Agenda item

To consider any items called-in by the requisite number of Members following the previous Executive meeting.

The Commission considered a supplementary report concerning the Call In Item EX2320 – Funding Arrangements Framework for Domiciliary Care and Non Residential Services which was submitted to Special Executive on 12 April 2012.

Councillor Jeff Brooks presented the reasons for calling in this item

1.      The decision was contrary to the views expressed by those responding to the public consultation;

2.      The decision contradicted the Council’s Strategy 2012-16;

3.      There was no evidence that the cost to the Council of managing this policy had been evaluated. 

Councillor Jeff Brooks expanded on these points, stating that he was concerned that a high level of officer time would be required to process the 26 people who had been identified in the report.  He believed that this cost would negate the expected savings.  Councillor Jeff Brooks further stated that the savings that were expected to be achieved by the introduction of this policy were not significant in relation to the Council’s total savings target and he was therefore not convinced that the introduction of this policy was appropriate.

Jan Evans provided the following responses to the points raised by Councillor Jeff Brooks:

1.      A summary of the consultation responses had been provided in the report.  The majority of respondents were concerned about the proposed changes, but most accepted that it would be unfair to expect the Council to pay significantly more to keep people in their own homes, if they were happy to take a place in residential care.  Further responses indicated that some people would be happy to pay to ‘top up’ their allowance.  Jan Evans explained that the proposals had been made with a clear priority not to affect front line services.

2.      There were four key priority areas within the Council Strategy 2012-16 including ‘Caring for and protecting the vulnerable’.  Jan Evans explained that the proposal would not take services away but would provide alternative options.

3.      The savings stated in the report were based on a current level of 26 people who were currently in the community and who had care packages in excess of £35,000.  Extending the savings into the future to include individuals falling into this category at a later date could see far greater savings.

Jan Evans went on to stress that the 26 individuals highlighted in the report were intended to be indicative of the possible savings.  It should not be inferred that these people would all be moved to care homes.  All cases would be assessed on an individual basis to ensure the most appropriate care was provided.  However the policy would allow care managers to recommend that an individual’s care needs could be better met in a care home.

Councillor Paul Bryant asked whether the 26 individuals had been asked whether they would like to stay at home or move to a care home.

Jan Evans reminded the Commission that the 26 individuals noted in the report were only indicative of savings, and that no changes would be made to their care package without a full assessment and consideration of the options.

Councillor David Rendel requested clarification on the statement that ‘needs were better met in a care home’ and asked who would make this judgement.  He went on to ask whether the Council would enforce moving an individual to a care home if it was cheaper, but against their wishes and those of their family.  Jan Evans responded that the assessment would provide the Council’s view, but that decisions regarding care provision would continue to be made in conversation with the individual and their family.  Where an assessment indicated that providing care in a residential home would be the most suitable option, but this was against the wishes of the individual or family, it could not be enforced, however the care manager would work with the family to understand the reasons for their preference.

Councillor David Rendel asked if care provision would be restricted in the individual’s home if they had refused to move to a care home, in order to reduce costs.  He was concerned that this policy would have a disproportionately adverse impact on those requiring the greatest levels of care.  He further asked for clarification as to whether there was a difference between care provided in the individual’s home and that provided in a residential home.  Jan Evans responded that whilst the cost of care was a consideration, it was just one of many elements that contributed to the final decision.  Consideration would equally be given to family wishes and the individual’s emotional well being.

Councillor David Rendel also asked for clarification as to how the savings total had been calculated.  Jan Evans replied that the figure of £160,000 was the result of adding each of the 26 individual’s care costs that were in excess of £35,000.   This figure was considered to be a generous allowance for care costs.  Jan Evans further explained that the 26 people who had been included in these calculations were all older people, however the policy would be applied across all care groups.

Councillor Dave Goff asked whether people would have an appeal route if they disagreed with a decision made about their care.  Jan Evans responded that appeals would be made through the Council’s complaints procedure.

Councillor Emma Webster asked for Jan Evans’ thoughts on the number of responses received to the consultation as her opinion was that past consultations of this nature resulted in far higher numbers of responses.  Jan Evans responded that she had been surprised that more responses had not been received, however feedback had also been received from open sessions.

Councillor Emma Webster asserted that she believed the appropriateness of care was paramount and understood that allowing time to be spent with the service user and their family was invaluable in reaching an appropriate, and agreed, care package.  She noted that although a cost parameter of £35,000 had been set, this did not mean that care would be withdrawn if the cost rose above this level, and that it would be decided on a case by case basis according to need.  She asked whether the assessment process allowed individuals to understand the different levels of care they could expect from different care packages.  She further asked whether people could be shown a care home environment to help allay their fears.  Jan Evans responded that individuals were provided with a clear understanding of the different levels of care they could expect at home or in a residential home.  She further stated that visits to care homes could be arranged.

Councillor Tony Vickers was concerned that the cost of contested decisions, in increased care management time and legal costs, would negate the proposed savings.  Jan Evans responded that the policy would allow conversation to be raised early with individuals beginning to show indications that a care home might better suit their needs. 

Councillor Joe Mooney explained that there were a number of people in West Berkshire with a high level of care needs. Whilst in their own homes they did not have 24 hour care provision.  In these cases, their needs might be better served in a care home where care provision would be available at all times.  He further stated that West Berkshire was considered to be ‘asset rich and cash poor’, and consideration should therefore be given to those families who wished their relatives to remain at home for financial reasons rather than for their best interests.  He explained that a charge could be put on an individual’s home if they were to move to a care home, this was not possible if the individual stayed at home, thereby preserving inheritance.

Jan Evans explained that neither Reading nor Oxfordshire had experienced problems with similar policies.  She was concerned at the negative views being shown by the Commission; that they seemed to feel that moving to a care home was the end of the line.  She countered that care home provision was a positive choice for people.

Councillor Tony Vickers clarified that the concerns raised at the meeting reflected the lack of choice afforded to families, not the fact of moving to a care home.  Councillor Joe Mooney reiterated that all cases were dealt with individually and assessed according to merit.

Councillor Jeff Brooks raised a concern that moving an individual to a care home represented a significant change to their life which would not be welcomed by many.  He also believed that the proposed savings were at risk of not being achieved.  He suggested that as the majority of respondents to the consultation had concerns over the change which could cause significant upheaval and distress, weighed against the risk of not achieving savings, made the decision to adopt the proposed changes incorrect.

Councillor Jeff Brooks proposed that the Executive be asked to reconsider their decision on the matter.

Councillor Joe Mooney responded that he had attended all of the public meetings regarding this consultation, and reminded the Commission that only a small proportion of those consulted provided their views.  He further reminded the Commission of the forthcoming increase in the numbers of older people in the district which could result in greater levels of savings as they entered the care system.  He stated again that each individual case would continue to be judged on its merits.  Councillor Joe Mooney did not believe that individuals would lose their right to choice and reminded the Commission that an appeal process was in place.  He pointed out to the Commission that savings needed to be made across the Council and questioned where savings should be made if these proposals were rejected.

Councillor Roger Hunneman expressed concern at the perception that had been created by the choice of words in the proposal report.  He suggested that stating a cost parameter of £35,000 would lead individuals who were in receipt of care at this level or higher to believe that they would automatically be placed in a care home.  He believed that the aims of the policy would be better served by a tone of encouragement rather than one of threat.

Councillor David Goff said that this policy was the same as other authorities who had not received a high level of appeals or objections.  He had heard from people with concerns about their relatives staying at home when a residential environment would be more beneficial.

Councillor Dominic Boeck stated that he understood the value of staying at home, but also recognised that every case was different.  He was encouraged by the compassion in adopting a policy that accounted for the merits of individual cases.  He believed that the proposed policy presented a sensible approach.

Councillor Paul Bryant recognised that people were not being forced into a care package that they did not want, and that discussion with the individual would lead to an appropriate decision being made.  He also pointed out that there were many people whose circumstances meant that they were not aware of what was best for them.  He believed that the proposal put forward to the Executive, with sufficient safeguards, was suitable for purpose.

Councillor Jeff Brooks noted that the Council was reliant on policies being implemented properly by Officers.  He expressed particular concern that the policy stated that the Council would be within its rights to refuse to fund home care where an assessment had indicated that care provision would be better met in a residential home.  He indicated that should this policy statement be implemented poorly in the future, a great deal of distress would be caused.

The Chairman allowed Councillor Joe Mooney to respond to this concern.  Councillor Jeff Brooks noted his objection to Councillor Joe Mooney speaking after Councillor Jeff Brooks’ proposal had been put forward.

Councillor Joe Mooney raised the issue of the duty of care the Council owed to those it was responsible for.  He speculated about the media headlines should an older person be allowed to remain at home when an assessment had indicated more suitable care would be provided in a care home if, for example, the older person received no visitors, or had an accident.

Councillor Jeff Brooks objected to a new opinion being raised after his proposal.

The Chairman noted the two points of view that had been expressed during the debate.  He reminded the Commission of the proposal put forward by Councillor Jeff Brooks to refer the decision back to the Executive for reconsideration.  The proposal was put to the vote.

At the vote the proposal was defeated.

RESOLVED that: the funding Arrangements Framework for Domiciliary Care and Non Residential Services would not be referred back to the Executive for reconsideration and could therefore be implemented with immediate effect.