AGENDA ITEM NO. 8
REPORT TO:
Executive Board
REPORT NO:
PAW/18/10
DATE:
1 June 2010
LEAD MEMBER:
Councillor Marc Pritchard (Housing & Planning)
Councillor Joan Lowe (Social Care and Health)
LEAD OFFICER:
Philip Walton, Strategic and Performance Director
CONTACT OFFICER:
Robert Louden (Tel: 315521)
Tracy Gibson (Tel: 315436)
SUBJECT:
Update on Sheltered “Hub and Spoke” Pilot
WARD:
All
1.
PURPOSE OF THE REPORT
1.1
To advise Members of the progress of Phase 1 of the restructuring of
the Council Sheltered Warden Service (Hub and Spoke model) and to
seek Members’ approval of the proposed commencement of Phase 2
of the pilot.
2.
EXECUTIVE SUMMARY
2.1
The proposed “Hub and Spoke” model will allow us to improve the
effectiveness of the current service, by meeting unmet support needs
of older people living in dispersed housing through increased access to
Sheltered Warden Services. It will reduce pressure on Social Care and
Health services and help us to increase the numbers of older people
supported to live independently at home in line with the Corporate
Improvement Priority.
1
2.2
Reports have previously been presented to Scrutiny Committee
(PAW/34/09s) on 15 July 2009, Executive Board (PAW/36/09) on the
15 September 2009, and Scrutiny Committee (PAW/1710s) on the 11
May 2010, which highlighted the rationale for developing a pilot “Hub
and Spoke” model for sheltered housing. The reports detailed the
proposed pilot scheme with the suggested patch for the pilot being an
area covering Cefn, Rhosymedre, Trevor, Garth and Froncysyllte.
2.3
Members approved in principle the proposals for Phase 1 of the pilot
scheme but asked for a report detailing the outcome of the consultation
process, and for further financial information to be submitted prior to
the commencement of Phase 2 of the pilot scheme.
2.4
The work detailed as Phase 1 in previous reports has now been
completed. Consultation has taken place with residents of both the
Sheltered Housing Schemes within the pilot areas and with other
residents in the remaining 20 Sheltered Schemes across the Borough.
The feedback from residents has been positive and supportive of the
principles of widening the delivery of the service.
2.5
Work has been undertaken to develop and implement an assessment
process for each individual resident. Assessments of all residents have
now taken place.
2.6
Work has also commenced to establish a level of demand from the
wider community for the visiting warden service. Letters have been
sent to those residents in the area of the pilot schemes who have
Telecare and do not currently receive any home care or domiciliary
care services.
2.7
The development work throughout Phase 1 has been overseen by a
Project Board, in line with the Council’s Project Management
guidelines. Both Lead Members for Housing and Planning, and Social
Care and Health, sit on the Project Board. A Project Team has also
been set up to undertake specific pieces of work, which includes tenant
representatives.
2.8
The early modelling undertaken in Phase 1 of the pilot suggests that if
the model operated across the Borough, an additional 155 older people
living in dispersed housing could be supported by Wardens within the
current service budget. This requires further evaluation during the pilot.
Any expansion beyond 155 would require additional funding from the
Supporting People Programme.
3.
RECOMMENDATIONS
3.1
Members are asked to consider the progress to date and to
approve the commencement of a pilot scheme and further
development work as outlined in the report.
2
REASONS FOR RECOMMENDATIONS
The proposed “Hub and Spoke” model will allow us to improve the
effectiveness of the current service and meet unmet need from people living in
dispersed housing. It will reduce pressure on Social Care and Health services
and help us to increase the numbers of older people supported to live at home
in line with the Corporate Improvement Priority.
Philip Walton
Strategic Director
4.
BACKGROUND INFORMATION
4.1
The Council’s Sheltered Housing Service has, for many years, provided
a service that is both popular and has made a significant difference to
the quality of life of many older people, both in providing
companionship and social contact and in providing safety and security.
It has been one of the key means by which the Council has delivered
preventative services to older people. Its core strengths are that the
wardens offer a 7 day a week/365 day a year service and that there are
schemes in most parts of the Borough.
4.2
The Warden Service is a valuable one in delivering preventative
services to older people enabling them to live independently for as long
as possible and reducing the need for other health and social care
interventions.
4.3
Previous reports to Scrutiny Committee (PAW/34/09s) on 15 July 2009
and Executive Board (PAW/36/09) on 15 September 2009 highlighted
the rationale for developing a pilot “Hub and Spoke” model for
sheltered housing, away from the ‘one size fits all’ approach to one
which offers more choice .This stems from the acknowledgement that
some tenants living in sheltered housing do not require the full level of
support offered, i.e. a daily visit, whilst some older people living outside
of sheltered housing do need support but are unable to access it.
4.4
The introduction of a more flexible Sheltered Warden Service will mean
older people being supported to live independently via a Visiting
Warden Service. Furthermore in introducing a Visiting Warden Service,
the service increases accessibility to a wider diversity of older people
who might otherwise choose to move into sheltered housing.
4.5
The principles of the proposed “Hub and Spoke” model would retain the
key features of the existing sheltered service, namely:


The service would be open to all older people over the age of 60
The service would retain its 7 day a week, 365 day a year warden
service
3



4.6
The new service would have two key aims:


4.7
The warden role would be retained.
The service would continue to be offered using a mix of
residential, on-site and peripatetic wardens
Existing sheltered tenants would be offered choice as to the tier of
service they require
To improve the effectiveness and efficiency of the Warden Service
by ensuring that individuals get the level of support that relates to
their needs
To extend the Warden Service across vulnerable older people, to
those outside of sheltered housing across all tenures
The new model introduces a tiered warden service, as set out in the
table below. Based on the outcome of individual assessments,
sheltered housing tenants are able to agree a level of service more
appropriate to their needs, encouraging independence and reducing
potential early dependency on services. Thus tenants could now opt for
daily, weekly, or two or three times a week visits from the warden. It is
intended that the 7 day service will only be available to people in
sheltered schemes, and the monthly visit is only available as an option
for dispersed clients.
Table 1-Tier of service
Tier of Service
High
Frequency
Daily (7 days a week)
Medium
2/3 visits per week
Low
Weekly
Low
Monthly (not available
sheltered tenants)
to
4.8
Flexibility is also a feature of the tiered service, so that if needs
subsequently change, (for example post-operative recuperation), the
service could respond with more frequent calls according to need.
4.9
The advantages of the tiered approach are that it offers:



A service based on need
Opportunity for service users to ‘step up’ or ‘step down’ as
required
Choice for existing sheltered housing residents, and residents in
the community
4

Opportunity to provide both long and short term support to older
people in the community irrespective of tenure.
Allows wardens to spend more time with those in greatest need

Update on Phase 1 of the Pilot
4.10
As identified in previous reports, the pilot is planned to work in three
phases. Phase 1 was identified as a crucial development stage,
planned to take 6-9 months. Phase 1 commenced following the
Executive Board’s approval in September 2009, and has included:





The setting up of a Project Management framework,
incorporating a Project Board with reporting mechanisms, a
Project Team, (including staff and tenants representatives),
Project Plan, and Risk Assessment Workshop
Consultation: A full programme of consultation has taken place
with all residents of the Sheltered Housing Service, both directly
involved in the pilot area and indirectly involved.
Assessment of need: A methodology of assessment has been
developed and assessments have been undertaken with each
resident within the pilot area
Capacity mapping
Financial modelling
Project Management
4.11
The Project follows WCBC’s Project Management guidelines. The work
has been developed and overseen by a Project Board, following a
Project Plan. A Project Team, comprising members of staff including
Wardens and tenant representatives of the 2 Sheltered Schemes in the
pilot area, has undertaken individual pieces of work.
4.12
Equalities and Health Impact Assessments have taken place, and have
proved a useful contribution to the Project Management Process. Key
outcomes have included:



The model will benefit older people living in sheltered schemes by
offering a level of Warden support suitable to their needs.
The model will benefit a diverse range of older people living in the
community who may wish to access the Visiting Warden Service but
who do not wish to move into sheltered accommodation.
The pilot needs to address any data gaps identified as part of the
equality impact assessment by introducing an Equality Monitoring
Form for use with any service user.
5
4.13
As part of the development work during Phase 1, a full programme of
consultation has taken place with the residents of the 2 Sheltered
Schemes in the pilot scheme area, at Llys Y Graig and Llangollen
Rural, and with residents of our other 20 Sheltered Schemes. The
overall response to the idea has been positive.
4.14
Events were held at Llys Y Graig Sheltered Unit for residents of Llys y
Graig, and at Froncysyllte Community Centre for residents of
Llangollen Rural scheme. Family members, advocates and Local
Members were also invited
4.15
At both events, tenants were generally happy with the proposal to
extend a service which they valued to other older people living in the
community nearby, with a number suggesting they knew of people
themselves who would benefit from such a service.
4.16
A number of queries were raised about possible impacts on existing
service provision, and these focussed on the following subject areas:





4.17
Cost (for the individual)
Assessment process
Level of flexibility
Anxiety of removal of Wardens
Mobile response
Officers were able to reassure residents, in particular that:





their Warden will remain in situ
they will still be able to receive a daily visit if they need one
there will be no change to the charge during the pilot
dispersed users of the service would pay the same
the service will be flexible enough for any tenants who reduce
their number of visits, for those with less than a 7 day service to
increase the number of visits in the future if the need arises.
4.18
Feedback following the consultations has also been positive with no
objections to the pilot having been received since the consultation
events took place.
4.19
Individual consultation events have been held for all sheltered schemes
outside of the pilot area. The feedback was similar to that of the pilot
area with no new concerns being raised. In particular, most were
reassured to hear that the model would be thoroughly tested during an
initial pilot before any decision was taken to roll it out and that they
would be kept informed.
4.20
All events arranged sought to ensure the Disability Discrimination Act
guidance concerning inclusivity was followed. Any individuals who
were unable to attend a group event were offered individual visit or
6
were updated individually by their Warden. Tenants were informed that
they could relay any further comments, feedback or concerns via their
Warden following the events.
4.21
Prior to the consultation taking place, legal advice was sought on our
approach. This followed publicity about legal challenge taking place
elsewhere with authorities, on the basis of their approach to
consultation. Legal opinion was that our proposals on remodelling the
service differed markedly to that which had taken place elsewhere.
Following legal advice we endeavoured to ensure that our approach to
consultation was as sound and inclusive as possible.
Assessment of Need
4.22
An assessment form and guidance has been developed with the
Project Team to facilitate the assessment of existing sheltered tenants.
Individual assessments have been carried out of all tenants by the
Warden in each scheme.
4.23
Wardens have carried out the assessments on a one to one basis with
each individual tenant taking account of the individual’s specific needs.
Family members have also been involved, where required, in these
assessments. The process has been thorough and time consuming but
extremely valuable.
4.24
Completed assessments have been scrutinised by Managers of the
service. Any assessments which indicate that a reduction from daily
visit is preferred are then subject to a full risk assessment to ensure
that reduced visits will not lead to any identifiable risk to the individual.
Dispersed Clients
4.25
The Hub and Spoke model would seek to deliver a Visiting Warden
Service to older people living at home in the community, targeting
primarily those currently in receipt of the Council’s Telecare service (or
willing to have it installed), but not in receipt of homecare or domiciliary
care.
4.26
We have sought initial expressions of interest from people in the
named communities who are existing service users of the Telecare
service.
4.27
Project Board have agreed during Phase 1 not to assess those who
had registered an interest prior to achieving Member approval to
proceed to Phase two, as it would be unfair to raise expectation,
pending Executive Board approval of the commencement of the
scheme.
7
4.28
Letters outlining the service offered have been sent to 55 people
initially, in the communities in the pilot area. To date 39 people have
responded. Of those responding, 11 people have stated that they
would be interested in taking up the service offered. Of those declining
the service, a number have stated that they support the initiative and
feel the service would be valuable to them at some point in the future,
but they do not feel they need it just yet. Thirteen people have yet to
respond.
4.29
If Phase 2 is approved there will be further work to advertise the
dispersed service across local groups and professionals.
Capacity Mapping
4.30
In order to ensure a consistent high level of service is maintained to our
existing residents and that we have the correct balance of resources to
meet any additional unmet need, modelling work has been undertaken
with Wardens. A series of meetings have been held to determine all
aspects of service delivery, likely capacity and the amount of flexibility
that needs to be built in to allow for unplanned occurrences and
activities around the schemes. Areas considered include:






4.31
Average length of a visit
What a visit entails
The types of unexpected events that occur on a daily round
Numbers and types of activities taking place
Cleaning duties
Other duties
Using this modelling framework, we can project any likely capacity
within our existing resources and the likely number of residents we
would be able to support in the community utilising our existing
resources.
Table 2- Options and Reduced daily visits
Llys Y Graig
Llangollen Rural
Total
45
87
Households opting for Daily 28 (67%)
visit
27 (60%)
55
Households opting for 2/3 11 (26%)
times a week visit
10 (22%)
21
Households
weekly visit
8 (18%)
11
Number of current
made per day
opting
visits 42
for 3 (7%)
8
4.32
As a result of the above assessments carried out and existing residents
choosing their preferred number of visits, we can calculate that
sufficient time would be released to enable us to support 22 people in
the communities within the pilot area.
4. 33 The pilot needs to take place to allow further development of this
methodology. Numbers may alter through the pilot taking place as
residents gain more confidence in the level of service that they receive,
together with the extra support received from telecare.
4.34
Following this method, based on the outcomes of the two pilot scheme
assessments that have taken place, we can further project that if
similar proportions of residents in other schemes were to choose a
reduced number of daily visits, an estimated 155 people could be
supported via the Warden service across the Borough within existing
resources.
Phase 2 of the Pilot
4.35
As outlined in previous reports, Phase 2 would commence, pending
Executive Board approval, in June 2010 for a period of up to 12
months, and includes the following elements:
-
-
4.36
The pilot “Hub and Spoke” model as outlined previously, to
commence operation in Cefn, Rhosymedre, Trevor and Garth and
Froncysyllte.
Initial marketing of the dispersed service in the above areas for a
short period once approval has been obtained.
Levels of take up and staffing capacity to be closely monitored and
reported back to Project Board.
Project Board to consider the charging framework and the impact of
charging on demand within the context of fair charging.
Further scoping of future service and mapping of demand for
service in other areas.
To identify the potential patch areas within the borough
Develop rolling programme of pilot schemes across the Borough in
parallel.
Continue to inform and consult the wider Borough, map need and
develop further schemes.
On-going monitoring and evaluation of progress and impact of pilot
scheme.
Report back to Scrutiny Committee and Executive Board on the
outcomes of Phase 2.
Subject to Member approval Phase 3 is proposed to commence June
2011, or before, depending on the progress of the pilot scheme and will
include:
-
Roll out of additional “Hub and Spoke” models elsewhere in the
Borough
9
-
Continuing monitoring and evaluation of” Hub and Spoke” model
5.
CONSULTATION
5.1
Consultation has taken place with a number of key stakeholders
including existing sheltered tenants, during this process. (Paragraph
4.13- paragraph 4.21 refers). We have kept staff informed of the
proposals, and we have discussed these and the reasons for them with
the unions. Staff and unions are broadly supportive of the proposed
changes as outlined.
5.2
Local Members have been kept informed of consultation events
occurring in their wards. In the pilot area, Local Members were invited
to attend the events and some Local Members from outside of the pilot
area chose to attend their local consultation event. Local Members
from the pilot area have been very supportive with no objections raised
following the consultations with residents.
5.3
Reports have previously been presented to Scrutiny Committee
(PAW/34/09s) on 15 July 2009, Executive Board (PAW/36/09) on the
15 September 2009, and Scrutiny Committee (PAW/1710s) on the 11
May 2010, which highlighted the rationale for developing a pilot “Hub
and Spoke” model for sheltered housing.
6.
SCRUTINY COMMITTEE COMMENTS
6.1
On 11 May 2010 a further report was presented to Social Affairs,
Health and Housing Scrutiny Committee (Report No. PAW/1710s).
The Committee commented on aspects of the report and
recommended that Executive Board approve the implementation of
phase 2: the commencement of a pilot scheme and further
development work.
6.2
Additional comments and questions proposed by members of the
committee were responded to at the committee meeting and will be
further explored as part of phase 2 and reported on further during the
evaluation of the pilot.
IMPLICATIONS
7.1
Policy Framework – The proposal as outlined would support the
delivery of the Council’s Key Improvement Priority for 2009-12 to Assist
Older people to live independently. In addition, the proposed model will
support the Older Persons Commissioning Plan and key actions within
the Accommodation, Housing and Support Strategy for Older people.
10
7.2
Budget –
7.2.1
The initial modelling, based on tenants in the pilot area choosing
the number of visits they require, suggest that around 155
additional older people living in dispersed housing could be
supported across the Borough within existing budgets.
7.2.2
It is estimated that delivery of the dispersed warden service could
be extended to up to 400 older people living in the community.
Based on these projections it is estimated that additional
revenue funding of approximately between £50,000 and
£110,000, would be required, dependent on the average number
of warden visits to people in dispersed housing. The financial
projections regarding any additional revenue funding required to
deliver the service across the Borough will be further evaluated
and refined as the pilot unfolds and provide us with more precise
information.
7.2.3
Any additional revenue costs if the service expanded up to the
400 figure identified in previous reports would need to be met
from the Supporting People Grant programme. While it is
possible the Supporting People Grant may be cut in the future,
savings have already been generated by Telecare and further
savings may be achievable from carrying out reviews of other
Supporting People funded services.
7.2.4
7.2.5
It is likely however that any increase in cost from providing this
model of service across the whole Borough will reduce service
pressures on areas such as Health and Adult Social Care.
Research published in England by CapGemini for the
Department of Communities and Local Government showed that
for every £1 spent on Older People living in Sheltered
Accommodation there is a saving of £3.26 to the public purse
(the primary saving is in reducing the numbers in residential
care, but also produces savings for Domiciliary care and Health.
It also found that for every £1 spent on Older People living in
their family home there is a saving of £6.45 to the public purse.
The research also evidenced non-financial benefits from
providing services such as Telecare and Warden Services.
These include:

Improved quality of life

Greater Independence

Improved health

Reduced burden on carers

Decreased Isolation

Decreasing fear of crime

Easier access to appropriate services
11
7.2.6
The Council sheltered warden service is funded from the
Housing Revenue Account (HRA) and the Supporting People
budget. The HRA funds all Council housing management and
maintenance functions carried out by the Warden whilst the
supporting people programme funds any housing related
support activity undertaken by them.
7.2.7
The HRA is a ring-fenced budget that can only be spent on
Council tenants; therefore the funding of any Warden Service to
non-Council tenants will not be met from HRA elements of the
Council’s Sheltered Housing budget.
7.3
Legal – No legal implications have been identified.
7.4
Staffing - There may be some aspects of the remodelling that may
have implications for patterns of working. Consultation with staff and
unions will be an ongoing part of the Project. It is anticipated that there
may be a need for additional staffing.
7.5
Equalities / Diversity - Equalities and Health Impact Assessments
have taken place, and have proved a useful contribution to the Project
Management Process. Key outcomes have included:



The model will benefit older people living in sheltered schemes by
offering a level of Warden support suitable to their needs.
The model will benefit a diverse range of older people living in the
community who may wish to access the Visiting Warden Service but
who do not wish to move into sheltered accommodation.
The pilot needs to address any data gaps identified as part of the
equality impact assessment by introducing an Equality Monitoring
Form for use with any service user.
BACKGROUND PAPERS
Proposals for the Restructuring of
Council sheltered Housing
Services ( PAW34/09s)
LOCATION
Council’s Intranet
Proposals for the Restructuring of
Council sheltered Housing
Services(PAW/07/09s)
Proposals for the Restructuring of
Council sheltered Housing
Services(PAW/1710s)
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