Proposed changes to older people’s specialist housing in Westminster

Councillor Adam Hug has set out the Labour Group’s view on the proposed changes to older people’s specialist housing in Westminster;

Appropriate Care

I support the Council’s aim of increasing the amount of care provision for the elderly that is based within the City of Westminster. I similarly support efforts to increase the provision of extra-care sheltered housing, an option that provides a suitable mix of independence and care support for our elderly population who do not need round the clock care. This shift will enable Westminster to more effectively meet the needs of future service users than the current configuration of services.

Service users need to be fully involved throughout this process, shaping the outcomes of this consultation setting out what type of care they’d want to use. However their involvement must continue after this consultation so that they drive the shaping of the service both in terms of design of new buildings (e.g. what facilities would they want in communal areas?) and in terms of what the care providers should deliver as a part of their service. While ultimately the design of the new facilities should be shaped by the input of current and future service users, it is important to ensure that new extra-care sheltered sites are developed in such a way to provide suitable areas for communal activity, giving opportunities for those who wish to socialise with other residents to be able to do so and reduce the risk of isolation that exists with individual properties (even within a communal setting).

Moving residents from one care setting can have a significant impact on the physical and mental health of patients and service users. This poses the City Council with a significant challenge of sequencing, particularly given that some of the existing residential home provision will need to be reconfigured (e.g. Westmead which has been identified as a site for one of the new extra-care sheltered facilities). This is likely to prove the most challenging part of delivering the new strategy and the five year transformation period envisaged in the Proposing Independence commissioning strategy may prove too short to allow this to be done in a dignified and sensitive way for all current service users. A dignified wind-down period for our residential homes should be provided that allows current users who wish to stay in their existing premises where possible while directing new entrants to the system to fill the new places. This means that the council will need to be able to provide some of the new extra-care provision prior to closing existing residential placements.

Forced moves must be kept to a minimum, with efforts taken once decisions have been made about which facilities will remain in use to encourage new service users into facilities that will not close and to actively incentivise voluntary moves ahead of time by residents in residential homes that are scheduled for closure. Where considering which of the new facilities to move residents to, patient choice should be prioritised and due regard should be given to the wishes of service users who wish to move to the same new provision as their friends and families so we ask that the disrupting established friendship groups (and carer relationships via the appropriate use of TUPE) should be avoided wherever possible.

While reconfiguration to more appropriate facilities and new contractual arrangements will yield a financial benefit, some of the early savings must be used to help manage the transition in the most sensitive way possible rather than being used to plug holes in the council’s general budget. Both current and future service users and their family members need to be confident that this reshaping of the service has their best interests at heart  and that it will not be undermined by the desire to make short-term savings.

Appropriate providers

Given the recent well publicised care standards scandals in the care home sector, the recent statement by the Care Minister of a ‘significant lack of corporate accountability for the quality of care’ and the financial collapse of a number of providers (including most notably Southern Cross) it is essential that when choosing all partners they are able to provide the highest standards of care and (particularly where longer-term contract arrangements are made) that their financial health can be verified to be extremely robust.

We must not allow the council to be locked into accepting poor standards of care or facilities management because we cannot afford to end the relationship with a provider that provided the funding for the build of the premises.  This is clearly a risk with using a 25 year licence arrangement, though we understand that a long-term arrangement may be necessary to ensure that partners are willing to make the initial capital investment. Contracts must be constructed in such a way that Westminster is able to enforce care standards, with real penalties including the option for the replacement of a poor performing partner by another provider. Similarly when agreeing such a deal the council must look to ensure it achieves value for money across the lifecycle of the contract, learning from mistakes in certain PFI contracts from previous decades.

From initial discussions there appears to be an assumption in the Council that contracts will involve private sector providers. However there is a need to give serious consideration given to voluntary sector and not-for profit providers who may wish to bid for contracts within the new framework. From discussions with officers at a meeting with Cllr Robathan it was clear that the higher costs per service user of current Westminster Council in-house care (compared to alternative providers) was due to the unsuitability of existing premises rather than an innate failings in the service. Therefore due consideration should also be given to keeping some services delivered by in-house providers if alternative partners can deliver the capital investment for new or remodelled premises where required.

We would strongly welcome an increase in provision within Westminster but in-order for this to become a reality this will require the Corporate Property department and Planning department work constructively to meet the needs of our elderly residents.

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