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Meeting of the Community Overview and Scrutiny Committee held on 19/06/2006
Developing Community Based Services for Older People



APPENDIX D
Waverley Borough Council

COMMUNITY OVERVIEW AND SCRUTINY COMMITTEE
– 19th june 2006
_________________________________________________________________________
Title:
DEVELOPING COMMUNITY BASED SERVICES FOR OLDER PEOPLE
[Wards Affected : All]

Summary and purpose:

At its last meeting, members of the Community Overview and Scrutiny Committee suggested that there would be merit in having a discussion about the Council’s approach to supporting community-based services for older people. This report provides some background information about demographic change, the varying needs and aspirations of older people, and duties of various statutory bodies in this regard, as well as considering the important role of the voluntary sector.

The intention is that this paper will help the Council to determine its approach to supporting community-based services for older people across Waverley.

_________________________________________________________________________
Environmental implications:

There are no environmental implications arising from this report.

Social / community implications:

There is a growing population of people over retirement age, many of whom are living better and healthier lives with greater aspirations and expectation than ever before. One of the challenges for service providers is to determine how the needs of the active elderly can be met, whilst taking account of the needs of very frail, elderly people who need high levels of care and support to help them retain their independence and dignity. Experience suggests that these two groups of clients do not integrate well in one building.

E-Government implications:

There are none arising from this report.

Resource and legal implications:

It will only be possible to consider resource implications in detail when the Council has given a view on the approach that it wants to adopt in relation to providing community based services for older people.
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Context

1. There have been numerous reports in recent years about the changing demographics of Britain, particularly in relation to its ageing population. In the next 25 years there will be 5.6 million more people aged over 65 in the UK, due to the decline in the mortality of older people and because of the post war baby-boom. 2. Waverley has the highest population of those aged 80 and over in the County of Surrey, with some 1,352 people between 80 and 84, 2,139 people between 85 and 90 and 1,093 people over 90. The 50–54 age group has seen an increase of 34.5%, and the over 90 group represents the largest age group increase since 1991 (56.1%)

3. The Table below provides a comparison of figures for 1991 and 2001 for Waverley


4. This growing group of older people will have different characteristics, and will therefore present different needs, from previous generations. 5. It is recognised that, with improvements in health screening and improved health care solutions, the new older generations are and will be living healthier lives in the future and are more likely to be better-off than previous generations (notwithstanding the current concerns about pension levels). Aspirations of the “new old” are higher than in previous years and potential customers and service users are likely to be more demanding with higher expectations.

6. However, an increasing number of older people will be living alone and will be socially isolated (7 out of 10 women and 4 in 10 men aged 85 or over live alone). Many will live a sedentary life and will not exercise enough to benefit their health (this is currently true for 40% of over fifties). Isolation and inactivity are shown to accelerate physical and psychological declines, creating a negative spiral towards premature, preventable ill health and dependency.

7. At the same time that there is a growing number of healthier, able bodied, financially secure older people, there is likely to be a growing number of increasingly older and ever frailer people who will require more services to enable them to retain their dignity and independence. These people are now living well into their 80s, 90s, and 100s.

8. The Council has already experienced some of the impact of changing expectations and aspirations of older people, and social policy and service delivery. There has been a clear decline in the numbers of older people seeking traditional sheltered housing, which seems counter-intuitive given that there are an increasing number of older people in the Borough. This has led to Council-owned and housing association sheltered housing schemes being decommissioned. This reflects the desire of many to remain in their ‘own home’ for as long as possible, the exercise of choice, and the way in which many services are now being targeted at people in their own home to enable them to retain their independence. The Council is therefore putting increased effort into such services as telecare and supporting people services.

9. It is clear from all the evidence that the growing number of older people who are living much longer than ever before presents a complex picture for policy makers and service providers, because older people are certainly no-longer a single clearly defined group as may have been the case in previous years.

The Case for Preventative Services and Activities

10. Government departments have commissioned much research and produced numerous reports on how the statutory and voluntary sector can respond to these changes with appropriate services and facilities fit-for-purpose today and into the future. However, at present in the Surrey context, such rhetoric about service provision is rarely followed with capital and revenue resources from central government.

11. Currently statutory resources are focussed on older people with the most severe needs, and priority is given to acute services providing care that prevents hospital admission or reduces delays in hospital discharge. This approach is largely based on damage limitation and the need to meet Government targets in order to avoid financial penalties.

12. It appears that the agenda for positive action to promote quality of life and provide ‘preventative services’ has (of necessity) been overtaken by the need to achieve financial balance in health and social services. Although it has been well recognised for many years that helping people to maintain their well-being by providing ‘preventative services’ delays or avoids the need for expensive acute/long-term chronic services, pressures on health and social service budgets have meant that funding for such services has been reduced or reallocated elsewhere. More recently, the Government has started to appreciate the value of true prevention and the promotion of well-being, because of the potential long-term benefits for the individual and for the future sustainability of health and social care services.

13. Preventative services aim to prevent people from moving from a relatively low need to requiring on-going health and social care services that are more costly. The preventative agenda also aims to enable independence, self-worth and good mental and physical health for as long as possible.

14. Preventative services include, for example: day centres, chiropody, bathing, opportunities to socialise and interact, meals, physical and mental activities; community participation, low-level day care, providing a safe environment to meet, handy-man and gardening services.
Background to Day Centre Provision in Waverley

15. In most counties, unitary and metropolitan districts in England, the provision of services for older people is the responsibility of the Social Services Department.

16. In Surrey, since 1948, this has not been the case and the Borough and District Councils directly manage the majority of day centres. In a few cases, voluntary groups are grant-aided by local authorities to fund day centre activity – as is the case in Waverley.

The Current Provision of Day Centres in Waverley

17. Day Centres were established to provide a stimulating, social environment for older people, providing a programme of activities and a range of services - meals, chiropody, bathing, hairdressing, advice and general support. The intention is to improve the quality of life of older people and, where possible, to provide services to support the more vulnerable people to remain active in the community and to live more independently, for as long as possible. 18. In Waverley there are five main day centres supported by the Council providing such services for older people viz:-

· Brightwells Gostrey Centre, Farnham (building owned by the Council)
· Cranleigh Day Centre (site leased from the Council)
· Farncombe Day Centre (building owned by the Council)
· Haslemere Day Centre (site leased from the Council)
· Milford and Villages Day Centre (centre owned by Trustees of MVDC)

19. The Denningberg Centre has always operated independently of the Council and has not sought revenue or capital funding from the Council for at least 15 years. The other five-day centres have been termed the “core day centres” which the Council, as a matter of policy, would wish to support on an on-going basis and all five have been admitted to the Sponsored Organisation Scheme (SOS).

20. In addition to the five core day centres there is also other provision for older people through day centres that operate on fewer than five full days each week – for example the Four Villages Day Centre and Bramley Age Concern. There are a number of lunch clubs and social activities managed by community groups and churches across the Borough.

21. The Council has provided resources to enable the five core day centres to provide for older people who are of retirement age but do not have significant support needs. However, as time has gone on, the day centres have responded to the increasing needs of their client group and assist people who are becoming ever older and physically and mentally frailer. They have achieved some additional funding from other sources for some low-level care and support services.

22. In recent years the Council has supported the development of new day centre facilities at Milford and Villages Day Centre and Haslewey. Whilst Milford and Villages Day Centre aims its services and activities primarily at older people, it offers its premises for use by other groups and holds a club for people who have suffered from Strokes, and their carers. Haslewey has adopted a more ‘community centre’ approach, with Age Concern Haslemere as its main user during weekdays.

Facing Future Challenges

23. Any new facilities for the future need to take into account changing demographics, and keep abreast of new initiatives elsewhere that successfully meet the changing needs of a growing number of older people, some of whom will be active and who need to sustain their well-being, others who will be frail and in need of support. Experience shows that the needs of these two customer groups are not easily met in one facility, and that with increased choices for older people the more active customers are unlikely to choose a facility where the focus is on ‘care’ or welfare’. The day centres are at risk of losing their original role as an inclusive preventative service.

24. There is evidence across the whole of Surrey that ‘Day Centres’ are struggling to attract new customers and need to adapt if they are to survive.

25. The closure of community hospitals across Waverley, and other changes in the organisational structure of the Primary Care Trust (PCT) and the County Council, will have an impact of the services available to older people in the community, especially those with complex needs. The day centres need to manage the possible pressure that may be placed on them to take care of people with complex needs. They will need to be clear about their own vision and direction and understand their customer base and who they can provide services for. It is recognised that very frail or confused elderly people need a high level of staff support. Most day centres in Waverley are not funded to deal with such clients and provide the requisite level of care staff. It is important that day centre committees are pro-active not reactive to these issues. Unfortunately, it is difficult to make hard decisions about who can and cannot attend day centres.

26. The PCT and the County Council have financial pressures on them and are very unlikely to provide/increase revenue funding for day centres even if they respond to the needs of the frail clients.

27. All of the day centres are now finding it challenging to manage within the revenue resources that they receive and from their fund-raising activities. It is worth noting that Waverley’s revenue grant accounts for approximately 25% of the running costs of these centres. If centres want to provide services for the very frail and elderly, there are additional revenue implications arising from the need to employ Care Assistants. In addition, it is likely that services dealing with elderly people in ‘high need’ will become subject to the ‘National Care Standards’ regime, which currently applies to residential care homes and domestic/home care services. Should these rules be applied to the day centres, there could be significant capital and revenue implications in order to meet the required standards.

28. In order to run the day centres professionally, all five core day centres have their own managers and three have deputy managers. However, in order to provide the range of services/activities provided and to undertake fund-raising activities, each of these day centres rely heavily on dedicated volunteers. Like all service providers, day centres are required to operate on a professional basis in the light of Health and Safety legislation, food hygiene, and so forth, and not least because of the evermore-litigious society in which we operate.

29. Like most voluntary organisations, all the day centres have concerns about the difficulty of recruiting and maintaining volunteers. Often, due to the increasing age of current volunteers and because of the greater demands placed upon the remaining volunteers, they are leaving and not being replaced. Lack of volunteers is a problem that is likely to grow rather than diminish in the future, and impacts upon the services a day centre can provide.

Looking to the Future

30. In coming years the Council needs to revisit the needs of the day centres at Brightwells Gostrey Centre in Farnham, which is affected by the East Street regeneration proposals. The redevelopment of the Rowland House site in Cranleigh will have implications for the Cranleigh Day Centre. Farncombe Day Centre is now some twenty years old and needs investment in its fabric.

31. Any decisions about these centres need to take account of:

a. local needs;
b. the aspirations of the day centre committee concerned;
c. the Council’s priorities;
d. the target client group;
e. requirements of partner organisations who are contributing to the service provision;
f. capital requirement;
g. revenue funding;
h. health and safety and other legislative requirements;
i. policy initiatives;
j. best practice; and
k. potential market for the services to be provided.

32. Over the years the Council has taken the view that it is aiming its resources to support day centre services at those who require an inclusive environment to socialise, participate in activities and be able to have a nourishing meal. The Council has not intended its resources to be directed at those who are the responsibility of other authorities.

33. There are a variety of ways in which the Council could address the needs of older people. There is a spectrum of services that the Council could offer to older people, depending on its philosophy and the resources available for such services, for example:-

34. The Virtual Day Centre

Most older people are looking for activities and opportunities to socialise to help retain mental faculties, physical ability, and social contact. Many of the activities that can be found in traditional day centres are also found at other venues. It would be possible to develop a ‘virtual day centre’ by employing staff to promote programmes of social, creative and physical activities at – say – leisure centres, museums, libraries, village/church halls, art centres, sheltered housing schemes, sports clubs, community centres etc.

The advantages of this approach (rather like that of the U3A) is that there would not need to be capital investment in premises nor the ongoing management and maintenance of buildings. The client group is likely to be wider than that of the traditional day centre user. However, day care for very frail older people would not figure as part of this option – but day cares are really a social services responsibility in any event.

35. Community Centre Approach

Another option would be to develop a centre with capacity to deliver more than traditional day centre services. This would rely on both careful investment in buildings – in order to attract other user groups and also in the management of the centre, so that it is offering services and activities that are of interest to a wider group of people.

The advantages of this approach is that community centres have a wider appeal and can better attract revenue and capital grants, as well as raising funds through hiring out of rooms. Depending on location, some community centres can attract considerable revenue through café facilities or retail outlets. The disadvantage of this approach can be the conflicting interests and priorities of different user groups.

36. Traditional Day Centre

The traditional day centre tends now to provide for a relatively small number of frail elderly people. Such centres are not attractive to ‘younger older’ people, who look elsewhere for social and recreational activities. Arguably, traditional day centres are the responsibility of social services departments.

The advantage of the traditional day centre is that it is clear whom such facilities serve and can provide a safe and secure environment for frail elderly people. The disadvantages are that they serve a relatively small number of people, they tend not to attract other able bodied older people, and find it increasingly difficult to operate within available revenue resources.

37. Members are invited to consider, in light of the above, which approach should be adopted by the Council when determining how best to invest in community-based activities for older people into the future.

38. Depending on the approach adopted, this could have significant implications particularly for the Brightwells Gostrey Centre, Cranleigh Day Centre and Farncombe Day Centre over the next five years.

Officer Comment

39. It is clear that the provision of Day Centre facilities for the elderly is not a duty or responsibility of the borough council, however Borough and District Councils agreed with Surrey County Council many years ago that they would provide day centres and meals-on-wheels services, in lieu of the County Council funding Concessionary Fares for people of retirement age. More recently, legislation has made the funding of Concessionary Fares a statutory duty of Borough and District Councils. In 2006/07, the Council will be spending £600,500 on the Concessionary Fares scheme. The County has not made any commensurate contribution to the day centre or meals-on-wheels provision in the Borough. Some Surrey local authorities are now transferring some of these non-statutory obligations to Surrey County Council – Mole Valley and Reigate and Banstead have transferred the responsibility for the Meals-on-Wheels service to the County Council.

40. Assuming this Council wants to continue to support day centre activity across the Borough, it has not formulated a clear strategy for the development of community based services across the Borough. The Council has been clear about its target group of customers, that is – people who need an environment in which to make social contact (i.e. people who are in ‘low need’, requiring preventative services). The Council has also been clear that it does not wish to increase its revenue grant to day centres.

41. The challenge for all the day centres across Waverley will be to operate within the resources that are likely to be available to them, and make realistic decisions in light of this.

Resource Implications

42. Each of the five core day centres are given revenue funding under the Council’s Sponsored Organisations Scheme. Broadly speaking, in 2006/07, each of the five core day centres operating five days per week were awarded revenue grant of over £43,000 by Waverley towards day-to-day running costs.

43. The Table below illustrates the income and expenditure of each of the five core day centres. These figures are taken from the most recent annual accounts (year ending March 2005 in most cases):

43.1 Cranleigh: Total Income £ 95,307 (including WBC Grant £43,000)
Total Expenditure £104,354
Surplus/(Deficit) £ (9,047)

43.2 Farncombe: Total Income £ 78,987 (including WBC Grant £43,000)
Total Expenditure £ 68,874
Surplus/(Deficit) £ 10,113 (NB exceptionally large donation received that year)

43.3 Haslemere: Total Income £ 53,821 (including WBC Grant £42,000)
Total Expenditure £ 50,310
Surplus/(Deficit) £ 3,520 (NB The Day Centre stopped managing the catering operation hence significant drop in income and expenditure)

43.4 Brightwells: Total Income £154,305 (including WBC Grant £42,000)
Farnham Total Expenditure £167,305
Surplus/(Deficit) £ (12,729))

43.5 Milford: Total Income £188,564 (including WBC Grant £44,600)
Total Expenditure £174,363
Surplus/(Deficit) £ 14,201

44. It would be fair to say that each of the five core day centres is concerned about the level of funding provided by the Council, as this does not meet their costs. A number of day centre committees are using their reserves to augment their revenue budgets. This is not a sustainable position, even in the medium term.

45. All of the core day centers (or in the case of Haslemere, Haslewey) look to other sources of funding to supplement their income. Most common sources of additional funds are from Social Services to provide bathing services and the Primary Care Trust for monies for specific services such as therapeutic support or care assistants. It appears unlikely in the current economic climate that Primary Care Trust and/or partnership monies will be readily available in the future.

46. Other sources of funding for the day centres also include charitable trusts, donations and fund raising activities and charges for services such as hairdressing, bathing, and chiropody. Day Centre Committees consider that, with a diminishing number of volunteers, and with ever more voluntary organisations trying to raise money, it will be difficult to sustain revenue funding from non-Waverley sources.

47. Annexe 2 illustrates the funding made to day centre activity by other local authorities in Surrey. As can be seen from the Table at Annexe 2 because this Council works with the voluntary sector it is managing to get very good value for money from its investment.

48. One of the issues that has been raised before is the inconsistent approach taken by Surrey County Council to the funding of Borough/District Council supported day centers. Some local authorities receive considerable sums of revenue support from Surrey County Council to support day centre and meals-on-wheels activity, whereas other do not. This has been raised with the County Council who say that this is a legacy of the changes to the way in which services were funded when the County Council, at its last reorganization, made set budgets on historic funding levels. As a result, day centers, meal-on-wheels and the voluntary sector in Waverley receives some of the least financial support. An example of this would be where the County Council contributes £142,510 to the Voluntary Grants Panel in the Guildford area; whereas the County Council contributes £50,725 to a similar funding body for Waverley.

Conclusion

49. Waverley has a long history of supporting local community groups to develop day centres for older people. These are well regarded and used by some of the most vulnerable people in our community.

50. Tension has arisen because the Council is not statutorily required to provide these services and receives no Government funding for them – whereas the County Council, as a social services authority receives funding from central Government for this area of responsibility. Three of the centres are in need of investment in the coming years and a clear direction is needed so that any resources are best applied to meet the Council’s objectives.

51. It appears that there are now greater challenges when considering the needs of people over retirement age. First there are those who are living longer, healthier and better lives with higher aspirations and expectations than ever before. It is clear that such people will not wish to attend traditional day centres. Indeed, it could be argued that they will be able to find their own entertainment, make their own choices and use facilities that are already available in the community. Others are increasingly frail/confused/isolated older people who require much more care and support so that they can have a reasonable quality of life in the final years.

52. And yet in between these two distinct groups are older people who may have lost partners, are isolated and lonely and who need support and encouragement to be more socially and physically active in order to maintain their well-being into the future. Perhaps this group is the greatest challenge and where Waverley should be focussing its resources.

Recommendation

It is recommended that the Community Overview and Scrutiny Committee considers and notes the issues raised in this report.

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Background Papers (DoH)

There are no background papers (as defined by Section 100 D(5) of the Local Government Act 1972) relating to this report.

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CONTACT OFFICER:

Name: John Swanton Telephone: 01483 - 523375

E-mail: jswanton@waverley.gov.uk




comms/o&s2/2006-07/020

ANNEXE 1

Description of the Five Core Day Centre in Waverley

Day Centre Services at Haslewey, Weyhill, Haslemere

The new Haslewey Community Centre designed to meet the needs of Haslemere residents and surrounding areas was opened in 2003. It was intended that Haslewey would provide a 5 days per week Day Centre facility, as well as affording wider opportunities for community use. The Council leased the land and provided £400,000 matched funding to enable this development. The centre acts as a Community Centre available to all people in Haslemere, but one of its main activities is the day centre operation. The Centre comprises:-

Reception Area
Lounge
Dining Room
Catering Kitchen and Stills Room
Bathroom
2 Activities Rooms
Hair-dressing room
Medical room
Office
Toilets

Farncombe Day Centre

Farncombe Day Centre is the smallest of the day centers. It was built as part of the Bowring House sheltered housing scheme in the 1980s. Its facilities include:-

Lounge
Kitchen and servery
Dining Room
Hairdressing Room
Chiropody Room
Office
Quiet Room/Area
Toilets
Use of bathroom at Bowring House

Most recently, the snack bar area was refurbished in May 2002. The refurbishment involved demolishing the semi-circular snack bar and refitted with mobile Grundymaid food service units. These new units have improved the storage and floor space area, and are easier to clean, improving the hygiene standards for that area of food serving. The snack bar area is now considerably safer for older people as it has a non-slip floor covering, and the Grundymaid units are designed with safety in mind.

This centre will need capital investment in the coming years.

Cranleigh Day Centre

Cranleigh Day Centre is the next smallest after Farncombe. This day centre is adjacent and connected to Rowland House sheltered housing scheme. The facilities at this day centre include:-

Lounge
Kitchen and servery
Dining Room
Hairdressing Room
Office
Toilets
Use of the bathroom at Rowland House.

Cranleigh Day Centre Committee has a lease making it responsible for the repairs and maintenance of the day centre building. There are proposals in respect of the redevelopment of Rowland House that could affect the day centre.

Milford and Villages Day Centre

Milford and Villages Day Centre is a specially designed facility and opened in 1998. Facilities comprise:-

Lounge
Kitchen and servery
Dining Room
Hairdressing Room
Chiropody Room
Craft Room
Quiet Room
Office x 2
Toilets
Bathroom

Brightwells Gostrey Centre, Farnham

The Brightwells Gostrey Centre is the oldest of the day centres and operates from premises at East Street. The first floor of Brightwells Gostrey Centre is occupied by the WRVS Meals-on-Wheels service and the MoW are cooked in the Day Centre kitchen. Facilities include:-

Lounge cum Dining Area
Kitchen and servery
Second lounge and activities area
Hairdressing Room
Bathroom
Office x 2
Toilets
Laundry Room



ANNEXE 2

A Comparison of Revenue Funding for Day Centres by Local Authority in Surrey


Local Authority
Population
Number of day centres supported
Net Expenditure on Day Centres
2005/06
£
Elmbridge
121,000
6 full time d/c
2 part time d/c
1,108,170
Epsom and Ewell
70,000
4 full time d/c
607,000
Guildford
130,000
5 day centres
904,820
Mole Valley
80,000
2 day centres
236,950
Reigate and Banstead
2 day centres
Not Available
Runnymede
78,000
5 day centres
681,000
Spelthorne
6 day centres
Not Available
Surrey Heath
80,000
2 full time centres
2 part time centres
336,520
Tandridge
79,000
3 day centres
239,800
Waverley
115,000
5 day centres
278,260
Woking
89,000
4 day centres
Not Available


comms/o&s2/2006-07/020