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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 cease the Community Support Service for adults living independently at home and adapt the service for adults living in supported accommodation |
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Purpose: |
To consider the outcome of the public consultation and to decide on the proposal to (a) cease the Community Support Service for adults living independently at home and (b) re-model the way care and support is provided to adults living in Learning Disability Supported Living Schemes.
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Cabinet is recommended to:
1) Agree:
(i) the proposal to cease the Council’s Community Support Service for adults living independently in the community in its current format;
(ii) to re-model the way care and support is provided by the Council’s Learning Disability Directly Provided Service to tenants in the Council’s Learning Disability Supported Living Schemes; and
(iii) to establish a new community outreach provision to meet the care and support needs of adults living independently in the community, as a replacement for the existing Community Support Service.
2) 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 (1) a proposal to cease providing the part of the Council’s Community Support Service (CSS) that provides support for people living independently and to support people to access alternative services; and (2) a proposal to re-model the Council’s Supported Living Service so that adults living in Support Living accommodation receive all their support from within the service rather than it being split between the Supported Living on-site staff and CSS staff (the papers are available: here).
1.2 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.
1.3 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 East Sussex Community Support Service is a registered service providing care and support for adults with a learning disability. The Council runs it and there are two parts to the service: Supported Living and Community Support.
Supported Living
2.2 The Council currently operates four supported living properties, with capacity for 33 tenants who each have their own tenancy. The service supports tenants with things like daily living tasks, personal care, and medication. The Council employs thirty members of staff to deliver this element of the service, although there are currently some vacancies.
Community Support Service
2.3 This part of the service supports adults living in their own home and adults living in supported living services who need more support than the onsite staff can provide. There are 35 adults living in their own homes that use the service, and they live across the county. All the residents in supported living receive additional support from this part of the service.
2.4 The service supports people to maintain their independence. The support ranges from helping people to do practical tasks such as shopping, cooking, and attending medical appointments, through to maintaining their social connections and relationships. The Council employs 22 members of staff to deliver this aspect of the service.
3.1 As set out above, there are two elements to the proposal that was consulted on. Firstly, it is proposed that the Council ceases the ‘CSS’ part of the service which supports adults living independently at home. Packages of care for such people would be re-commissioned to be provided by the independent sector.
3.2 The second part of the proposal is to adapt the service for adults living in the Council’s four Learning Disability Supported Living Schemes. Supported Living services would be reconfigured such that an individual's support was all provided by the accommodation-based staff rather than additional support being provided by the Council’s Community Support Service.
3.3 The estimated annual revenue savings in a full year for this proposal are £286,000.
3.4 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 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.
4.3 157 responses were received to this consultation, across the survey, consultation meetings and other feedback methods as follows:
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Respondent method |
Total |
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Survey |
126 |
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Email, phone calls etc. |
11 |
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Consultation meetings (attendees) |
20 |
4.4 Approximately two thirds of respondents across all response methods disagreed with the proposal to make changes to the Community Support Service:
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Answer |
Number |
Percentage |
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Strongly disagree |
72 |
46% |
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Disagree |
20 |
13% |
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Neither agree or disagree |
17 |
11% |
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Not sure |
3 |
2% |
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Strongly agree |
14 |
9% |
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Agree |
27 |
17% |
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Didn’t answer |
3 |
2% |
4.5 The full consultation results report can be found in Appendix 1, but the key messages included the following themes:
· The service supports people to live more independently, providing them with socialisation, stability, and a feeling of safety. It also provides valuable respite to family and carers;
· Stopping this service would affect the most vulnerable and disabled people in particular. It would also increase the burden on family and carers;
· It would destroy people’s support structures and stability, and affect their independence. This is likely to lead to poorer mental and physical health for those affected;
· There is concern about where people would get alternative support and how suitable this would be. People also disagree with the use of private organisations;
· Any change in routine and support for adults using this service would be particularly difficult, so careful risk assessments and planning would be needed to keep disruption to a minimum;
· There would be increased pressure on other services, which would ultimately lead to an increase in cost and limit any savings made from closing the service;
· People suggested that the service shouldn’t be closed and savings should be found elsewhere.
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 out 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 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 are deemed to be vulnerable. Some people may have further complexities such as sensory impairment, physical disabilities, and other health conditions. This proposal will not impact carers as much as others within Learning Disability Directly Provided Services as it predominantly affects people living independently in their own home. No negative impacts on any other protected characteristics were identified.
4.10 The full equality impact assessment can be found in Appendix 2 of this report.
5 Revised Proposal for this Service
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, Community and Social Enterprise (VCSE) sector, and funding for staffing frontline and care market roles.
5.3 While we recognise the importance of these services, the budget pressures we face mean that we have to make difficult decisions about how we spend our money. One of the suggestions made through the Consultation was that the Council should not cut this service and should achieve the saving by cutting other services instead. However, given that there are alternative services available that can provide community support to people, in the current financial position, it is not possible to continue to fund this service without making significant changes.
5.4 We have carefully considered the feedback received from the consultation and the impacts for those with protected characteristics identified by the Equality Impact Assessment. We have also undertaken an assessment of the alternative provision available in the independent sector.
5.5 In reviewing the proposal, it has become evident that, for those living independently at home and receiving the CSS element, having a Personal Assistant (PA) would be the most appropriate alternative to CSS. However, from a review of the independent sector we do not consider that sufficient provision could be provided by Personal Assistants at this time.
5.6 Therefore, this proposal has been modified to develop an alternative model of support for those living independently. Under the revised proposal, the existing CSS offer would still be ceased; however, the support for these adults could be re-provisioned within Learning Disability Directly Provided Services. Specifically, the Council would establish a new Community Outreach offer operating from the existing day service hubs at Beeching Park in Bexhill and St Nicholas in Lewes.
5.7 This would provide a Monday to Friday provision between the hours of 9am and 6pm. CSS is currently available between 7am and 10pm seven days a week; however, delivery currently is only between 9am and 5pm, and therefore within the hours of the proposed Community Outreach offer. This would ensure that the assessed care needs of the adults impacted by the proposed closure of CSS would continue to be met.
5.8 There are, however, five Adults accessing some of their support at weekends and these people would still be impacted by this proposal. These adults will be offered an ASCH Review and will be supported through this process to either change the day they receive support or to identify an alternative form of support for them at weekends.
5.9 The revised model of service delivery proposed in this report will:
· achieve the necessary savings;
· ensure that care and support needs continue to be met;
· minimise the disruption caused to most adults accessing this element of the service.
5.10 By revising the service in this way, the savings achieved would be £342,000, which is £66,000 greater than the anticipated saving for the original proposal. This funding would then be available to contribute towards the Council’s savings target for 2024/25. It is anticipated that this could be used to mitigate the impact of a reduced saving on another ASCH proposal, set out in a separate item on the agenda, for Hookstead Day Services.
5.11 The proposal to adapt the service for adults living in the Council’s four Learning Disability Supported Living Schemes would remain unchanged.
6 Impacts and risks
6.1 This section explores the impacts and risks of going ahead with the proposal, including those outlined in the EqIA.
Financial implications
6.2 The Community Support Service is currently operating with a net budget of £637,000. By making the changes proposed in this report and providing a new ‘Community Outreach’ offer, it would be possible to re-provide services internally at a reduced cost of £285,000.
6.3 This would over-deliver on the original proposal of a £286,000 saving by £66,000, delivering a total of £342,000 per annum as set out below:
Savings summary for original CSS proposal:
|
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 |
712 |
351 |
351 |
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Income budget |
(75) |
0 |
0 |
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Net budget |
637 |
351 |
351 |
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|
|
|
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Net savings |
0 |
286 |
0 |
286 |
Savings summary for revised CSS proposal:
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|
Current Budget |
Revised Budget |
Total Savings |
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|
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2024/25 |
2025/26 |
2026/27 |
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|
|
£'000 |
£'000 |
£'000 |
£'000 |
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Expenditure budget |
712 |
285 |
285 |
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|
Income budget |
(75) |
0 |
0 |
|
|
Net budget |
637 |
285 |
285 |
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|
|
|
|
|
|
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Net savings |
0 |
342 |
0 |
342 |
The calculation of the revised budget assumes that:
· Services will largely be re-provisioned by a new Community Outreach offer as set out in section four, 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.
6.4 As set out above, it is proposed that the additional £66,000 saved by this proposal could be used to off-set a reduced savings target on the proposal for Hookstead day services (a later item on this agenda).
6.5 The table below explores the potential impacts the original and revised proposals would have on the health and care system, organisations, services, and residents.
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Health and care system |
There was the potential for the original proposal to impact on the health and care system in different ways. The CSS team are skilled and dedicated, and replacing this effectively will be essential to avoid a negative impact on adults who access the service. Health organisations have raised a concern that this could cause a rise in missed appointments that could impact on the quality of health care an adult receives, along with increasing the pressure on the health system. Re-provisioning the care and support will increase demand on independent sector providers, while these changes would also increase demand for ASC teams carrying out additional reviews and sourcing placements. The impact on the Health and Care system from the revised proposal is significantly reduced. There would be continuity of care should adults accessing their support from CSS choose to receive support from the new community outreach offer. Similarly, this would reduce the potential impact on the independent sector. This revised proposal could still result in the loss of skilled staff from the workforce although the Community Outreach offer would create an additional five posts available for re-deployment should this proceed. |
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Organisations and services |
As the adults supported by CSS live independently many access a range of other organisations and services such as Department of Work and Pensions, housing benefit, probation etc. and they would often be supported by CSS to access these organisations. Without CSS there is a risk these appointments could be missed, generating more work for re-arranging missed appointments and possibly the support not being correctly received e.g. housing benefit not being paid. The impact on organisations and services would be reduced in the revised proposal should adults accessing support from CSS choose to receive their support from the Community Outreach offer. Where some adults will be impacted this could add some pressure to other organisation as described.
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Residents |
All the adults who receive support from CSS are East Sussex residents, as are many of their parent/carers. This proposal has caused a level of distress and anxiety as adults are concerned their care and support provider might change, although the quantity of support they receive is defined by their assessment. Many parent/carers are also East Sussex residents and knowing their relative has support from CSS provides great assurance. It is recognised that consulting on peoples care & support has caused anxiety for the adults accessing support from CSS and their parent/carers. It is anticipated that the revised proposal will lessen that as there would be an option for Care and Support to be provided by the new Community Outreach offer. There would be some minor changes to how that support is provided, and those receiving their support at a weekend will need to work with care management to review how this is provided. |
6.6 The main risks of going ahead with the original proposal are:
· The current supply available in the Personal Assistant market risks there not being suitable alternative options for re-commissioning this support;
· There is a risk that this change could have a negative impact on the wellbeing of adults involved;
· There is a risk that this could increase demand on other health and care settings
6.7 The revised proposal to develop a Community Outreach provision will mitigate these identified risks by ensuring a suitable alternative service is provided by Learning Disability Directly Provided Services.
6.8 The five adults who currently receive support at the weekend will unfortunately experience disruption to their current services. We anticipate commissioning alternative service for this smaller group of people will be possible from within available supply. Additionally, the impact upon these people will be mitigated by providing them with additional support in terms of adjusting to the changes and, where required, identifying alternative service provision at the weekend.
7 Outline implementation plan
7.1 If this Proposal is agreed:
· 25 Feb 2025 – Cabinet Decision.
· March 2025 – Adult’s reviews will commence and take place over a 4-week period.
· April 2025 - As reviews identify alternative provision adults will be supported in the transition to their new service.
· June 2025 - CSS closes. The re-modelled supported living settings will be established.
7.2 To ensure the timescales for delivering savings can be met, we have taken steps to begin consulting staff affected by the proposals set out in this report; however, the final proposals for staff consultation won’t be known until after Cabinet have decided on these proposals.
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 Council. It is clear from the contributions to the consultation that these proposals are not welcomed, with the vast majority of respondents disagreeing. We have considered all of the feedback from the consultation process in putting together the revised proposals set out in this report.
8.4 It is recognised that ceasing the provision of CSS for adults living independently would cause an element of disruption for those involved and anxiety for the parent/carers involved. It has also become clear that the Personal Assistant market is not in a position to address the care and support needs of all of the adults accessing CSS support in the community. Cabinet are therefore recommended to agree the closure of the current Community Support Service and to agree to the establishment of a new community outreach service that will provide these services instead.
8.5 The proposal to re-model supported living provision would improve the way that element of the service is delivered and therefore the experience of adults living in Supported Living settings. The remodelled support would improve the consistency of support adults receive and therefore the quality of their care. Cabinet is therefore recommended to agree to implement the remodelled service provision at the Council’s Learning Disability Supported Living Schemes so that all tenants’ care and support is provided by the accommodation-based staff.
Director of Adult Social Care and Health
Tel. No: 07701 395081
Email: richard.lewisASC@eastsussex.gov.uk
Local members
Councillor Phillip Lunn, Councillor Gerard Fox, Councillor Johnny Denis, Councillor David Tutt, All
Background Documents
Consultation responses
Appendices
Appendix 1: Consultation Report
Appendix 2: Equality Impact Assessment