A Feasibility Report for The

Appendix 2

Berkhamsted & Tring

Day Services

A Feasibility Report for the

Re-provision of the day services at Manor Street and Victoria Hall

Introduction

In June 2006 the countywide review of day services for older people was refocused on three areas that were identified as needing a more detailed review. One of these areas wasBerkhamstedand Tring. As well as providing a service at the Manor Streetsite in Berkhamsted, the in-house (HCC Adult Care Services) staff team also run a satellite service at Victoria Hall in Tring. Thus this service serves the west Dacorum area.

This feasibility reportdetails the options appraised for re-providing the day services that are currently run at Berkhamsted and Tring. The day serviceprovides a service for older people with varying degrees of physical needs as well as a dementia service. In addition, there are a couple of younger people with physical disabilities who need to be considered.

In this feasibility report relevant information about the needs of service users and options for reprovision have been gathered. These have been analysed and the costs of each option have been appraised.

NB. With regards to terminology, any references to Berkhamsted & Tring Day Service encompasses the whole service, i.e. both sites in Berkhamsted and Tring, while references to Manor Street and/or Victoria Hall refer to the individual services provided at those sites specifically.

Background

Berkhamsted & TringDay Service is an in-house (HCC Adult Care Services) provided service consisting of two day centres –Manor Street and Victoria Hall. Manor Street can accommodate 20 to 25 places per day Mon-Fri, while Victoria Hall in Tring is only provided 3 days a week and has a capacity of 14 places per day. Recently,the service has been organised so that all service users with dementia attend the Berkhamsted site along with those people living in the Berkhamsted area with physical disabilities, while those in the Tring area who typically have lower physical needs attend Victoria Hall.

The day service runs with 15 members of staff (including non-care staff), which equates to 9.75 whole time equivalentsand consideration must be given to probable TUPE issues if a new service is provided by another organisation as an alternative to Berkhamsted & Tring Day Service. While a room at Victoria Hall is booked for the day service 3 days a week, it is not always possible to run the service on all these days due to staffing levels and service user attendance – at least 2 members of staff are required to run Victoria Hall at current attendance and level of need of the service users.

The service at Manor Streetis located in a temporary building (portacabin) that is unsuitable and temporary planning permission has expired. A strategic decision has been taken not to reapply for planning permission as no permanent solution for the service has been found and HCC is still reviewing options for the site.

Needs analysis

Berkhamsted & Tring Day Service currently has 72 people on the books and operates a Mon-Fri service (Tues, Thurs, Fri at Tring). There is currently no waiting list. The full needs analysis matrix with details of each service user can be viewed in Appendix 1.

Service users can be categorised as follows:

33 older people with dementia (who are allocated an average of 13 places per day)

13 older people with high needs physical disability (who are allocated an average of 4 places per day)

24 older people with lower needs physical disability (who are allocated an average of 8 places per day)

2 younger adults with a physical disability (who are allocated 3 places per week)

The numbers of service users and booked places can be illustrated in the following table:

Total nos.

Monday

Tuesday

Wednesday

Thursday

Friday

Average per day

Dementia

High PD

Low PD

Young PD

Total

On average, 25 places are booked per day (incl. Tring). Over the last year average attendance at the day service has been 71% (down 9% on the previous year).Eligibility Criteria (Fair Access to Care), Charging Policy, Smoking Policy and Direct Payments are all relevant factors impacting on referrals and attendance. The service also experiences rapid turnover due to users ceasing the service, frequent new referrals, and alterations and additions to days attended. 10 of the service users also receive rolling respite care (every 6 weeks), which affects attendance levels. The manager of Berkhamsted & Tring Day Service liaises with the ACS Service Solutions Team on a daily basis.

Of the 72 service users, 24 live in Tring and12of these travel to Berkhamsted (9 dementia, 1 high PD, 2 low PD), 11 do this on HCC transport.

It should be noted that this analysis of the needs of service users has been done in conjunction with the in-house team that provides the service at Berkhamsted & Tring Day Service. This will suffice for the purposes of making an overall recommendation about the reprovision of the service. However a re-assessment/review of need must be carried out for each service user by the local ACS care management team before a decision is taken about moving individuals to a specific new service.

Service users attend Berkhamsted & Tring in the following ways:

1 day a week

2 days a week

3 days a week

4 days a week

5 days a week

Total service users

Dementia users (B)

High needs (B)

Low needs (B)

Young PD

Dementia users (T)

High needs (T)

Low needs (T)

B = service users living in Berkhamsted

T = service users living in Tring

Thus, dementia service users living in Berkhamsted are the only people who attend a service more than 3 days a week and almost half of service users (34) only attend once a week.

Appendix 2

Options Appraisal

As part of the feasibility study, 4 options for reprovision were identified and analysed:

SUMMARY OF OPTIONS

a). Maintain Berkhamsted & Tring Day Service at current levels and reprovide as a single service within Berkhamsted.

b). Reprovide Manor Street only in Berkhamsted whilst maintaining Victoria Hall ‘as is’.

Move all people who currently attend Berkhamsted & Tring Day Service to services in Hemel Hempstead.

Service users attending Manor Street who live in Berkhamsted move to services in Hemel Hempstead. A service is provided in Tring to meet the needs of service users living there.

Berkhamsted & Tring Day Service to be reprovided via a mixture of services in Hemel Hempstead, Berkhamsted and Tring.

The option to ‘do nothing’ was also considered and rejected as the existing temporary building is not sustainable long term.

OPTIONS 1(a) and (b) – Maintain Berkhamsted & TringDay Service at current levels and reprovide within Berkhamsted, either as a single service or whilst maintaining Victoria Hall ‘as is’

DETAIL

Secure a new site / building in Berkhamsted through Hertfordshire Property, DacorumBC or the PCT.

COMMENT / RISK

Initial market testing by Hertfordshire Property has shown some interest from developers in rebuilding on the Manor Street site with a day centre incorporated into any plans. This option could present a long-term solution but would not meet short-term need or efficiency objectives. The business case for an expensive new build is weak given the falling numbers of people using the day service (trend over seven years) and expected developments in social care e.g. Individualised Budgets.

Indications from PRRG show there are no current options in Berkhamsted.

Discussions with DacorumBC have also failed to identify a suitable site in Berkhamsted. DacorumBC have confirmed that Lagley House (new extra care scheme) in Berkhamsted cannot be used for day care.

A meeting with Debbie Pyne from West Herts PCT regarding Gossoms End showed the site to be suitable but the presence of a GP surgery in part of the building would make access problematic. It was also revealed that Gossoms End forms part of the PCT’s acute services review so long-term use of the building by HCC would not be possible. The PCT have failed to provide information on the cost to HCC of renting the space or on the terms of the lease to the GP.

ACS purchases beds at 2 residential care homes in Berkhamsted – Ashlyns and Dunsland House – however, neither is registered to provide day care and on enquiry neither is interested in providing day care.

Enquiries have been made into the possible use of BerkhamstedTown Hall, which is owned by Berkhamsted Town Council. They do not have a suitable room available or the capacity within their current bookings to accommodate a day service.

OPTION 2 – Move all people who currently attend Berkhamsted & TringDay Service to services in Hemel Hempstead

DETAIL

Fill vacancies at Highview Lodge for dementia service users and make further use of Half Moon Yard and Age Concern day services in Hemel for high and low PD service users. Younger adults with physical disabilities move to vacancies at Greenhills Day Service.

COMMENT

The current needs analysis (see matrix 1 below) shows that an additional 13 places per day would be required for dementia service users; an additional 4 places per day for high PD service users; and an additional 8 places per day for low PD service users. NB. The needs analysis assumes that all service users will maintain their current numbers of days.

The recent review of the Highview Lodge contract has reinstated the original block levels of 25 places per day (capacity to increase to 30) with 15 places available at weekends, as of 1/8/07. The most recent contract monitoring information shows that on average just under 22 places are booked per weekday and 10 places are booked per day at weekends. Uptake of booked places is at 79%. Therefore, taking into account actual attendance at Highview and the option to attend Highview at the weekend, dementia service users currently at Manor Street could be allocated a place at Highview as per their agreed number of days. This cost would be met within the existing block contract.Consideration would need to be given to the most appropriate use of available space at Highview in order to cater for those most in need of this specialist service.

Half Moon Yard is run by Hemel Hempstead Day Centre, a voluntary organisation that HCC provides funding to. The service runs Mon-Fri and caters for older people with low and high physical needs. They have a capacity of 35 places per day, of which HCC fund 16 places per day. There have been positive discussions with Hemel Hempstead Day Centre, who would be keen to expand the service to meet the needs of ACS service users coming from Manor Street. The Alzheimers Society also use Half Moon Yard to run a Saturday Club for people with dementia.

Age Concern Dacorum currently run 8 day care clubs in Hemel Hempstead and 1 in Bovingdon, which between them provide a Mon-Fri service. They can cater for low to medium physical needs but are not staffed to deal with any personal care needs. The most recent information received through contract monitoring suggests that across these 9 services there is the capacity to provide 8 additional places per day for low PD service users.

The 2 younger adults with physical disabilities who currently attend Manor Street over 2 days, could have their ongoing needs met at Greenhills Day Service. Both live in Hemel Hempstead.

The needs analysis determines that all service users could be provided with a service in Hemel Hempstead through existing provision.

RISK

There are 12 service users currently attending Manor Street who live in Tring and the distance they would have to travel to reach services in Hemel Hempstead would contravene good practice, which states that service users should not travel for longer than 45 minutes to get to a day service.

Matrix 1 – how existing service users could be reprovided with a service in Hemel Hempstead

Monday

Tuesday

Wednesday

Thursday

Friday

Average per day

Highview (Dementia)

Half Moon Yard (High PD)

Age Concern (Low PD)

Greenhills (Young PD)

NB. This table shows how all service users attending Manor Street could be allocated a place in an appropriate service in Hemel Hempstead whilst still maintaining their current number of days and being able to attend when they attend at the moment. The figures correspond with thosepresented in the table on page 4.

OPTION 3 – Service users who live in Berkhamsted move to services in Hemel Hempstead. Service users who live in Tring attend a service in Tring.

DETAIL

Victoria Hall to be maintained for service users living in Tring or an alternative site to be provided if Victoria Hall is deemed unsuitable for higher needs service users (service user need would be clear post-assessment/review and option of direct payment).

COMMENT

Manor Street currently provides a satellite service for service users with lower needs in Tring 2-3 days a week at Victoria Hall, which is owned by DacorumBC. The room hired can take up to 14 service users and is situated next to a kitchen, which is used by meals on wheels as well as the day service, and 2 disabled toilets. Currently only 13 service users attend the Tring service in total, attending on a Tuesday, Thursday and Friday. Whilst the service is mainly for people with lower needs, at least 2 of the current service users have high physical needs and/or dementia and a third has mild dementia. Consideration should be given as to how this service can be maximised. There is capacity to increase the number of days should that be required for care practice / operational reasons.

Use of a currently empty HCC-owned building(Temperance Hall) has been considered. The building has not been used for many years and is in a state of disrepair. The roof has been condemned. Access to the building is directly from the road but it sits on an unused part of a school’s playing fields. Tring Town Council are in discussions with HCC about taking on a lease and refurbishment costs in the region of £80,000 in order to use the building for a youth club. It is our view that refurbishment costs to make the building DDA compliant (in addition to the replacement roof) would be significantly higher.

There are a number of other sites such as 8 sheltered housing schemes and halls owned by Tring Town Council that could be pursued for possible ACS use, should this be necessary. We have previously provided a day service from Pond Close.

There is one private residential care home in Tring (St. Joseph’s) but it is not registered for day care and does not wish to take non-residents.

Initial discussions about joint working on day service provision were raised with Buckinghamshire County Council, due to Tring’s proximity to the county border. However, Bucks CC are currently carrying out their own review of older people’s day services and have not been able to present any options for us to pursue further.

Matrix 2 (below) shows that current service users who live in Berkhamsted would require the following provision: 10 places per day for dementia; 3 places per day for higher physical needs; and 4 places per day for low needs.

As detailed in option 2 (above) there is capacity in existing services in Hemel Hempstead to provide for service users moving from Manor Street.

Matrix 2 also shows that service users living in Tring would require the following provision: 3 places per day for dementia; 1.5 places per day for high PD; and 3 places per day for low PD. These needs could be met in a number of different ways:

1.One service to cater for all needs – a small day service to provide 8 places per day over 5 days or 9.5 places per day over 4 days or 13 places over 3 days. This may or may not be provided at Victoria Hall, at least in the short term until a long term solution for Tring is agreed. NB. No service users living in Tring currently attend a service more than 3 days a week. It is likely that this service would need to be provided in-house or through a block provider (Quantum Care or Runwood) due to the dementia expertise required. However, there are no QC or Runwood care homes in Tring so this would be difficult to arrange.Continuing the in-house (ACS) provision in Tring is a strong option given the level of expertise and continuity of service.

2.Secure a single site (e.g. Victoria Hall) that could be used to provide different services by different providers on different days i.e. on 1 or 2 days in-house or QC / Runwood to provide dementia service; on 1 day provide high PD service; on 1 day Age Concern to set up 10-3 club.