Priory and Delaware
October 15, 2013 1 Comment
I have been given permission to reproduce an email that was copied to me. This is on the subject of the two council-run care homes in Southend-on-Sea and their threatened closure. Whatever your view of the proposed closures of these two homes (and there are considerable numbers who are against it) this email raises many interesting questions.
Dear Mr Leftley,
Please consider this e-mail as my response to the above consultation. For the record, I am a relative of a resident at Delaware House – my father has been living there for around six months – and I strongly oppose anything other than option 1 (continue as now) for both homes. My experience of the care my father receives at Delaware is that it is excellent, and that the standards of care at Delaware exceed those of the independent sector; my great aunt was a resident in a number of independent homes in Southend until her death in 2009.
I will not be completing the consultation feedback paper itself as I consider it, and in particular question 2 relating to Delaware House, to be misleading. In fact I find much that is misleading in the consultation, as I shall set out below.
It is natural for anyone who receives such a consultation to look at the questions first, then look at the detail behind it. I did just that, and question 2 (asking how much one agreed with “the modernisation and refurbishment of Delaware House”) led me to believe that what was being proposed for Delaware was to do what the words say; modernise and refurbish. It was only when I went on to read the consultation (and in particular option 3) in much greater detail that the implication of the last line of option 3 struck me: “it is difficult to envisage how Option 3 could be implemented without the closure of the home(s)”. That the word ‘close’ is only mentioned here, in the final sentence, is in itself grossly misleading, but in any event the wording for question 2 is misleading in the extreme.
I will state here, quite openly, that I was misled by both the wording of question 2 and the roundabout way that option 3 is worded, and that I thought the Council’s preferred option for Delaware was to keep it open and refurbish the building. It has been reported by significant numbers of other relatives that they too were misled in the same way, and it is almost certain that a number of responses were made under a false impression of the Council’s preferred option for Delaware House.
It is stated in the consultation, drawing from the report by Mike Boyle of 19 March 2013, that over a 10-year period “capital investment of £1.8m will be required to maintain the homes” (emphasis mine). However, this is misleading on a number of counts.
First, that figure includes approx £283k that is identified as costs falling after year 10 (see appendices 2 and 3 of the consultation). This has been confirmed as costs that are not expected until beyond year 10 (and probably around year 15) following discussions between a handful of relatives (including me) and the Council’s property services team who carried out the condition surveys. It is thereforeinaccurate to include those costs with the years 0-10 capital spend.
Second, information provided in those discussions show around £190k total expenditure for installing a second lift in each property. A new lift for each property was included as a recommendation for improving the properties, not a required spend to maintain the homes. It would be unrealistic to expect any independent home to have more than one lift (and some don’t even have that), so adding a second at such expense to Council-run homes is unaffordable gold-plating. And again, it is simply incorrect to include these as costs that “will be required” when they are clearly discretionary.
These two factors alone account for over a quarter of the £1.8m, which is a significant overstatement of the ‘required’ works in years 0-10. Further, the discussions mentioned above also revealed that some of the costs identified are for works that could be needed in the 0-10 year timescale, but are not 100% certain; they are therefore patently not required, merely possible. For example, there is a sum of around £220k noted for a complete electrical rewire at both homes, where there is no guarantee that this will definitely be required once the buildings’ next 5-year certificates expire; it is possible that either or both buildings will receive another 5-year certificate at that time. There are other such items on the list where the risk of the work being required increases after year 5, but does not increase to a 100% likelihood. This makes the statement of an absolute figure of £1.8m even more misleading.
What is also not revealed in the consultation, but has come to light in the discussions, is that the costs are based around prolonging the homes’ lives for another 30 years, not just for 10 years. It is therefore again misleading not to have mentioned that in the consultation itself, as that substantially alters any perception of the value in spending such a capital sum.
It is stated in the consultation, drawing from the report by Mike Boyle of 19 March 2013, that the 10-year revenue spend on Priory and Delaware will be approximately £20m. This figure is not quantified, but based on per bed costs stated elsewhere it appears to be the annualised cost of providing each bed, multiplied by 10. This is, however, a misleading oversimplification of the revenue cost to the Council of running the two homes.
First, income is received by the Council from residents whose assets/income exceed the maximum for full Council funding. The consultation paper does not quantify how much income is received for Delaware and Priory for such residents, nor does it compare this to how much income would be received were all of those residents to be placed in independent homes. While I accept that circumstances vary for each resident, nevertheless the data the Council the already has should have enabled it to provide a more accurate figure and a comparison between scenarios, rather than a lazy calculation.
Second, income is received by the Council from the NHS for residents placed by them. These beds are fully NHS-funded, and I understand that around half of Delaware’s beds are NHS-placed at any one time. This is a significant income stream for the Council that helps offset its running costs, and it is a significant omission not to include even an estimate of such revenue (even if only an average of previous years).
Third, there has been no attempt to quantify the reduced maintenance spend as a result of the capital expenditure, other than a simple statement that “some savings in the annual repairs budget may arise” – clearly there will be savings on areas like Priory’s boiler and roof if they are replaced. For a consultation to be meaningful, it must accurately quantify these figures; anything else is grossly misleading.
Fourth, the consultation sets out an amount of revenue budget savings in Adult Social Care the Council needs to make in the next two years, but does not set out the baseline against which savings need to be made or what that budget covers. This therefore potentially misleads the reader into thinking that the cost of Delaware and Priory is a significant part of the Adult Social Care budget, when in fact the proportion is unknown.
Comparison between public and independent care home costs
On various occasions, the consultation (and the reports from Mike Boyle that preceded it) makes the comparison between the per-bed cost of running Delaware and Priory and the per-bed cost paid to independent homes for Council-placed residents. This is one of the most misleading statistics in the consultation.
First, the cost of approx £430 paid by the Council to independent homes is heavily inferred to be the cost to the independent sector of providing comparable facilities. This gives the misleading impression that it is significantly cheaper to run a comparable independent home to Priory or Delaware. However the Southend-on-Sea Care Services Directory for 2013 (produced in association with the Council) states the following at page 36: “If… the care home you eventually choose costs more than the rate Southend Borough Council usually pays… someone will have to make up the difference”, and goes on to add that if nobody can pay the extra then ”it may be that the resident may have to find a cheaper home”. Not only is it therefore misleading not to state this possibility in the consultation, it is fundamentally misleading not to state in the consultation what the actual cost (or range of costs) is for an independent home to provide a high-dependency bed comparable to those at Delaware and Priory. It was only at one of the public meetings that the owner of an independent care home gave a very broad estimate of about £600 for a high dependency bed.
Second, it is misleading not to factor in what it costs the Council in staff time and non-staff costs to monitor, inspect and provide other services (such as training) to the independent care homes in the borough. To quote the consultation, the Council has “a statutory duty to improve standards… in care homes operated by the independent sector”, and that duty will come at a cost. That cost would potentially be even higher if there were no Council-run homes, so not to include what it costs now and what it will cost if there are no Council-run homes, averaged out per bed across the independent sector, is a significant omission.
Number of vacant independent beds
The consultation uses the total number of vacant beds in the Borough as a justification for anything other than option 1. However, this is yet again a misleading statistic. For a start, it was revealed at the first public meeting that not every bed in the independent sector is available to the Council at its ‘usual rate’, therefore the statistic that should have been revealed is how many high-dependency beds comparable to those provided at Priory and Delaware are available to the Council at its ‘usual rate’, and how many of those are vacant on average at any one time. It is also a serious omission to not reveal how many beds are available to NHS-placed residents with mental health needs, and how many are taken up on average at any one time, given the number of such people that are housed at Delaware.
Much is also made of the reduction in placements from 2010/11 to 2011/12, without justifying how this is projected to continue in future years. Every professional report agrees that there will be an ever-increasing number of people with dementia in the medium and long terms, the only disagreement is how much more. This consultation would have us believe that Southend, despite having a higher than average proportion of over-65s in the region, is somehow immune to this and won’t see an increase in the number of people with dementia who will need to go into a care home, or an increase in the number of people who will be placed in homes via the NHS, or that the supply of independent beds will remain constant. Frankly, that is incredible, and if this is seriously asserted then it is wrong not to include data and analysis to explain this rationale. There isn’t even a mention of the Government’s Care Bill, which will surely have an impact on future care home requirements – and if the impact isn’t known yet, surely the risk of closing the last two Council-run homes is a significant one?
The benefits of maintaining Delaware and Priory
It is mentioned only in passing in the consultation that, in closing the homes, “there is a risk the Council would lose knowledge and expertise to objectively assess standards” which echoes the report by Mike Boyle of July 2012 which states that “the ownership of these homes means the council maintains the knowledge and expertise in the delivery of residential care services”. Nowhere else in the consultation is this benefit quantified, or the risk assessed of what effect closing Delaware and Priory would have to the standards of care in the borough. The recognised excellent standards of care at Delaware and Priory set the bar for the independent sector to strive to, and closing them would have a detrimental effect to the overall standard of care in Southend. If the knowledge and expertise is lost, it is lost forever.
Delaware is acknowledged in the consultation as providing specialist dementia support, but nowhere is it stated how that specialist support would be provided in any of options 2 to 4. Given the much-reported future increase predicted in the numbers of people requiring dementia support, it is incredible to not consider that more, not less, specialist care home support will be needed in the medium and long terms.
NHS mental health placements
The consultation is deficient in detailing the effect of closing Delaware on its current NHS-funded residents with mental health needs, of whom my father is one, as well as future mental health care requirements in Southend. In retaining ownership of Delaware, the Council is able to act as the safety net for such placements if the independent sector is unwilling or unable to provide such specialist care, and given the number of NHS placements at Delaware it is clearly a much-needed service.
My own experience when my father needed to be housed was that no independent home was willing to accept him given his mental health history, and if Delaware hadn’t been there he would either still
be in hospital or would have had to be moved out of the area, away from family. It is a significant and serious omission in the consultation not to set out the risks to people like my father with mental health needs if the safety net of Delaware is taken away. I should note at this point that my father’s own views are that Delaware has been a much better environment for him than hospital, and that he is happily settled there – I have also noticed the improvement in both his general and mental health since moving to Delaware.
Equality and Diversity Implications
The March 2013 report by Mike Boyle states that “there are Equality Implications arising from Options 3 and 4 and detailed Equality Impact Assessments will be undertaken… should Cabinet decide to proceed to a formal consultation”, echoing a similar statement in the July 2012 report. These impact assessments have still not taken place, according to a question I asked at the second public meeting, and their omission from the consultation is a striking flaw, particularly when virtually all residents will fall into at least one protected characteristic under the Equality Act. The Council does of course have an obligation to fulfil its public sector equality duty.
There is one possible option that hasn’t even been considered; merging the two homes into one larger home on one site, by redeveloping the Delaware site. This would reduce the capital costs to the Council while using the proceeds of selling the Priory site to create an even better care home with the same (or possibly greater) capacity. That this option hasn’t even been mentioned is a serious omission.
For a statutory consultation to be valid, it must adhere to certain requirements laid down by the courts. One of the Gunning requirements is that adequate information must be provided to consultees to enable them properly to respond. I have set out above the many misleading pieces of information, the omissions, and the misleading question about the Council’s preferred option for Delaware House, and I strongly question the legal validity of this consultation.
The problems with this consultation go right back to the reports produced by Mike Boyle in July 2012 and March 2013, where a lack of rigorous analysis and detail in figures, plus spend assumptions I’ve referred to above, were carried forward to the consultation. These reports were also written by someone who confused his thousands, millions and billions – in the July 2012 report, at para 5.1, the gross annual budget for Priory is quoted as “£1,018m” (i.e. a little over a billion pounds), a mistake carried forward to para 6.2 of the March 2013 report. Also in the March 2013 report at 6.2, “£750,000k” capital expenditure will be needed in years 3-5 (i.e. 750 million pounds). These are, of course, nonsense figures. It is this later report which also first makes the misleading statement (at para 6.2) that “£1.8m of capital expenditure will be required if both homes are to remain operational for a further 10 years”, which I have already debunked above.
It is clear that the Cabinet were misled and given incomplete data, just as consultees have been now, and the only conclusion I can draw is that the consultation and the reports on which it is founded should be discarded and the whole process started again. The Council should:
• commission a new conditions survey of both Priory and Delaware, taking into account updated costings received during the course of this flawed consultation, and taking into account repairs made by on-site staff in the past year
• write a new report to Cabinet in much greater detail than the ones written in July 2012 and March 2013, rectifying all of the misleading and incorrect statistics cited above regarding capital spend, revenue spend, income, available comparable beds, NHS mental health requirements and so forth
• set out clearly in that report what capital spend repairs must be made over the 0-3, 3-5, 5-10 and 10+ years timescales, and which repairs may be needed (and the likelihood of each)
• also set out in greater detail in that report the 30-year benefits of maintaining Priory and Delaware as they currently are and making capital spend improvements
• also set out detailed Equality Impact Assessments.
Then, and only then, should the Council proceed to a consultation with clear and unambiguous questions, and complete data, if it believes that options other than keeping both homes open as they are need to be explored.