 The Council’s ambitions to develop and embed home first approaches that support people to remain independent in their own homes for longer and reduce reliance on residential care are well documented. These ambitions are in line with the Council’s intentions as set out in the Council Plan 2023 – 27 and set out within the Health and Adult Services Plan 22 – 25 as well as the Council’s Market Position Statement.
7.0 ALTERNATIVE OPTIONS CONSIDERED
7.1 Alternative site options considered as part of the options appraisal for the Neville House site included:
· Replacement of Neville House with Extra Care on the site
· Retention of Neville House on a permanent basis
· Redevelopment of Neville House as NYC provision
· Offer Neville House as a going concern to the Care Market
· Development of general needs and/or supported housing
More detail on each of these options is included at Appendix A.
8.0 IMPACT ON OTHER SERVICES/ORGANISATIONS
8.1 Assessment of the local care market in Craven indicates that there is capacity to meet future needs of the local community through the care market developments and interventions outlined at section 4.
9.0 FINANCIAL IMPLICATIONS
9.1 Replacement of Neville House has an allocated saving of £135,000 within the Council’s Medium Term Financial Strategy. Considering the proposals for extra care and supported housing, there is potential to achieve increased recurrent savings but these are yet to be determined. Initial savings will be achieved by the closure of the home in Autumn 2023 which will contribute to this target.
9.2 Extra Care Housing is also evidenced to deliver circa £300,000 annual recurrent savings based on a 60 unit scheme due to diversion of costs from residential care, meaning we can estimate a recurrent saving of £150,000 to be achieved through the replacement of Neville House with an Extra Care Housing scheme in Gargrave.
9.3 The procurement exercise will determine the capital costs and therefore the value for money test for a new Extra Care facility. At this stage these are unknown and therefore a further decision will be required by Executive to determine whether or not to proceed with this aspect.
10.0 LEGAL IMPLICATIONS
10.1 Section 5 of the Care Act 2014 places a duty on the local authority to promote diversity and quality in the provision of services. It must do this by “ensuring that any person in its area wishing to access services in the market- (a) has a variety of providers to choose from who (taken together) provide a variety of services (b) has a variety of high quality services to choose from and (c) has sufficient information to make an informed decision about how to meet the needs in question”.
10.2 The Care and Support Statutory Guidance (CASSG) states at paragraph 4.2 – “The ambition is for local authorities to influence and drive the pace of change for their whole care market, leading to a sustainable and diverse range of care and support providers, continuously improving quality and choice, and delivering better, innovative and cost effective outcomes that promote the wellbeing of people who need care and support”.
10.3 The CASSG emphasises the duty upon the local authority to promote quality and that it must have regard to ensuring the continuous improvement of a diverse range of high quality and appropriate services (paragraph 4.21 of CASSG). The local authority should also however commission services having regard to the cost effectiveness and value for money that the services offer for public funds (paragraph 4.27 of CASSG).
10.4 With regard to the consultation process, in accordance with the principles set out in the case of R v London Borough of Brent ex parte Gunning [1985], consultation must take place when proposals are still at a formative stage. There must be sufficient information to enable those affected to make an informed decision regarding how their care and support needs are met in the future. Sufficient time should be given to allow sufficient opportunity for individuals to participate. Any responses received as part of the consultation process must be given due consideration and there should be evidence that consultations responses were taken into account in the decision-making process.
10.5 In accordance with the Mental Capacity Act 2005, for any person affected by the proposals who lacks capacity in relation to their care and support and residence, it is necessary to ensure that any person with Lasting Power of Attorney or Deputyship for Health and Welfare is consulted to enable a decision to be made regarding the person’s care, support and residence in accordance with the person’s best interests.
11.0 RISK MANAGEMENT IMPLICATIONS
11.1 A detailed initial risk assessment has been included at Appendix B
12.0 HUMAN RESOURCES IMPLICATIONS
12.1 There are currently 31 established staff, equating to 20 full-time equivalents, at Neville House including the Registered Manager, Deputy Manager and non-care staff. All staff have been briefed of the proposals outlined in this report in advance of its publication. Clear communications and sensitive consultation with remaining Neville House staff team would be undertaken, supported and led by HR, if recommendations are approved.
12.2 As part of the staff consultation, wherever possible, the staff team from Neville House will be offered alternative roles including roles at either Ashfield EPH, Jubilee Lodge or within the community reablement service where there are current vacancies. The preferred option is to retain as many staff as possible within the Council’s Care Provider Services, however there is the potential for redundancies.
13.0 EQUALITIES IMPLICATIONS
13.1 Consideration has been given to the potential for any equality impacts arising from the proposed closure of Neville House. The Equality Impact Assessment is attached at Appendix C.
14.0 CLIMATE CHANGE IMPLICATIONS
14.1 A climate change impact assessment has been completed and is attached at Appendix D. A further assessment will be undertaken by Corporate Property Services following handover of the site to inform future options for the site. There will also be further opportunities for improvements as part of the wider adult social care transformation programme, including opportunities as part of the transformation of the Council’s in-house care provision.
15.0 REASONS FOR RECOMMENDATIONS
15.1 The changing needs of people requiring care and support alongside the Council’s ambitions to further develop our home first approach to achieving better outcomes for people through supporting people in their own home wherever possible requires alternative care and support options for people to those traditionally delivered in residential care.
15.2 Developments in, and support to the care market in the Craven area over the last two years, alongside proposed developments of new Extra Care Housing in Gargrave and supported accommodation in Craven to replace Neville House mean there are more favourable and personalised alternative support options available for people to meet demand, both now and in the future.
15.3 The current operational position at Neville House indicates that it is not viable to continue to deliver services from Neville House until new Extra Care Housing and supported housing developments are completed. It is, therefore, recommended that Neville House ceases to deliver services from Autumn 2023.
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16.0 |
RECOMMENDATION(S)
The Executive are asked to note: i) The care market development work undertaken in Craven to support the Council’s strategic priorities in embedding a home first approach that enables people to remain independent and remain in their own homes for longer, reducing reliance on residential care. ii) The intention to replace Neville House with new Extra Care Housing in Gargrave, subject to a successful procurement exercise, and the associated closure of Neville House in Autumn 2023. iii) The wider work to develop supported accommodation for people with a range of care and support needs, including younger adults, across Craven.
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Richard Webb
Corporate Director – Health & Adult Services
County Hall
Northallerton
20th June 2023
Report Author – Hannah Brown
Presenter of Report – Hannah Brown
BACKGROUND DOCUMENTS:
Executive Report dated 31 August 2021 - Development of Adult Social Care Provider Services, see:
Agenda for Executive - 31/08/2021
APPENDICES:
Appendix A – Options Appraisal
Appendix B – Initial Risk Assessment
Appendix C – Equalities Impact Assessment
Appendix D – Climate Change Impact Assessment
Note: Members are invited to contact the author in advance of the meeting with any detailed queries or questions.