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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: |
Proposal to close the Phoenix Centre Day Service for older people |
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Purpose: |
To consider the outcome of the public consultation and to decide on the proposal to close the Phoenix Centre Day Service for older people with physical and mental health needs, and support people to access alternative services in the community |
Cabinet is recommended to:
1) Agree to close the Phoenix Centre Day Service in Lewes for older people with physical and mental health needs;
2) Agree that the Council will support people to access alternative services in the community which, subject to Cabinet’s decision on the Milton Grange Day Service proposals, will include the East Sussex County Council run Day Service, Milton Grange in Eastbourne; and
3) Delegate to the Director of Adult Social Care and Health authority 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 a proposal to closethe Phoenix Centre Day Service in Lewes for older people with physical and mental health needs, and support people to access alternative service in the community (a copy of the papers are available: here). This 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.
1.2 The consultation ran between 3 October and 28 November 2024. The impact of the new funding settlement for the Council has been considered when making the proposals in this report.
2.1 The Phoenix Centre is managed within Older People’s Directly Provided Services, supporting approximately 32 older people. The service provides a range of support to older people with a range of complex physical and mental health needs, some requiring one to one support.
2.2 The service is based in Lewes and has the capacity to offer care and support for up to 25 people per day, Monday to Friday, for 6 hours per day; offering a maximum weekly total of 750 hours. A hot lunch and transport to and from the day service is provided.
2.3 Based on the current staffing structure and complexity of people attending, the current maximum places per day is 15 (total of 75 places per week). For the last year the Occupancy vs Total Spaces available is 56% and the Occupancy vs Allocated Spaces is 81%
2.4 The aim of the service is to prevent social isolation and provide respite for carers. Most people attend one or two days a week.
2.5 Phoenix Centre have 12 staff (8.26 full time equivalent) covering a range of different roles. These staff are employed by the Council.
2.6 In formulating these proposals, consideration was given to the following challenges to current service provision:
· Demand for day services has reduced in the wake of the covid-19 pandemic, which has resulted in lower occupancy and a consequent increase in unit costs.
· The cost effectiveness of the service at a time when the County Council is facing significant financial challenges; and
· The opportunity to consider alternative ways to meet the needs of the people who currently use these services.
2.7 In proposing to discontinue the direct provision of day services at the Phoenix Centre, consideration has been given to alternative provision in the community. This includes accessing existing independent sector day services where these are appropriate to meet peoples’ needs and accessing support via personal assistants (PA’s).
3.1 The proposal consulted on is to close the Phoenix Centre Day Service for older people with physical and mental health needs, and support people to access alternative service in the community.
3.2 The estimated annual revenue savings in a full year for this proposal are £191,000.
3.3 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.
3.4 The consultation responses are summarised in section 4 below and highlight several potential impacts.
4. Insight
4.1 An eight-week public consultation on the 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.
4.3 323 responses were received for the consultation, as follows:
|
How feedback given |
Number of responses |
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Survey |
285 |
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Meetings |
21 |
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Letter and email |
17 |
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Total |
323 |
4.4 Most respondents across all response methods disagreed with the proposal to stop providing the day service at the Phoenix Centre and support people to access alternative services in the community:
|
Response |
Total |
Percentage |
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Strongly disagree |
240 |
84% |
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Disagree |
24 |
8% |
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Strongly agree or agree |
10 |
3% |
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Neither agree nor disagree |
11 |
5% |
4.5 The final public consultation analysis report is attached as Appendix 1. The key themes raised in the consultation were:
· The service is vital for those who attend, particularly for the social interaction it offers, and for the respite it provides for families and carers. It is also not clear what alternative services there are;
· The current location of the service in Lewes is a strength, as it is convenient and easily accessible. Money has recently been spent on the building, and this would be wasted if it closed;
· If it closed, people would become isolated, lose social contacts, and experience a reduction in their mental health and wellbeing, while families and carers would be under more strain;
· Transporting people to an alternative service would be very expensive and not everyone would be able or willing to travel further;
· Moving into residential care, or receiving a service at home, were often not practical or palatable options for people;
· Closing the service would be short-sighted and the amount saved would be small, particularly if people end up going into more costly residential care as a result;
· People said the service should stay open because it is vital to many people and offers a community benefit to the area. It was suggested that more money be raised by charging more and renting out space in the building.
Equalities Considerations
4.6 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.
4.7 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).
4.8 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.
4.9 The service is for older people aged 65+ and 43.9% of those accessing the service are aged 85+. The proposal to close the service will therefore have a negative and disproportionate impact on older people. For some, this service may be their primary source of social interaction, and the proposal would mean a loss of local services and friendship networks.
4.10 Respondents to the public consultation said that the service is vital for older people with more complex needs. The change in routine could be disruptive and result in a more difficult commute to alternative services. Organisations were concerned that suitable alternative services are not available which could increase isolation and may cause people to decline or go into crisis. This in turn could result in people requiring more expensive services and/or or moving into residential care earlier.
4.11 The proposal to close the service will also have a negative impact on disabled people. Most people accessing the service have a physical, neurological or mental health condition including dementia - only 3.5% did not have a long-term health condition. Respondents to the public consultation highlighted that the proposal will be detrimental to disabled people in particular and that the mental health and wellbeing of those accessing the service, and their carers, will be affected.
4.12 People told us that the service is important to and valued by carers. If the service were to be closed, this could increase the burden on carers and reduce their ability to access crucial respite from their caring role. This could increase the likelihood of carer breakdown where carers will no longer be able to continue in their caring role, which could put people at risk of moving to residential care prematurely.
4.13 The proposal will also have a disproportionate impact on women. 70.2% of those accessing the service are women, which is significantly higher than the proportion of women in the county (52%). Given that the majority of carers in the UK are women, the proposal could also disproportionately impact on women who are carers. Older people and disabled people living in poverty and/or in rural areas may be particularly impacted by reduced access to alternative services due to lack of transport links and increased cost/time to get to alternative services.
4.14 If Cabinet agree to continue to provide day services at Milton Grange (details of this proposal are covered in a separate item on the agenda), this could mitigate these impacts for some people by offering Milton Grange as one of the alternative services available to meet people’s needs.
4.15 The full equality impact assessment can be found in Appendix 2 of this report.
5. Alternatives considered and Mitigations
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 While we recognise the importance of this service, the budget pressures we face mean that we must make difficult decisions about how we spend our money.
5.4 Under the Care Act, we are required to meet people’s eligible needs, but that does not necessarily mean providing the service ourselves. We have seen a reduction in attendance at this day service since the pandemic and it has been challenging to increase the numbers attending to a financially viable level.
5.5 A review of the current adults attending Phoenix centre has highlighted the following:
· Approximately 32 people with mid to high care & support needs currently attend the service;
· 72% require transport to the service, 100% require a meal.
5.6 A review of independent day services available within the County has been undertaken. A map of available services is set out in Appendix 3. This review has highlighted that:
· There may be limited choice within existing independent day care services for everyone who currently attends day services at the Phoenix Centre. Additional capacity at Milton Grange Day Services would be beneficial in offering people another service option to consider;
· Costs vary depending on length of sessions and level of support provided and rates range between £50 - £120 per person per session;
· Those services providing higher levels of support such as support for people with dementia are likely to be at the higher end of the rates set out above;
· Most services provide transport; however, some of these arrangements incur an additional cost and are limited to certain locations;
· Travel distance may increase where capacity is available, some adults may not want to or be able to travel the extra distance and costs may increase;
· Most services provide meals; however, not all include this within their attendance rates and therefore this will incur an additional charge.
5.7 Appendix 4 provides a map showing where attendees of day services at the Phoenix Centre live in the county.
Alternative Providers
5.8 During the consultation period, some third-party providers contacted the Council to express an interest in taking on the provision of day services from the Phoenix Centre. Fixed and transferable costs mean that this would not realise the required saving and so this has not been pursued as a viable alternative.
Mitigation
5.9 Following the feedback received through the consultation, the Council has considered whether there is scope to retain any Phoenix Centre Day service provision in the Lewes area without impacting on the agreed savings target for this service area. Unfortunately, we have concluded that it is necessary to close the day service in order to achieve the required savings.
5.10 However, in light of the risks and impacts of closure, as highlighted above, consideration has been given to how these can be mitigated. As set out above, Cabinet are asked to consider another ASCH savings proposal relating to Milton Grange in Eastbourne, in a separate item on the agenda. Subject to Cabinet’s decision on whether Milton Grange Day Services remain open, adults currently attending day services at the Phoenix Centre could be offered alternative provision at Milton Grange as well as in the independent sector.
5.11 Milton Grange has been used successfully on several occasions to provide an alternative day service for adults receiving their day service at the Phoenix Centre. For example, when the Phoenix building was closed for several weeks for major refurbishment works, adults accessing the service were temporarily accommodated at the Milton Grange Day Service and this worked well.
6. Impacts and risks
6.1 Financial implications:
The proposal to close the Phoenix Centre Day Care service corresponds to savings of £191,000 per annum, as set out in the table below.
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Current Budget |
Revised Budget |
Total Savings |
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2024/25 |
2025/26 |
2026/27 |
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|
£'000 |
£'000 |
£'000 |
£'000 |
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Expenditure budget |
383 |
158 |
158 |
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|
Income budget |
(110) |
(76) |
(76) |
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Net budget |
273 |
82 |
82 |
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|
|
|
|
|
|
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Net savings |
0 |
191 |
0 |
191 |
The calculation of the revised budget assumes that:
· Services will largely be re-provisioned in the private sector or at Milton Grange as described above.
6.2 The table below explores the potential impacts the proposal would have on the health and care system, organisations, services and residents.
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Health and care system |
There is a possibility this could increase demand on health settings. |
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Organisations and services |
All adults who attend the Phoenix Centre have an assessed eligible Care Act need and whilst the proposals are not a reduction in services, there would be a change to how those needs are met. This would have an impact on ASCH which will need to review all the adults and offer a carers assessment or review to unpaid carers. |
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Residents |
Changes of circumstances that impact on adults will also have an impact on their family and carers. One of the reasons that people attend days services is to provide carers with a break, enabling them to continue in their caring role and for some carers, enable them to continue working. If day services are discontinued, and it is not possible to find a suitable alternative, there is a risk of carer breakdown where carers will no longer be able to continue in their caring role. This may create further risk of people having to move to long term care prematurely. 60% of adults accessing services at the Phoenix Centre have informal carer support. There is a risk that the new offer of a day service at a different location or alternative support does not meet their needs or results in the potential loss of friendship networks. |
6.3 The main risks of going ahead with the proposal are:
· Increased transport time to access alternative services;
· Changes to the days people attend. This will be dependent on capacity within alternative services;
· A significant change in how or where people receive their service in the future. This may have an impact on their health and wellbeing.
7. Outline implementation plan
7.1 If Cabinet agree to close the Phoenix Centre, all adults who are affected will be offered an individual review to consider whether their support package, considering the service closure, continues to meet their assessed needs.
7.2 Where it is agreed that day services are the best way to meet assessed needs, Care Managers will seek alternative support across all day service provision, including (subject to Cabinet agreeing the proposals in relation to Milton Grange Day Services) at Milton Grange in Eastbourne.
7.3 As part of the individual service reviews mentioned above, carers would be offered a carer’s assessment, or a review of their assessment, to determine whether support packages continue to meet their assessed need.
7.4 To ensure the timescales for delivering savings can be met, we have taken steps to begin consulting staff who will be affected by this proposal; however, the final proposals for staff consultation will not be known until after cabinet have made the decision whether or not to proceed with this proposal.
7.5 As the day service is the majority user of the building, if the proposed closure of the service goes ahead, we would work with Property colleagues to find alternative provision for other users of the building and look at suitable options for the vacated site.
8. Conclusions and reasons for recommendations
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 by the Council. It is clear from the feedback highlighted in the consultation, that most respondents disagree with the proposal to close the Phoenix Centre Day Service and to support people to access alternative services in the community.
8.4 However, the savings of £191,000 cannot be met unless we close the Phoenix Centre Day Service and look at alternative options for meeting the assessed care needs of the 32 people currently using the service.
8.5 Having considered the feedback from the consultation process we have identified the potential mitigation as set out in this report, namely, to offer adults receiving a service at the Phoenix Centre the opportunity to consider the Milton Grange Day Service as well as other alternative services in the community. This is subject to Cabinet’s decision on Milton Grange Day Services.
8.6 Cabinet are therefore recommended to agree to close the Phoenix Centre Day Service in Lewes for older people with physical and mental health needs. Cabinet are recommended to agree that the Council supports people to access alternative services in the community, which will (subject to Cabinet agreement) include the East Sussex County Council run day service, Milton Grange in Eastbourne. This will ensure that the eligible needs of these people are still met whilst allowing the Council to achieve the required £191,000 savings.
Director of Adult Social Care and Health
Tel. No: 07748 931426
Email: Paul.welch@eastsussex.gov.uk
Local members
Councillor Johnny Denis, Councillor John Ungar
Background Documents
Consultation responses
Appendices
Appendix 1: Consultation Report
Appendix 2: Equality Impact Assessment
Appendix 3: Map of Alternative Provision
Appendix 4: Map of adults attending the Phoenix Centre