Agenda item

Purpose:

The report presents options for the development of a new residential home to replace the current services provided at Severn View Residential Home in Chepstow. This development is a unique opportunity for Monmouthshire to lead within the county and nationally on a new model of residential care based on bespoke building design and a bespoke staffing model that supports the highest possible quality of life for people needing 24 hour care who are living with dementia. The report presents, for consideration, the reasons that underpin the need for this development, the options available but specifically seeks feedback prior to the commencement of the next phase of the project.

Key Issues:

1.         The current home at Severn View in Chepstow was built c1979 and although the layout is good, it has a number of significant weaknesses:

      i.        Bedrooms are not en-suite. This is becoming increasingly unviable and there is the potential to be given a non-compliance order from Care and Social Services Inspectorate in Wales (CSSIW) in due course.

     ii.        The layout is one of long corridors which is seen as poor practice in care home design; particularly in respect of people living with dementia due to difficulties in orientation and feelings of restriction.

    iii.        The home is on two floors, and this prevents ease of access to outdoor spaces.

   iv.        Respite Services for people with dementia are supported on the same wings as those occupied by our long-term residents. Best practice would be to separate out the respite for people with dementia to avoid disruption to our long-term residents. Residential respite for people with dementia is significantly over subscribed.

2.         In-house provision has a role to support the market. Demand and availability of long and short terms beds for older frail people [not living with dementia] suggests that this should not form part of future plans for the new build. Before a decision is made in this respect, further detailed discussion is required.

3.         There are elements of fragility in the market with two independent sector provider homes closing in the last two years. Demand is set to increase and a balanced, resilient and stable cross sector provision is required to meet the demands of the future

4.         The development of the home sits within a complex picture demographically. In summary:

      i.        There are 19,863 people over 65 years old in Monmouthshire, approximately 22% of the population, this part of our community is projected to grow by 56.9% to 31,157 between 2012 and 2033. In the South of the County 18% (7,138) of the population is 65+ according to the 2011 census. This shows a 30% increase in people who are 65+ between the 2001 and 2011 census (5484 to 7138).

     ii.        According to research conducted for Dementia UK in 2013 (Alzheimer’s Society 2014) 95% of people with dementia in the UK are 65+.

    iii.        The over 85 age group is expected to increase in Monmouthshire by 153% from 2,714 in 2012 to 6,863 in 2033. Between 2001 and 2011, this age group increased by 61%, from 547 to 882, in the south of the county.

   iv.        People are living longer with increased life expectancy as evidenced by the 57% increase in people over 90 in the South of the County between the 2001 and 2011 census (188 to 295).

    v.        The current trends that there is an increase in older people moving to Monmouthshire.

   vi.        Increase in demand and expectation for health and social care services.

  vii.        Increase in people who are 65+ with conditions such as circulatory diseases, respiratory diseases and dementia (or long term health conditions as this is the census measure). The data from the census shows a 42% increase (2858 to 4053) in people with LTH problem or disability who are 65+ between 2001 and 2011.

 viii.        14.4% of older people in Monmouthshire live alone, in the south of the county this figure is 27.9%. In the south of the county 25% of households are single occupancy, of which 50% are single occupancy households who are 65+.

   ix.        The number of Monmouthshire people aged 65 and over predicted to have dementia is expected to increase by 82% from 1377 in 2012, to 2,506 in 2030.

5.         Social care services are developing to keep pace with increasing demand and      complexity.  Much of the detail around the development of adult social care      services is available elsewhere and so is not repeated here but in summary:

      i.        Demand for residential placements has been maintained due to the development and associated training that supports people to continue to live at home for as long as possible. It is anticipated though that demand will increase over time in response to the demographic challenges outlined above.

     ii.        The independent market in the provision of residential placements is fragile and a number of providers have given notice in recent years due to the unsustainability of the service. Council provided services are seen as integral to a balanced and stable market.

Member Scrutiny

 Following a report from the Integrated Service Manager (Abergavenny) and Direct Care Service Lead (Countywide), Select Committee Members asked questions.

The Cabinet Member for Social Care, Safeguarding and Health supported the presentation stating that this was an opportunity for the Council to lead following on from the successful Raglan and Monmouthshire models in providing bespoke design and staffing models that will suit the needs of the residents, especially those who have dementia.  She welcomed the design feature of individual homes to overcome the institutional feel and provide a more communal approach to care.

The Chair asked why the report was before the Select Committee believing that it should have been the subject of a members’ seminar as it is a long term investment.  It was noted that the report had been supplementary to the wider Crick Rd development and, due to oversight, had only just been separated. It was agreed that there should have been a members’ seminar and apologies were accepted.

A Member asked if the commercial and affordable housing planned for this mixed development site will be affected by the proposal and what proportion of the site for each.  The Member added that the existing Severn View site will be surplus to requirements so both elements should be considered together in planning terms.   The member questioned if the estimate of £700,000 for the existing Severn View site as a capital asset was low.

In response, it was explained that the proposal won’t affect the number of houses.  The Estates Team will be able to provide further details.   It was explained that the number of houses in the wider proposals is fixed on the new build residential home being part of the site.  The wider site is owned by the Council but a small parcel of land behind Mitel is under private ownership for which an agreement is under negotiation.  The new build will occupy 2.3 acres and buying the additional land will meet or exceed the proposed 285 houses. 

A Member requested information on the percentage, in 20 years’ time, of older persons forecast to be suffering from dementia and from other different needs.  It was agreed to circulate this information. 

A Member questioned why the south of the County was chosen to provide such a facility, how the outreach service will work and if it will be available to all Monmouthshire.  It was replied that the design is community focussed so outreach will be available to the immediate locale.  It was agreed that there is inconsistency between provision in the north/south of the County and equity is an issue. The Member responded that it was very concerning that there will be good provision in the south of the County, and the north will be neglected.

It was confirmed that the Home will continue to offer short respite for the Abergavenny area (noting some individuals currently travel to Chepstow for this service).  The importance of working flexibly alongside independent providers to develop equity was emphasised. 

It was asked if it is proposed to have a strategy in the longer term to provide services similar to the Raglan Project and also if the Council should be looking at delivering homes in other parts on Monmouthshire.  It was suggested that a detailed business plan for residential provision across the county should be commissioned.  The need to identify funding to deliver such a strategy was stressed.

A Member referred to the clear statutory responsibilities for scrutiny and the consequent need to be fully informed.  It was commented that the report option appraisal doesn’t provide options, instead directs Members to just one option, stating that Councillors should be making the decision not officers.

The Cabinet Member commented that the proposal is for a replacement plan not a new scheme and added that if extra homes are considered, all options can be reviewed.

A Member felt it was ambitious to plan for twenty five residents living independently as progressively it is likely they will become less able. He queried the shortfall (6.5.4), the plan to build the ground floor and the viability of exploring partnership with Aneurin Bevan University Health Board (ABUHB) to develop the first floor.  He commented that the Health Board is due to consult on a proposal to close St. Pierre Ward (dementia care) at Chepstow Hospital and questioned if it might be better to utilise St. Pierre Ward at Chepstow Hospital instead of building a new facility.

It was clarified that the reference to independent living is to maximise what residents are able to do encouraging as much participation as possible.  In terms of partnership with ABUHB, positive collaborative steps have been taken and monthly meetings are held with Senior Managers.  These proposals have been discussed broadly with them, and interest has been expressed in partnership on the new site.  It was also explained that there will be opportunities related to Clinical Futures and the opening of the Specialist Critical Care Centre.  There have also been discussions with the Neighbourhood Network Lead (South) who is interested in urgent social care beds in that area.  The Member questioned how the Health Board will manage elder and dementia care in the north of the county in the future. 

A Member recalled that a planning application was submitted previously for a private residential care home in Llanfoist that did not progress but remains live.  It was commented that a planning application was approved recently on the McDonalds site for a large complex, and there are facilities in Lavender Court (run by Melin) and Mardy Park in Abergavenny. 

In response to how the proposal will proceed, it was confirmed that another detailed report will return to this Committee after March 2018, will go to Cabinet then Council.

The Chair agreed that there is a need for a long term strategy to deliver cohesive specialist care in the County, and also a need to identify who the partners will be.

A Member was in favour of the proposal, also supporting the continuation of St. Pierre Ward in Chepstow Hospital and suggested that there are experts in Swansea and Bangor who could be engaged in the consultation to ensure that the design is right.

The need to ensure that the design is right for residents with quiet spaces for visiting relatives was emphasised.

In response it was explained that the Council is mindful of the need to manage demand and expectations in the future.  The Chair’s point that proposals need to sit within a wider strategy, working with partners and third sector was accepted. It was explained that the level of dependency that can be supported in the community is much higher than before.  It was queried if future models are going to be looked at as part of the design stage with a view to expansion in the future.  The Cabinet Member explained that this is just one strand of provision, balanced with the Monmouthshire Project working alongside supporting people in their own homes to live as independently as possible for as long as possible.

A Member recognised that the proposal represented one strand but noted that it will involve a significant amount of taxpayers’ money from all of Monmouthshire so it will be important to see how it fits in the wider strategy.  It was agreed that Select Committee Members would be sent the location of the parcel of land concerned.