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Report to: |
Cabinet |
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Date of meeting: |
25 February 2025 |
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By: |
Director of Adult Social Care and Health |
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Title: |
Hookstead Day Service |
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Purpose: |
To consider the outcome of the public consultation and to make a decision on the revised proposal for Hookstead and St Nicholas Day Service. |
Cabinet is recommended to:
1) Agree to reduce the capacity of Hookstead Day Service by 25%, as detailed in section 5 of this report;
2) Agree the revised session times for both Hookstead and St Nicholas Day Services, as set out in paragraph 5.9 of this report;
3) Delegate authority to the Director of Adult Social Care and Health to determine the days of the week on which ‘Twilight’ sessions can continue to be offered at Hookstead Day Service; and
4) Delegate authority to the Director of Adult Social Care and Health to take all necessary actions to give effect to the above recommendations.
1.1 Cabinet agreed on 26 September 2024 to launch a consultation exercise relating to the potential closure of Hookstead day service for adults with a learning disability (the papers are available: here). As part of this proposal, the Council set out that it would find those currently attending Hookstead alternative day service provision, either in an alternative service run by the Council or by an alternative private or voluntary sector provider. To facilitate those who may wish to remain at a Council-run day service, the proposal suggested that St Nicholas Day Service be adapted to allow for additional capacity.
1.2 The proposal, as well as other potential service changes being explored by Adult Social Care and Health, is to help close the Council’s funding gap.
1.3 The consultation ran between 3 October and 28 November 2024. The impact of the new funding settlement for the Council has been taken into account when making the proposals in this report.
2.1 The Hookstead day service is run by the Council and it is based in one of our buildings in Crowborough. The service delivers support to people with a learning disability and has several aims, including to:
· prevent social isolation,
· enable vulnerable adults to learn and maintain skills, and
· provide respite for parent/carers.
2.2 The service currently has 13 members of staff, although there are some vacant posts. The staff are all employed by the Council. The service has the capacity to provide three sessions a day, from 9am to 12pm (known as AM sessions), 12.30pm to 3.30pm (known as PM sessions), and from 4pm to 7pm (known as twilight sessions). The service is open Monday, Tuesday, Thursday and Friday and has space for up to thirty-one people for the AM and PM sessions and up to seventeen people for the twilight sessions. The service is closed on a Wednesday.
2.3 There are currently 38 people regularly attending the day service, with around 70% of the spaces filled for the AM and PM sessions and nearly 50% of the spaces for the twilight sessions. Some adults who attend require a smaller, quieter setting as they struggle with large groups and noise.
2.4 The majority of people who attend the day service at Hookstead live at home with their family. Most people who attend live in Crowborough and the surrounding area in Uckfield. Appendix 3 provides a map of where people attending day services at Hookstead live in the county.
2.5 The building-based daytime sessions include art, cookery, music, baking, journalism and gardening. The twilight sessions focus more on social activity and include supper clubs, music nights and a movie evening. The community sessions are sports and a dinner/social in a local pub.
2.6 There is also a Supported Living service based in the same building. Some of these residents attend the Hookstead day service and the Supported Living service uses the day service space when the service is closed on a Wednesday.
3.1 As set out above, the original proposal that has been out to public consultation, was to close the Hookstead Day Services for people with a learning disability, and to support people to access alternative services in the community.
3.2 As part of the proposal, it was expected that for those who wished to continue using a Council-run day service, the best option would be for them to move to St Nicholas, our day service in Lewes. To accommodate this, the proposal also included extending the opening hours of St Nicholas, returning it to a five-day a week service. This would increase the number of adults who could be supported there by 20% (increasing the number of sessions available by 105) and allow us to offer a place at the day service to everyone currently attending Hookstead (provided the service can meet their assessed care needs).
3.3 St Nicholas would continue to offer three sessions a day. However, the timings of those sessions would change to manage the increase in adult numbers. Changing the times of the sessions would ensure people have the support they need over lunchtime, as well as providing enough non-contact time for staff to do administrative tasks and attend team meetings. We would continue to have a standard adult to staff ratio of five-to-one and provide one-to-one support to adults where they are assessed as needing this.
3.4 The estimated annual revenue savings in a full year for this proposal are £124,000.
3.5 To determine the potential savings, we took the overall gross budget for the service and subtracted any ongoing costs of providing alternative services. One-off costs, including the costs of restructuring staff, have been considered in the context of the ongoing saving but not included in the figures presented.
4.1 As set out above, an eight-week public consultation on the original proposal ran from 3 October to 28 November 2024. We asked people for their views on the proposal and how they would be affected if it went ahead.
4.2 All the feedback received during the consultation is available within the Members’ and Cabinet Room for Members’ consideration.
4.3 256 responses were received across the survey, consultation meetings and other feedback methods on this proposal, as follows:
|
Respondent method |
Total |
|
Survey |
124 |
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Email and letters |
29 |
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Consultation meetings (attendees) |
103 |
4.4 Most respondents across all response methods disagreed with the proposal to close the day service at Hookstead and find people places in alternative services. The responses were as follows:
|
Answer |
Total |
Percentage |
|
Strongly agree |
6 |
5% |
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Agree |
7 |
6% |
|
Neither agree nor disagree |
11 |
9% |
|
Disagree |
11 |
9% |
|
Strongly disagree |
82 |
66% |
|
Not sure |
5 |
4% |
|
Didn’t answer |
2 |
2% |
4.5 The full consultation results report can be found in Appendix 1 of this report, but the key messages included the following themes:
· Hookstead is seen as a vital service, providing a safe environment and a high standard of care. Family and carers rely on Hookstead for much needed respite;
· People are happy there. They have a routine, social connections and stability, which would be destroyed if the service closed;
· Family and carers are angry and upset about the proposal. They wanted to know why Hookstead has been proposed for closure instead of St Nicholas;
· It is wrong that there would be no day service in the north of the County;
· The building and facilities are better at Hookstead and money has been spent on improving it. There are concerns about how well St Nicholas could accommodate the additional people;
· People who attend the service are particularly concerned about being able to: attend on the same days for the same sessions, continue taking part in the activities they like, and see their friends;
· Closing Hookstead would cause significant distress for those who would be affected and family and carers said the majority of people at Hookstead are unlikely to want to move to St Nicholas;
· Travel is the main concern and many see the proposal as unrealistic. The journey would take much longer and wouldn’t work for many people and their families. The combined service could also be too busy and loud for some people;
· The few alternative services that are available have long waiting lists and private services would not provide the same level of care. This means that people could be left without a service if St Nicholas doesn’t work for them;
· Family and carers challenged the Council to provide detailed figures setting out how the savings would be achieved and questioned how much would actually be saved due to the cost of providing alternative support, transporting people further to access support and the risk that people may have to go into residential care if there is no day service for them;
· People said the proposal should not go ahead and Hookstead should stay open. If that wasn’t possible, family and carers urged the Council to consider allowing another provider to take over the service so that people could still have a service in their local area.
4.6 A petition opposing the closure of Hookstead day services was set up by a parent of an adult who accesses the service. At the County Council meeting on 11 February 2025, this petition was presented to the Chairman by Councillor Georgia Taylor, calling on the Council to “Stop the Closure of Hookstead Day Services in Crowborough”. The petition has not reached the 5000-signature threshold to trigger a Full Council debate. However, Standing Orders provide that the Chairman will refer the petition to the Cabinet or relevant Cabinet member to consider. The Chairman has referred this petition to Cabinet to consider as a relevant factor when deciding whether or not to implement the proposal set out in this report. A copy of the petition is available in the Members’ and Cabinet Rooms.
Equalities Considerations
4.7 In considering these proposals, Cabinet must have due regard to the need to:
(a) eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Equality Act 2010;
(b) advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it;
(c) foster good relations between persons who share a relevant protected characteristic and persons who do not share it,
as required under s.149 of the Equality Act 2010.
4.8 To better understand the likely impacts of the Proposal on those who have one or more protected characteristics, an Equality Impact Assessment (EqIA) has been carried out (a copy of which can be found in Appendix 2).
4.9 The responses from the consultation were used to inform the analysis carried out in the EqIA. Cabinet members must read and have regard to the EqIA when making the decision about this Proposal.
4.10 The Equality Impact Assessment told us that the impact of the original proposals will be upon adults with learning disabilities and their carers. All adults accessing the services included in the original proposals have a learning disability or have recognised additional needs. Some people have further complexities such as sensory impairment, physical disabilities and other health conditions which may impact on them further. A change in routine may cause anxiety as well as less opportunity for social interaction.
4.11 Carers of working age who are employed may have been negatively impacted by the original proposal as this could have resulted in carers not being able to maintain their current employment and potentially experience a reduction to their income. The proposed original reduction may also have impacted directly on carers’ mental and physical health.
4.12 The full equality impact assessment can be found in Appendix 2 of this report.
5.1 Our priority in Adult Social Care and Health is to meet our legal duties under the Care Act. To help us to do this, we have identified funding areas that we think need to be protected when we are looking at savings options.
5.2 These priority areas are the community care budget, carers support services, funding for the Voluntary and Community Enterprise Sector (VCSE), and funding for staffing frontline and care market roles.
5.3 The budget pressures faced by the Council has necessitated consideration of how we provide all our services, and ultimately difficult decisions about how we spend our money.
5.4 The Council currently runs two-day services in the west of the county. Given the financial pressures we face, and the need to get best value from the services we run ourselves, it was necessary to explore potential changes to these day services. By merging Hookstead with St Nicholas, this would have reduced the number of services the Council runs and would have generated cost savings by reducing both staff costs and building-based costs.
5.5 Following the feedback we have received, we have explored alternative options to the proposed closure of Hookstead that would still deliver the required level of savings. An alternative proposal suggested through the consultation was to retain Hookstead and close St, Nicholas Day Service instead. However, of the two services, St Nicholas Day Service would have had the capacity to offer an equivalent service to everyone attending Hookstead, but the same was not true for Hookstead (which could not accommodate everyone currently attending St. Nicholas). This proposal was therefore not explored further.
5.6 However, an alternative option that Cabinet are recommended to consider is for Hookstead Day Service for adults with learning disabilities to remain open for four days a week, but to reduce the capacity by 25%, from 45 adults per day to 34 adults per day. Hookstead is currently operating below capacity, and has been for some time, with the maximum current attendance being 33 people per day. Consequently, the reduction in capacity should not impact on adults currently accessing the service as their current provision would be unchanged.
5.7 However, if the proposal to retain Hookstead, albeit with a reduced capacity, is agreed, it is anticipated there may need to be some changes to the twilight sessions as set out in the table below, which are attended by up to eight people on each evening the service is open. This would be to ensure adequate staffing levels across all sessions given the reduction in staffing.
5.8 As no one currently attending Hookstead would be displaced under the revised proposal, it is no longer necessary to make any changes to the days St Nicholas Day Service opens. However, it is recommended that the session times change at both Hookstead and St. Nicholas to ensure people have the support they need over lunchtime, as well as providing enough non-contact time for staff to do administrative tasks and attend team meetings. We would continue to have a standard adult to staff ratio of five-to-one and provide one-to-one support to adults where they are assessed as needing this.
5.9 The table below sets out the proposed changes to session times at Hookstead and St Nicholas:
|
Session name |
Current times |
Proposed new times |
|
AM session |
9am to 12pm |
9.30am to 12pm |
|
PM session |
12.30pm to 3.30pm |
1pm to 3.30pm |
|
Twilight session |
4pm to 7pm |
4pm to 6.30pm |
Adults attending Hookstead or St Nicholas day services would still be able to arrive from 08:30am.
5.10 The estimated savings for this revised proposal are £68,000, leaving an additional £56,000 savings to be achieved elsewhere. Modified proposals for the Community Support Service (CSS), provided by the Council’s Learning Disability Directly Provided Services (LD DPS) (detailed in a separate report earlier on the agenda), if agreed, would achieve a greater saving than anticipated by the original proposal for CSS. There is potential, therefore, if Cabinet are so minded, that the additional savings from the CSS proposals could be used to support the revised proposal for Hookstead and St Nicholas. The £68,000 saving delivered through this proposal will be achieved through a proportionate reduction in the staffing levels at Hookstead to reflect the reduced capacity. It is anticipated that, as the service is holding vacancies, the majority of this will be through deleting vacant posts.
6.1 This section explores the impacts and risks of going ahead with the proposal, including those outlined in the EqIA.
Original proposal for Hookstead and St Nicholas
|
Current Budget |
Revised Budget |
Total Savings |
||
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2024/25 |
2025/26 |
2026/27 |
||
|
£'000 |
£'000 |
£'000 |
£'000 |
|
|
Expenditure budget |
1,116 |
987 |
987 |
|
|
Income budget |
(121) |
(116) |
(116) |
|
|
Net budget |
995 |
871 |
871 |
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|
|
|
|
|
|
|
Net savings |
0 |
124 |
0 |
124 |
Revised proposal for Hookstead
|
Current Budget |
Revised Budget |
Total Savings |
||
|
2024/25 |
2025/26 |
2026/27 |
||
|
£'000 |
£'000 |
£'000 |
£'000 |
|
|
Expenditure budget |
1,116 |
1,043 |
1,043 |
|
|
Income budget |
(121) |
(116) |
(116) |
|
|
Net budget |
995 |
927 |
927 |
|
|
|
|
|
|
|
|
Net savings |
0 |
68 |
0 |
68 |
The calculation of the revised budget assumes that:
· Services will remain at Hookstead at a reduced capacity, the costs of which form the revised budget;
· One-off costs to remodel the service will be absorbed in current ESCC budgets or met corporately.
6.3 The table below explores the potential impacts the proposal would have on the health and care system, organisations, services and residents.
|
Health and care system |
All adults who attend Hookstead have an assessed eligible Care Act need and whilst the original proposals were not a reduction in services, there would be a change to how they are provided. This would have had an impact on ASCH which would need to review all the adults, alongside offering a carers assessment to unpaid carers. If implemented, the original proposal could have impacted on adults' emotional wellbeing as a result of the changes to their day service and there is a possibility this could have increased demand on health settings, particularly specialist provision such as the Sussex Partnership Foundation Trust Community Learning Disability Team. Feedback from NHS Sussex highlights the potential impact on adults who require a quieter environment, the challenge in providing this in a busier day service and resulting challenge if this type of bespoke provision is not delivered effectively. This could have put additional strain on families, increase demand for health provision and potentially create additional challenges for some adults living in their family home. If the revised proposals are agreed, the degree of change for the adults who attend Hookstead, and their parent/carers, will be minimal thereby minimising the potential impact on the Health and Social care system. There would be capacity for future demand, although reduced from the current level. Hookstead has not been at capacity since opening therefore future demand isn’t anticipated to exceed the new proposed capacity of 34 people a day. |
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Organisations and services |
All changes in ASCH have an impact on other areas – if changes to social care packages are made, demand increases on Care Management, brokerage and finance teams. There could also be increased demand for services in the independent sector and the potential for this to spread to organisations such as Housing departments and Citizens Advice Bureau. Crowborough Town Council wrote: “The 18+ offering provided by Hookstead forms part of a transitional service supporting families and allowing carers to remain economically active within the community. Change to this offering will undoubtedly lead to families reassessing the viability of working outside the home, or indeed, the ability to care for their young person at home.” The new proposal would not necessitate much change for the people who attend, therefore the potential to increase demand on other organisations would be negligible. |
|
Residents |
The people who attend Hookstead, along with their parent/carers, are East Sussex residents – this proposal has caused a significant degree of distress and anxiety as Hookstead provides valuable support. The alternatives on offer under the original proposal would have necessitated a lot of change for some people. The revised proposal would have minimal impact on the current support provided, therefore removing the need to change any current arrangements. Other East Sussex residents who may require a day service in the future will still be able to be considered, although capacity would be more limited. |
6.4 The main risks of going ahead with the original proposal were:
· The journey time involved for adults to travel to Lewes rather than Crowborough is likely to be significantly longer. This may have been un-manageable for some people, and for most would be disruptive;
· Many adults attending Hookstead find managing change difficult and this can cause distress;
· Alternative options for Day Service provision in the north of the county are limited (please see appendix 4); if the majority of adults attending Hookstead declined the option of St Nicholas there could be a challenge identifying adequate alternative provision;
· These additional pressures could have created additional challenges to how and where adults live, with a potential for people to require 24/7 care and support rather than remain in their family home;
· Adults attending St Nicholas may have had the times they attend changed, causing distress and disruption to them and their parent/carers.
6.5 These risks are mitigated through modifying the proposal as described in section 5 of this report, namely retaining a reduced day service at Hookstead. The modified proposal would mean that all adults currently attending Hookstead could continue with their current service; therefore the risks set out above are significantly reduced if not negated.
7 Outline implementation plan
7.1 If this Proposal is agreed, those who currently attend the Hookstead day service would not experience any significant change to the service they currently receive. Similarly for St Nicholas as there would be no change to the day service there, other than the slight revision to session times set out in paragraph 5.9 above.
7.2 There may also be minor adjustments to twilight sessions at Hookstead, as per the table in 5.9 above which would be managed within the service, although this would not lead to any reduction in the service received.
7.3 To ensure the timescales for delivering savings can be met, we have already taken steps to begin consulting staff affected by the original proposal to close the Hookstead day service and merge with the day service at St. Nicholas. If the revised proposals are agreed, staff consultation will still be required. However, the final proposals for the consultation won’t be known until after Cabinet have made a decision on the proposals for Hookstead and St. Nicholas.
8 Conclusions and reasons for recommendations
8.1 The Council is required to set a balanced budget. The ‘State of the County’ report presented to Cabinet in June 2024 set out a projected £55m deficit on the 2025/26 budget. Savings proposals requiring public consultation that would help to close this gap were presented to Cabinet in September 2024.
8.2 The total savings proposals for the Medium-Term Financial Plan for 2025/26-2027/28 set out in November 2024 were £20.628m, across all Council departments. The Adult Social Care & Health (ASCH) contribution to the savings total is £11.455m. In addition to these savings proposals, in order to achieve a balanced budget, the Council is also drawing on its financial reserves.
8.3 The original proposals put forward were designed to contribute to the savings required for the County Council. It is clear from the consultation responses that the proposal to close Hookstead and merge with St Nicholas is not welcomed, with the vast majority of respondents disagreeing with the proposal.
8.4 Closing Hookstead would cause an element of disruption for adults who attend the service, and their parent/carers. While the alternative provision at St Nicholas in Lewes would be able to meet the needs of most adults if needed, the distance would be a significant barrier for some. The lack of alternative independent sector provision in the north of the county has exacerbated this concern.
8.5 We have carefully considered the consultation feedback and developed a revised proposal to retain the day service at Hookstead on four days per week and to reduce the capacity by 25% from 45 adults per day to 34. Cabinet are recommended to agree that the Day Service at Hookstead be retained, on this basis. As a result of this revised proposal, additional capacity would no longer be required at St Nicholas. Cabinet are therefore recommended to also agree that no changes to the service at St Nicholas be made at this time but that the session times be revised at both Hookstead and St. Nicholas, as set out in paragraph 5.9 of this report.
8.6 Cabinet are also recommended to delegate authority to the Director of Adult Social Care and Health to determine the days of the week on which ‘Twilight’ sessions can continue to be offered at Hookstead Day Service, and to take all necessary actions to give effect to the recommendations set out in this report.
8.7 Cabinet members must read and have regard to the EqIA when making decisions related to this proposal.
Director of Adult Social Care and Health
Email: Richard.lewisASC@eastsussex.gov.uk
Local members
Councillor Phillip Lunn, Councillor Wendy Maples
Background documents
Consultation Responses
Appendices
Appendix 1: Consultation Report
Appendix 2: Equality Impact Assessment
Appendix 3: Map of Hookstead Attendees locations
Appendix 4: Map of Alternative Day Service Provision