The quality of the care provided by 10 residential homes and day centres whose futures have been thrown into doubt will be a factor in determining whether or not they remain open, it has emerged.
The Lancashire County Council-run facilities are the subject of a controversial review that will assess their viability after the buildings from which they operate were deemed to be in “significantly poor condition”.
A public consultation is currently under way into the possible “reprovision” of the services – five care homes and five day centres – which could see them shut next year.
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However, the authority – which stresses that no decisions have yet been taken – has now confirmed that service quality will be amongst the considerations it weighs when making its final decision.
It came during a meeting of the authority’s health and adult services scrutiny committee, which heard concerns that not enough attention was being paid to how well people were being looked after in the under-threat facilities.
The care homes – Favordale (Colne), Grove House (Adlington), Milbanke (Kirkham), Thornton House (Thornton Cleveleys) and Woodlands (Clayton-le-Moors) – have a combined capacity to accommodate 229 people, roughly 45 at each location, with all bar Milbanke currently being at least 89 percent full.
Meanwhile, the day centres – Byron View (Colne, attached to Favordale), Derby Centre (Ormskirk), Milbanke Day Centre (Kirkham, attached to Milbanke care home), Teal Close, (Thornton Cleveleys, attached to Thornton House) and Vale View (Lancaster) – provide daytime support to older people, including those in the early stages of dementia, although Byron View and Teal House have so far not reopened after what were intended as temporary closures at the onset of the pandemic. The remainder are all at less than 60 percent capacity.
Petitions in defence of individual homes and day centres have sprung up across the county, garnering thousands of signatures in total.
Pendle Rural’s Liberal Democrat representative David Whipp told committee members that there had been lots of talk of the cost savings that could be generated by closing the services – an estimated revenue saving of £4.1m a year, along with potential income from the sale of the sites – but too little focus on the exceptional care provided by them, including Favordale in his area.
“All the families of residents that I’ve listened to – both current and former residents – have praised the quality of care to the high heavens.
“They are absolutely delighted, not just with [that], but the love that their relatives have seen and been the recipients of at Favordale. I think that that needs to be given far greater weight,” Cllr Whipp said.
A draft framework detailing how each of the facilities will be assessed as part of the review – which was shown to the committee – sets out the four broad areas that will be examined. Each of them is worth 25 percent of the overall score, with one of the categories being “service quality”.
However, within that bracket, 18.5 percent relates to “building condition” and the other 6.5 percent to the rating of the service by the regulator, the Care Quality Commission (CQC).
An assessment of “service quality delivery”, although listed, is not currently afforded any weighting in the process.
Pressed by committee members on the subject, the county council’s executive director of adult social care, Helen Coombes, said the percentages were a “baseline” and indicated that it was simply a matter of outstanding work needing to be done on some elements before the weightings were finalised.
The framework itself is also the subject of a consultation ahead of its planned use, not just during the current exercise, but a wider review of all Lancashire County Council’s in-house services for older and disabled people which will take place over the next 18 months.
Watched over by supporters of services including Grove House and Favordale, who sat in the public gallery bearing banners backing the homes, Ms. Coombes added that “the whole point” of seeking feedback on the principles that will underpin future service delivery decisions was to ensure that “the voice of people is absolutely at the heart of it”. .
The cabinet member overseeing the review at the Reform UK-run authority went a step further, advising residents, service users and their families to “be emotional” in their consultation responses about why the care on offer at the 10 facilities was so important.
County Cllr Graham Dalton, himself a nurse, said: “I think quality of care sometimes trumps a lot of things. People will tell you that it’s not just the nurse that does something effectively, it’s the nurse that engages you and does it effectively – that is the nurse you want to work with you.”
He told the meeting that while he would be obliged to take “very seriously” any advice from council officers about whether a particular building should be closed, he also wanted to hear the heartstring arguments that many of those affected have already been making.
“I would say, in everything you express, talk about the quality [of the service] where you see it. Feel free to be emotional about it – give us stories about what the staff did, because that will affect how the cabinet look at it…and even if it’s not in a direct assessment, that, to me, carries weight.
“Whilst you think I’m just a decision-maker wanting to go in one direction, I’m not. We have a lot of assessing, a lot of thinking [to do]. Let’s make the right decision…so please engage with that assessment [process] and make it valuable for us,“ County Cllr Dalton appealed.
Committee member Azhar Ali – who is also leader of the Progressive Lancashire opposition alliance group on the county council – said that the “emotional and psychological impact of moving the residents” of the care homes should also be formally considered. A cabinet meeting last month heard that one of the facilities was home to a 106-year-old woman.
The committee has demanded to see the final version of the assessment framework ahead of the consultation responses and officer recommendations over the future of the facilities being put to cabinet members in February. At the moment, as well as service quality, the other three themes against which each of the sites will be tested are “strategic alignment”, “value for money” and an assessment of the sustainability of the current workforce and the availability of alternative services within the care market.
Three out of the five care homes under the spotlight – Grove House, Milbanke and Thornton House – were rated overall as ‘requires improvement’ by the CQC at their last inspections, but each of them was given a ‘good’ rating in the ‘caring’ domain. The other two facilities – Favordale and Woodlands – both received a ‘good’ overall rating. The day centres are not CQC inspected.
Meanwhile, County Cllr Ali told the meeting that within days of the review process being approved by cabinet a month ago, he had received approaches from private care companies enquiring how they might go about purchasing Favordale and Woodlands if the local authority decided to close them.
He said that the firms were “small organisations”, not large conglomerates, and that when he advised that not only was there a campaign to keep them open, but that the county council was saying “significant investment” was required in the buildings, they were undeterred. The companies noted the high occupancy rates and said they believed they could keep the services running and allow the residents to stay put.
“So that then begs the question, if the private sector can put investment in to keep [these homes open]…why can’t Lancashire County Council?” County Cllr Ali asked.
He suggested the authority could pursue a three-year programme of “remodelling” the buildings – and even expanding them on adjacent land to provide new specialist, modern services.
Chorley Rural East division representative Kim Snape, who spearheaded the campaign to save Grove House in Adlington, said that that home was already providing much-needed dementia care of the type the CQC had noted was in short supply in Lancashire.
The Labour politician also expressed concern that a block on new admissions to the five homes that form part of the review created “a perception” that their closure had been predetermined.
However, John Williams, the county council’s director of operations for adult social care, said that a pause had been placed on accepting new residents because he felt it was “unreasonable” for people to be allowed to move into the facilities now, when there was possibility that closure or a disruptive redesign might be the outcome of the process in just a few months’ time.
A recent CQC assessment also highlighted an overreliance on long-term residential and nursing care by Lancashire County Council, which has double the number of residential care placements per 100,000 people than comparable areas.
Counting the cost
An initial estimate suggests the bill for essential repairs to the buildings, combined with an attempt to bring them closer to the standard of modern facilities, would come in at almost £6.5m.
However, that total – contained in papers presented to the meeting – is based on condition surveys that are almost five years old. New assessments of the current state of each building have now been commissioned and will be used as the basis for the final decisions taken on each property.
Simon Lawrence, the county council’s director growth and regeneration, said that the facilities were all deemed to “meet current compliance standards and are therefore safe”.
However, John Williams said that, with five of the buildings dating back to the 1960s, they had serious shortcomings in some respects, including that the lifts in some of the homes are too small to transport residents in a bed – meaning they would have to be taken down the stairs, should they need an ambulance.
The meeting heard that some modernisation investments have already been made, but County Cllr Ged Mirfin – a committee member, but also the authority’s cabinet member for resources and property – warned that there had to be “some realism” over what else could be achieved.
“We’re not necessarily working with assets that we can modernise in the way that we’d like to.
“Part of that modernisation process may result in the invidious position whereby if we were having to [install] ensuites…we end up reducing the number of rooms,” he said.
Consultation criticism
There was cross-party criticism of the way the review process has so far been handled.
Addressing the committee, County Cllr Mark Clifford, the Labour opposition group leader, condemned what he said had been the “drip by drip” provision of information that he believed should have been in the public domain from the outset – giving the impression of a “rushed consultation”.
Committee member – and Reform UK backbencher – Joel Tetlow accused some politicians of having turned the issue into a “political football”, but nevertheless questioned whether more work should have been done “in the background” before launching the reprovision review.
“Ultimately, the biggest losers in all of this [are] the residents. They are the ones that are absolutely distraught and fearful, which at [this] time of their lives, is really not something that they need to be put through,” County Cllr Tetlow said.
Helen Coombes accepted that the authority needed to “learn lessons, particularly around the communication”, but added that the day-to-day operation of some aspects of the facilities had become “really difficult for the registered managers”.
Conflict of interest clash
At the start of the meeting, County Cllr Dalton declared that he was part-owner and director of a company called First for Care, but said that he wanted to “have it on the record that I have no pecuniary [financial] and no non-pecuniary interests in any of the in-house reprovision that we’re looking at”.
A group of Labour MPs last month demanded to know what steps would be taken “to ensure that councillors with a vested interest in the private adult social care sector do not profit” from any decisions about the future of county council-run care services.
Committee member Liz McInnes, who sits on Rossendale Council, said that someone in the same position as County Cllr Dalton would be considered by her authority to have “at least a non-pecuniary interest”, because “there is a potential that they could possibly benefit from care homes and day care centres closing”.
However, County Hall’s head of democratic services, Josh Mynott, said his department was “absolutely clear” that the cabinet member had no interest in the matter – and had advised him accordingly.
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