Agenda item

(NOTE: At this point, the Chair, Councillor Mick Rooney, left the room and the position of Chair was taken by the Deputy Chair, Councillor Sue Alston.)

6.1

The Committee considered the decision of the Leader of the Council, Councillor Julie Dore, made on 3^rd February 2015, to give approval to tender for the reprovision of day services and residential short-term care beds for people with dementia.

6.2

Signatories

The Lead Signatory to the call-in was Councillor Jillian Creasy and the other signatories were Councillors Sue Alston, Robert Murphy, Sarah Jane Smalley and Brian Webster.

6.3

Reasons for the Call-In

The signatories had confirmed that they wished to scrutinise the decision relating to the tender, as it could have important and far reaching consequences for service users, their families, the carers and for colleagues providing hospital services. 

6.4

Attendees

·                Councillor Mary Lea (Cabinet Member for Health, Care and Independent Living)

·                Joe Fowler (Director of Commissioning)

·                Sharon Marriott (Commissioning Officer)

·                Jason Swann (Project Officer, Commercial Services)

6.5

Councillor Jillian Creasy addressed the Committee as Lead Signatory and emphasised the importance of the decision to tender to a private provider.  She also expressed concerns about the decision to cut costs by £½ million and the lack of information on current provision and questioned the link which the present report had to the Dementia Strategy.  Councillor Creasy also went on to refer to the implications for the integration of health and social care and whether any private provider would be able to provide the required service.  In conclusion, she asked about the complexity of the care provided, what the view of the Clinical Commissioning Group (CCG) was, and the stage at which any further discussions with the Sheffield Health and Social Care Trust (the Trust) were at.

6.6

Public questions were asked about the savings to be made, discussions with the managers at Hurlfield View, consultation with staff, quality issues, the instability created by the introduction of a third party provider and ensuring the voice of carers was heard.

6.7

In response, Joe Fowler, Director of Commissioning, stated that there were no concerns as to the quality of services at Hurlfield View and pointed out that it was not a hospital but a residential care home which had about 20 beds and provided day care services.  The aim was to change provision to meet people’s needs in a community setting, rather than transporting them to one location for day care and, in doing this, the needs of hundreds of people would be met rather than just a handful.  The proposed savings were set out in the report, with £700,000 being released to fund community based activities during Years 2 and 3.  There were no plans to reduce bed based services at Hurlfield View and work had been undertaken with the Trust, so it would be disappointing if management had not been involved.  The CCG were supportive of the overall Dementia Strategy and, if the Trust came up with a proposal to meet the Council’s objectives, then this would be considered.

6.8

As a point of clarification, Councillor Mary Lea, Cabinet Member for Health, Care and Independent Living, indicated that the consultation which she had mentioned in a radio interview, referred to consultation which had taken place on Dementia work in Sheffield in 2012, which had revealed that people wanted more community based services.

6.9

Sharon Marriott, Commissioning Officer, indicated that work had been undertaken on the original Dementia Strategy, with Hurlfield View users being included in the consultation process.  In relation to the tender process, carers and users had been advised of the proposals.  It was estimated that there were approximately 6,000 dementia sufferers in Sheffield and the Council were in touch with 4,500 of these.  A small part of the community was using Hurlfield View and the proposals aimed to shift investment to release funds to invest in community based services.  Short-term care beds would facilitate unplanned admissions and these instances could be complex as crisis situations were often involved.  Reasons for admission included deterioration in the user’s condition, respite care and carers being taken ill.  It should be noted that in December 2014, 60% of admissions were planned.  In relation to the costs of running the service, the wider market had been examined and Core City comparisons had been made.  It had been found that the cost of a nursing bed at Hurlfield View was £1,000 per week and that such a bed provided by EMI Care Homes was £600 per week.  In conclusion, Sharon Marriott emphasised that the proposal sought to release money to grow the day care service in a different setting, providing activities such as walking, hobbies and peer group settings. 

6.10

Jason Swann, Commercial Services, explained that the present agreement for these services expired at the end of March 2015 and that the Council was legally obliged to carry out a formal test of services at Hurlfield View and, as such, meetings had been held with the Trust to allow this to take place.  As the staff employed there were not Council staff, they couldn’t be consulted with directly, with this being a Trust responsibility. 

6.11

Questions from Members of the Committee

Members made various comments and asked a number of questions, to which responses were provided as follows:-

·                Hurlfield View was not the only day care provider in the City, with the Alzheimer’s Society and Age UK also providing such services.  The intention was to build on what was there already in the community and have a mixture of paid and volunteer staff. 

·                Other organisations provided services for dementia sufferers with a spectrum from community support to services at Hurlfield View being available.  It was hoped to keep an element of day provision at Hurlfield View.

·                Any providers would need to comply with specific requirements on matters such as training. 

·                There were a range of nursing homes providing respite care.

·                Carers and users had been notified of the proposals by letter and once a decision on the provider had been made a formal consultation would take place.

·                Officers would advise the Leader and Cabinet Member if the Trust put in an appropriate proposal.

·                The timescale for the start of the contract had been extended until the end of August 2015.

·                The present model would not be sustainable if the present rate of increase in demand for dementia services continued.

·                A range of options were available with regard to the tendering process, which could take the form of either asking for bids or going out for a price, with an evaluation being made on that basis.  Regulations did allow for weight to be given to price.

·                If a respite care bed was not available at Hurlfield View, there were other homes in the City which provided such care.

·                The Council was not looking at a single organisation to work in the community and consideration had been given to operations in the form of clusters.

·                One-third of the people using day care services at Hurlfield View paid for this.  As far as community services were concerned, there was a mix, with some people paying for the service.

·                The idea behind the tender was to move away from instructing organisations how to act and looking at higher level objectives.  Evaluation would take place based on the ability to deliver outcomes.

·                The Council was in the process of recruiting 20 support workers who would be able to assist people wishing to gain access to dementia services.

·                The challenge for the Council was living within the financial constraints of a reducing budget, so value for money had to have some real impact.  This proposal enabled a stepping up of the service and it was unfair to assume that paying a lower rate for the service implied a worse service.

·                The Care Quality Commission (CQC) inspected the residential provision at Hurlfield View and would continue to do so, whilst the Contracts and Grants Monitoring Team monitored community based activities.  In addition, regulatory frameworks were involved in the provision of clinical support. There was no extra cost in monitoring at the present time.

·                The operation of the Stocksbridge satellite service would continue.

·                It was proposed, after one year of operation, to look at real demand and service users and taper off the day care element.  Consequently, there was a need to grow day care opportunities and initiatives.

·                The Trust proposal did not meet the Council’s requirements, and in any event, there was a legal requirement to go to tender.  Whilst any further Trust proposals could be considered, there would be significant commercial risks.

·                There were a range of providers who interfaced with the Trust already.

6.12

RESOLVED: That the Committee:-

(a)       notes the contents of the report together with the comments made and responses provided;

(b)       notes the decision of the Leader of the Council, made on 3^rd February 2015, to tender for the reprovision of day services and residential short-term care beds for people with dementia;

(c)        recommends that no action be taken in relation to the call-in decision; and

(d)       requests officers to take into account the discussion when drafting the next report to the Committee on Dementia Services.

(NOTE: Prior to the passing of the above resolution, an alternative motion was moved by Councillor Jillian Creasy and seconded by Councillor Denise Reaney, namely that:-

“The Committee refers the decision back to the Leader of the Council for reconsideration in the light of recommendations from the Committee.”

This alternative motion was put to the vote and negatived).