Financial Information for Scrutiny Task Group

on Intensive Day Care Centres

1. The number of people using day centres and the number of people with a Personal Budget:

Total number of day centre users and number of day centre users with personal budgets
Apr / May / Jun / Jul / Aug / Sep / Oct
Total number with personal budgets / 120 / 123 / 120 / 120 / 122 / 127 / 138
Total number using day care / 158 / 157 / 154 / 149 / 146 / 149 / 144
Number of people using the day centres in receipt of a Personal Budget
Apr / May / Jun / Jul / Aug / Sep / Oct
Ham / 21 / 22 / 24 / 23 / 23 / 23 / 26
Sheen / 43 / 45 / 44 / 45 / 43 / 41 / 39
Tangley / 30 / 28 / 26 / 28 / 29 / 30 / 36
Twickenham / 26 / 28 / 26 / 24 / 27 / 33 / 37
Total / 120 / 123 / 120 / 120 / 122 / 127 / 138
  1. The number of people purchasing additional days over and above their Personal Budget allocation is shown below. This includes 2 people at Tangley Hall who are privately purchasing services directly from the centre without having had a needs assessment.

Places Purchased in Addition to Personal Budget Allocations
Ham / Sheen / Tangley / Twickenham / Total
Apr / 0 / 0 / 2 / 0 / 2
May / 0 / 1 / 3 / 0 / 4
Jun / 2 / 0 / 2 / 0 / 4
Jul / 1 / 2 / 2 / 0 / 5
Aug / 4 / 1 / 2 / 0 / 7
Sep / 4 / 1 / 3 / 0 / 8
Oct / 3 / 2 / 2 / 1 / 8
  1. The NHS (South West London and St George’s Mental Health Trust) provides a service at Ham with 4 places every Tuesday for assessment and treatment. Whilst this service is located at Ham Day Centre, this remains a separate service.
  1. The average number of people attending Tangley Hall at the weekend is shown below:

Saturday / Sunday
Apr / 12 / 9
May / 12 / 9
Jun / 12 / 9
Jul / 12 / 15
Aug / 12 / 15
Sep / 12 / 15
Oct / 14 / 15
  1. The charges for attendance, meals and transport to day centres for people with a Personal Budget:

Attendance / Transport / Meals / Total
Full day attendance with transport and meal / 48.00 / 10.00 / 4.10 / 62.10
Full day attendance with one way transport and meal / 48.00 / 5.00 / 4.10 / 57.10
Full day attendance without transport / 48.00 / - / 4.10 / 52.10
Half day attendance with transport and meal / 24.00 / 10.00 / 4.10 / 38.10
Half day attendance with one way transport and meal / 24.00 / 5.00 / 4.10 / 33.10
Half day attendance without transport / 24.00 / - / 4.10 / 28.10
  1. The gross cost of running the day centres in 2010-11 is £2.1m as follows:

Tangley
£000 / Ham
£000 / Twick
£000 / Sheen
£000 / Total £000
Expenditure
Employees / 258 / 197 / 232 / 264 / 950
Premises / 16 / 33 / 23 / 9 / 82
Transport / 119 / 106 / 119 / 126 / 470
Supplies & services / 44 / 36 / 63 / 63 / 206
Overheads / 94 / 119 / 93 / 140 / 446
Gross cost / 531 / 491 / 530 / 602 / 2,155
Income from meals / -14 / -10 / -10 / -30 / -64
Net cost / 517 / 481 / 521 / 572 / 2,090

Provided below is information sent to residents, following recent requests received under the Freedom of Information Act:

  1. Analysis of overhead costs at Intensive Day Care Centres:

SERVICES FOR OLDER PEOPLE DAY CENTRES ANALYSIS OF OVERHEADS 2010-11.
TOTAL
DAY CENTRE
DESCRIPTION / TANGLEY / HAM / TWICKENHAM / SHEEN / OVERHEADS
£ / £ / £ / £ / £
HR Recharge / 12,100 / 8,500 / 12,100 / 12,100 / 44,800
Corporate Income Recharge / 1,400 / 1,000 / 2,000 / 700 / 5,100
Finance Recharge / 6,900 / 8,400 / 10,800 / 3,200 / 29,300
IT Recharge / 33,900 / 28,300 / 33,000 / 35,600 / 130,800
Web Team Recharge / 1,400 / 1,200 / 1,400 / 1,500 / 5,500
Accommodation Recharge / 0 / 0 / 0 / 32,000 / 32,000
Property S
ervices recharge / 3,300 / 16,100 / 4,600 / 5,300 / 29,300
Health and Safety Recharge / 900 / 800 / 900 / 1,000 / 3,600
ACS Divisional Management Recharge / 7,700 / 6,400 / 7,500 / 8,100 / 29,700
ACS Directorate Recharge / 21,300 / 19,100 / 21,100 / 22,900 / 84,400
Depreciation Other Land & Buildings / 4,700 / 29,500 / 7,300 / 17,300 / 58,800
Grand Total / 93,600 / 119,300 / 100,700 / 139,700 / 453,300
  1. Transport Costs

SERVICES FOR OLDER PEOPLE DAY CENTRES ANALYSIS OF DAY CENTRE TRANSPORT COSTS 2010-11.
TOTAL
DAY CENTRE
DESCRIPTION / TANGLEY / HAM / TWICKENHAM / SHEEN / TRANSPORT COSTS
£ / £ / £ / £ / £
Drivers / 47,800 / 42,000 / 55,600 / 59,800 / 205,200
Escorts / 23,600 / 18,000 / 0 / 0 / 41,600
Council Vehicles / 18,400 / 20,800 / 37,100 / 38,100 / 114,400
Fuel / 6,600 / 6,500 / 9,800 / 9,900 / 32,800
Supervisors / 6,300 / 5,300 / 4,900 / 5,300 / 21,800
Total Direct Costs / 102,700 / 92,600 / 107,400 / 113,100 / 415,800
Total Overheads / 16,300 / 13,200 / 11,600 / 12,000 / 53,100
TOTAL COST / 119,000 / 105,800 / 119,000 / 125,100 / 468,900

9.Day Services Income

Under SDS, service users pay a single means-tested contribution towards their services, therefore it is not possible to provide a breakdown of client contributions for the IDCCs. The figures below are actual contributions in 2008/09 to give an indication of the level of contributions paid by service users.

SERVICES FOR OLDER PEOPLE DAY CENTRES ANALYSIS OF DAY CENTRE INCOME
TOTAL
DAY CENTRE
DESCRIPTION / TANGLEY / HAM / TWICKENHAM / SHEEN / INCOME
£ / £ / £ / £ / £
CLIENT CONTRIBUTIONS 2008-09 * / 33,000 / 42,800 / 39,000 / 33,500 / 148,300 / *
MEALS INCOME 2010-11 / 14,800 / 10,300 / 13,900 / 17,600 / 56,600
Total Projected Income / 47,800 / 53,100 / 52,900 / 51,100 / 204,900

10. Note outlining who owns the freehold to Tangley Hall, who owns the lease and what time period it covers.

The Council leases the building (1 Bramble Lane, HamptonTW12 3XB) from Richmond Churches Housing Trust Ltd. The lease to the Council is for 999 years from 5 August 1986 at a fixed annual peppercorn rent. The Council sold the freehold to Richmond Churches Housing Trust Ltd on 5 August 1986 along with other land, at which time it took back the lease for Tangley Hall.

11.Breakdown of budget, staff establishment, average used places and total places available.

Budget
£000 / Staff (FTE) / Average Used Places
Per Day / Available Places
Per Day
Sheen Lane / 572 / 8.1 / 21.5 / 30
Twickenham / 521 / 7.5 / 16.5 / 30
Ham / 481 / 6.4 / 11.6 / 20
Tangley Hall / 517 / 7.7 / 13.9 / 15

12. Breakdown of the estimated budget savings from the day service proposals:

Expenditure Category / Older People (Frail)
£000 / Older People (Dementia)
£000 / Total
£000
Employees / 147 / 103 / 250
Premises / 23 / 16 / 39
Transport / 0 / 0 / 0
Supplies and Services / 11 / 15 / 26
TOTAL / 181 / 134 / 315

13.Breakdown of Day Care Service Users by Post Code:

Twickenham Service Users / Sheen Lane Service Users
Postcode / Postcode
TW1 / TW10
TW11 / TW10
KT1 / TW9
TW2 / TW9
TW2 / TW9
TW2 / TW10
TW1 / TW9
TW2 / TW10
TW12 / TW10
TW2 / SW13
TW2 / SW14
TW12 / SW13
TW11 / TW10
TW1 / SW14
TW12 / SW14
TW2 / TW10
TW10 / TW9
TW1 / TW10
TW1 / TW9
TW10 / TW9
TW2 / TW10
TW2 / TW10
TW1 / TW10
TW1 / SW13
TW11 / TW9
TW10 / SW13
TW2 / TW10
TW2 / SW14
TW11 / SW14
TW12 / TW10
TW2 / TW9
TW2 / SW14
TW2 / SW13
TW2 / TW9
TW2 / SW15
TW2 / SW13
TW12 / SW14
TW1 / SW15
TW10
Tangley Hall Service Users / Ham Service Users
Postcode
TW7 / TW1
TW11 / SW13
TW11 / TW9
TW1 / TW10
TW2 / SW13
TW2 / SW14
TW3 / TW9
TW12 / TW10
TW1 / TW9
SW13 / TW1
TW2 / TW9
TW2 / TW10
SW15 / SW13
TW9 / SW15
TW12 / TW9
TW1 / TW9
TW12 / TW9
TW1 / TW10
TW1 / SW14
TW2 / SW14
TW12 / TW10
TW2 / TW10
TW12 / SW14
TW10 / TW10
TW1 / SW13
TW12 / TW10
TW4 / TW9
TW2 / SW13
TW11 / SW14
TW11 / TW10
TW2 / SW13
TW11
TW2
TW2
TW12
TW1
TW2
TW2
TW2
TW2
TW2

14.IDCC 2009/10 budget and actual expenditure for each day centre.

TANGLEY
Actual
£000 / Budget
£000 / (Under) / overspend
£000
Expenditure
Employees / 245 / 255 / -10
Premises / 15 / 17 / -1
Transport / 119 / 119 / -1
Supplies & services / 55 / 54 / 1
Overheads / 102 / 102 / 0
Gross cost / 536 / 546 / -10
Income / -15 / -14 / 0
Net cost / 521 / 532 / -11
HAM
Actual
£000 / Budget
£000 / (Under) / overspend
£000
Expenditure
Employees / 219 / 196 / 23
Premises / 32 / 35 / -4
Transport / 105 / 106 / -1
Supplies & services / 55 / 55 / 0
Overheads / 127 / 127 / 0
Gross cost / 538 / 520 / 18
Income / -12 / -10 / -1
Net cost / 526 / 509 / 17
TWICKENHAM
Actual
£000 / Budget
£000 / (Under) / overspend
£000
Expenditure
Employees / 222 / 225 / -3
Premises / 13 / 22 / -8
Transport / 118 / 119 / -1
Supplies & services / 81 / 69 / 12
Overheads / 109 / 109 / 0
Gross cost / 544 / 544 / 0
Income / -16 / -17 / 1
Net cost / 528 / 527 / 1
SHEEN
Actual
£000 / Budget
£000 / (Under) / overspend
£000
Expenditure
Employees / 247 / 265 / -18
Premises / 4 / 10 / -6
Transport / 125 / 126 / -1
Supplies & services / 73 / 75 / -2
Overheads / 149 / 149 / 0
Gross cost / 599 / 625 / -26
Income / -31 / -30 / -1
Net cost / 568 / 595 / -27

15. Analysis of day centre budget 2010-11.

Tangley
£000 / Ham
£000 / Twick
£000 / Sheen
£000 / Total
Expenditure
Employees / 258 / 197 / 232 / 264 / 950
Premises / 16 / 33 / 23 / 9 / 82
Transport / 119 / 106 / 119 / 126 / 470
Supplies & services / 44 / 36 / 63 / 63 / 206
Overheads / 94 / 119 / 93 / 140 / 446
Gross cost / 531 / 491 / 530 / 602 / 2,155
Income / -14 / -10 / -10 / -30 / -64
Net cost / 517 / 481 / 521 / 572 / 2,090
Overheads as a % of Direct Costs / 21% / 32% / 21% / 30% / 26%

APPENDIX A

Member Briefing

Intensive Day Care Centre Reconfiguration Proposal,

Budget Review

1.Purpose of the Report

The purpose of this report is to provide background and context to the proposal to

reconfigure the existing four Intensive Day Care Centres (IDCCs) for older people

with physical frailty or dementia to two remaining centres.

2.Background

The proposal to reconfigure the Council’s provision of Intensive Day Care Centres

formed part of a wider Stage 1 Review of Older People’s Day Services in the London

Borough of Richmond upon Thames.

The review was undertaken due to a range of factors including the introduction of self

directed support and personalisation, the imperative on the Council to make savings

and the more recent review of Voluntary Sector Grant Funding.

As work progressed on the review it became clear that both a long term vision and

change to the way all day services are commissioned, provided and organised needs

to be made. In addition, in the short term, it was identified that some changes could

be made to the way in which our in house day centres are configured in order to

make them as efficient as possible going forward. This document provides some

summary information from the Stage 1 Review.

  1. Proposal

The proposal in relation to the in house Intensive day Care Centres is to reconfigurethe existing four Intensive Day Care Centres at Twickenham, Sheen Lane, Ham and Tangley Hall to two centres at Sheen Lane and Ham.

  1. Analysis

The proposal is based on analysis of occupancy of the centres over the last three years which has indicated that the centres have consistently, and increasingly not been used to full capacity (73% occupancy at Q1 of 07-08 and 66% occupancy at Q4 of 09-10). The following provides more detailed analysis on the use of the centres.

4.1Who attends?

4.1.1Age Distribution

As at May 2010, there were a total of 153 service users on the registers of the four IDCCs combined. The average age of those attending the IDCCs was 83, with one client under the age of 70 across all centres, and the eldest client being 101.

4.1.2Fair Access to Care Services (FACS) Banding

As at November 2009, the majority of users (71%) were in the ‘substantial’ banding, with 9% of users banded as moderate – a larger than expected proportion (as the level of service provided at the centres is high or ‘intense’ the expectation would be that those of moderate banding or lower would not be in need of this type of service).

4.1.3Duration of service use

As at March 2010, the majority of users had been attending for between 1 and 5 years (with the exception of Tangley Hall which has a higher proportion of ‘newer’ service users).

Ham, Tangley and Sheen have very low proportions of service users who have been attending for over 5 years, with Twickenham being the exception.

4.2Buildings and capacity

The four buildings currently in use as IDCCs are located around the borough and vary in terms of capacity, facilities and ownership. The following provides an overview:

Ham / Tangley Hall / Sheen Lane / Twickenham
Opening Hours of IDCC / 9am to 5pm
5 days a week excluding bank holidays / 9am to 5pm
7 day a week including all bank holidays / 9am to 5pm
5 days a week excluding bank holidays / 9am to 5pm
5 days a week excluding bank holidays
Current IDCC capacity / 20 / 15 / 30 / 30
Maximum capacity of building for intensive day care users (potential) / 50 / 16 / 50 / 40
Room configuration /
  • 2 offices
  • 3 breakout rooms
  • 1 large activity/dining room
/
  • 1 office
  • 2nd office / meeting room/quiet room
  • 1 large room divided into two areas: dining area and lounge area
/
  • 2 offices
  • 1 large activity room
  • 1 ADL Kitchen
  • 1 therapy room / Activity room
  • 1 hairdresser’s room
  • 1 main hall used for activity/dining
/
  • 2 offices
  • 2 breakout rooms for clients use
  • I hairdresser’s room
  • 1 large room for dining/activities
  • 1 ADL / Therapy room.

Toilet and kitchen facilities /
  • 2 toilets
  • 3 toilets that are assessable to disabled clients
  • 1 toilets with bathing / changing facilities
  • I large kitchen
/
  • 2 toilets in addition to
  • 1 other room with another toilet and shower/
  • changing facilities. Also for hair washing/ /chiropody and therapies
  • 1 domestic
  • sized kitchen
/
  • 2 toilets
  • 1 toilet with showering / changing facilities
  • 1 large kitchen
/
  • 3 toilets
  • 1 toilet with bathing/showering room
  • 1 medium size kitchen

No. floors / 1 / 1 / 1 / 2
Outside space / Plenty of open space / Compact garden area including seating and water feature. / 1 small garden / Open space shared with the nursery.

1

Briefing for Members – Intensive Day Care Centres Reconfiguration Proposal, Budget Review 2010

4.3 Occupancy levels

The following displays information on booked places, new clients, clients on register and available places over the last three full years of attendances diagrammatically alongside associated information in order to understand the pattern of service usage over the last three years.

4.3.1Actual Attendances

The overall trend in attendances is downwards. However whilst the centre at Sheen has seen a significant decrease (from a high of 2154 in Q2 of 2007-08 to a low in the final quarter of 2009-10 of 1357) the other three centres have not seen such a dramatic reduction.

4.3.2Booked places

Actual attendances and booked places will always vary due to sickness, hospitalisation etc.

Booked places at Sheen and Ham have both seen a downward trend, although this is more marked at Sheen. Booked places at Tangley have remained constant, with places at Twickenham seeing some ups and downs, but remaining fairly constant.

4.3.3New Clients

The number of new clients has seen an overall slight downward trend but has varied significantly over the course of the three year period. This could be indicative of the small numbers involved (i.e. maximum of 16 new clients in any one period at any one centre).

4.3.4 Clients on Register

The total number of clients registered has seen an overall reduction, with the most significant drop again being at Sheen. Twickenham has seen an overall slight increase.

4.3.5Usage of Centre

Finally, the usage of the centre (actual attendances expressed as a proportion of the places available) indicates that over the three years, Tangley has almost consistently held occupancy at over 80% of availability. The other three centres have been much less consistent, with Ham in particular seeing a large drop since Q1 of 2008, to an occupancy level at end of 2009-10 of 53%.

It is recognised that 100% occupancy would be difficult to achieve due to hospitalisation and sickness. Anecdotally, Tangley’s consistent high levels of occupancy are due to overbooking.

4.4 Charging

4.4.1 Cost per service unit

The unit cost for the services is currently £78 per day (including transport). LBRuT currently subsidises the unit cost by 26% for clients attending the centres, charging a maximum of £58 per day (including £10 for transport).

4.5 Transport

As at March 2010, 91% of service users were using the Local Authority’s transport service to get to and from the day centres for all attendances (4% used the service for one part of the journey/a proportion of their attendances).

Only 6% of users (or 9 individuals) did not use the transport service at all.

The transport service drops users off at the centres at c.10am, and collects again at c.3pm. This is due to the need to ‘route’ the services so as to pick up the maximum number of service users. This in turn means that some service users are currently experiencing long journey times to and from the centre.

4.6 Demography

Local demographic analysis indicates that:

  • Whilst the older people’s population is going to increase in the borough over the next five years, there is not an associated expected increase in the older population (i.e. 75+)
  • Certain areas of the borough (e.g. Hampton, Heathfield) have larger proportions of those aged 65 and over, which is likely to increase further.
  • Whilst the long term direction of travel nationally is towards increases in the number of older people with dementia, locally in the next five years this is expected to be limited to an increase in the younger older population (65-74), which in turn is due to an overall increase in that population, rather than an increase in dementia prevalence specifically

4.7 Summary based on analysis

The majority of the information explored above has been limited to the last three years (2007-2010) which has illustrated that consistently, and increasingly the centres are not being used to full capacity:

Period / Q1 07-08 / Q2 07-08 / Q3 07-08 / Q4 07-08 / Q1 08-09 / Q2 08-09 / Q3 08-09 / Q4 08-09 / Q1 09-10 / Q2 09-10 / Q3 09-10 / Q4 09-10
Avg usage across four centres / 73% / 74% / 77% / 77% / 82% / 80% / 76% / 70% / 73% / 74% / 74% / 66%

This could be, and will be, due to a variety of factors, including self directed support, service user choice and cost of the service.

Whilst usage of the service:

  • Has consistently been below 80% over the last three years (with the exception of the first two quarters 2008/09),
  • At Ham and Twickenham at the end of Q4 of 2009-10 was 53% and 62% occupancy respectively

The centres continue to be configured and staffed to support full occupancy/usage.

This is not a sustainable position, particularly in the current financial climate.

In addition, the high staffing and low occupancy creates high unit costs for service users which could be argued has thus further reduced usage of the centres.

5. Basis for Proposal

5.1 Centres for the physically frail

5.1.1 Reconfiguration of both centres to a single centre at Sheen Lane

It is proposed that the only viable option for the two centres for the physically frail is to reconfigure the two existing IDCCs (Twickenham and Sheen) into one centre at Sheen.

The choice of Sheen is due to:

  • The building is fit for purpose with all accommodation located on a single floor with a range of facilities suited to those with physical frailty
  • The building has a maximum capacity for 50 service users. The current total places available at both Sheen and Twickenham combined is 60 per day. Both services are currently under-utilised, with usage in the fourth quarter of 2009/10 averaging 39 attendances per day across the two centres.
  • The capacity of the building at Sheen would therefore be sufficient for the current level of attendances, with spare capacity of 11 places per day. The maximum capacity of the building at Twickenham is only 40 per day.
  • The Sheen Lane Centre is co-located with two Integrated Health and Social Care Teams (covering Richmond, Ham and Kew, and East Sheen and Barnes) and has garden space (Twickenham has minimal outside space).

The total potential for savings (staffing and building costs) through reconfiguration of Sheen Lane and Twickenham to Sheen Lane is £177,642

As a proportion of the total current budget for the two services (£864,100), this represents a saving of 21%

5.2 Centres for those with dementia

5.2.1 Reconfiguration of both centres to a single centre at Ham

It is proposed that the only viable option for the two centres for those with dementia is to reconfigure both existing centres onto a single site at Ham.

Of the two existing centres, the building at Ham is suitable, as opposed to Tangley Hall for the following reasons:

  • The building is fit for purpose for use by those with dementia
  • There is space both inside and outside to increase capacity beyond the current 35 places (to 50) if demand increases for dementia services in the future. Tangley does not offer this option as its maximum capacity is 16 (which is already currently nearly fully utilised). Level of attendances at Q4 2009-10 was 22 per day across the two centres.
  • The joint working with the OP CMHT outreach team could continue at this site.

The total potential for savings (staffing and building costs) through reconfiguration of Tangley Hall and Ham to Ham is £136,500

As a proportion of the total current budget for the two services (£812,800), this represents a saving of 17%

5.3 Transport

The provision of transport to the remaining centres is being considered, with the aim of minimising changes to individual transport arrangements (including pick up and journey times) within the existing budget.

6. Conclusions and approach

The two proposed remaining centres have the facilities, physical space and will be staffed to ensure that all service users currently attending an Intensive Day Care Centre can continue to do so.