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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 Milton Grange Day Service for older people |
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Purpose: |
To consider the outcome of the public consultation and to decide on the future of Milton Grange Day Service for older people with a range of physical and mental health needs associated with dementia |
Cabinet is recommended to:
1) Agree to continue to provide day services at Milton Grange, in Eastbourne, for older people with a range of physical and mental health needs associated with dementia;
2) Agree that the service provision at Milton Grange Day Service in Eastbourne be remodelled as set out in paragraph 5.8 of this report; 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 close the Milton Grange Day Service in Eastbourne for older people with a range of physical and mental health needs associated with dementia, and to support people to access alternative services 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 Milton Grange Day Service in Eastbourne is managed within Older People’s Directly Provided Services, supporting approximately 89 older people. The service delivers a range of support and activities to older people living in the community who have mental health and physical needs, including some complex needs that require one to one support.
2.2 The aim of the service is to prevent social isolation and provide respite for carers.
2.3 The service is based in Eastbourne and provides a day service that has capacity to provide places for 45 people per day, Monday to Friday, and up to 25 people per day on Saturday; offering a maximum weekly total of up to 1,500 hours of care and support per week. A hot lunch and transport to and from the day service is provided.
2.4 Based on the current staffing structure and complexity of people attending, the maximum capacity per day is 35 Monday to Friday and 25 on a Saturday (total of 200 places per week). For the last year the Occupancy vs Total Spaces available is 75% and the Occupancy vs Allocated Spaces is 78%.
2.5 Most people who attend the service, attend for one or two days per week.
2.6 Milton Grange day services have 22 staff (19.56 full time equivalent) covering a range of different roles. These staff are employed by the Council.
2.7 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 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.
3.1 The proposal that went out to public consultation is to close the Milton Grange Day Service in Eastbourne for older people with a range of physical and mental health needs associated with dementia, and to support people to access alternative services in the community.
3.2 The estimated annual revenue savings for a full year for this proposal are £203,000.
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.
4.2 All the feedback received during the consultation is available within the Members’ and Cabinet Rooms for Members’ consideration.
4.3 284 responses were received to the consultation on this proposal, as follows:
|
How feedback given |
Number of responses |
|
Survey |
206 |
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Meetings |
62 |
|
Letter and email |
16 |
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Total |
284 |
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Response |
Total |
Percentage |
|
Strongly disagree |
179 |
87% |
|
Disagree |
15 |
7% |
|
Neither agree nor disagree |
3 |
1% |
|
Agree |
3 |
1% |
|
Strongly agree |
6 |
3% |
|
Not sure |
0 |
0% |
|
Didn’t answer |
0 |
0% |
4.5 The final public consultation analysis report is attached as Appendix 1. The key themes raised in the consultation were:
· The service is a vital lifeline for those who attend and is crucial in providing respite for their families and carers. It provides valuable socialisation and mental stimulation, which help to prevent people’s needs becoming more complex;
· The service is praised as being high quality and people value the specialist skills and knowledge of the staff. The service is the only one if it’s kind and closing it would be short-sighted;
· The alternative options are seen as being unsuitable, both in terms of the support on offer and the potential travel time to get there;
· If the service closed it would affect the mental and physical health of those affected and put them at increased risk of isolation. It would also increase the burden on family and carers, affecting their ability to take respite and maintain their employment if they work;
· The likely outcome is that people need to access more expensive support and in some cases people may have to go into residential care sooner than needed. This would be more expensive for the Council in the long run and would increase pressure and costs on other services.
· People said that the Council should keep the service open and look for savings elsewhere, although some suggested charging more for the service.
4.6 The Council also received feedback from independent sector providers who expressed an interest in taking over the running of the service.
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). The EqIA was updated to reflect the revised proposals for Milton Grange Day Services which are set out in section five.
4.9 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 decisions related to this proposal.
4.10 The service is for older people aged 65+ and nearly half (48.3%) of those accessing the service are aged 85+. Closing Milton Grange Day Services would therefore have a negative and disproportionate impact on older people. Respondents to the public consultation said this is one of very few services to support older people, who would be at increased risk of isolation, deterioration of physical and mental health, loss of independence and increased risk of entering residential care earlier, if the service was closed. Continuing to offer a different model of day services at Milton Grange would mitigate this impact.
4.11 Older people living in poverty and/or in rural areas may be acutely impacted by reduced access to alternative services due to lack of transport links and increased cost/time to get to alternative services. The proposal to close the day service may also have a negative impact on disabled people. Most people accessing the service have a physical, neurological or mental health condition including dementia - only 3.9% did not have a long-term health condition. Respondents to the public consultation highlighted that the day service staff have specialist skills and knowledge. Without this specialist support it is likely that people’s dementia will worsen more quickly. Continuing to offer a different model of day services at Milton Grange would mitigate these impacts.
4.12 Ceasing to provide day services at Milton Grange could also have a knock-on effect on carers, for whom this service is a ‘vital lifeline’, providing crucial respite and preventing people’s needs from becoming more complex. Closing Milton Grange Day Service could increase the burden on carers and reduce their ability to have respite from their caring role. This could increase the likelihood of carer breakdown, where carers will no longer be able to continue in their role, which could put people at risk of moving into residential care prematurely. Given that the majority of carers in the UK are women, the proposal could disproportionately impact on women who are carers. Continuing to offer a different model of day services at Milton Grange would mitigate these impacts.
4.13 The full equality impact assessment can be found in Appendix 2 of this report.
5 Revised Proposals for the Milton Grange Day 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 and community enterprise sector (VCSE), and funding for staffing frontline and care market roles.
5.3 A review of the current adults attending Milton Grange has highlighted the following:
· Approximately 89 older people with mid to high care & support needs currently attend Milton Grange;
· 78% of current attendees require transport to the service;
· 97% of current attendees require a meal.
5.4 A review of capacity within the independent day service market has also been completed. A map of available provision is set out in Appendix 3. This review has highlighted:
· Currently there is insufficient capacity within existing independent day care services to provide sufficient places for everyone currently attending Milton Grange. Currently it is unlikely all adults could receive a ‘like for like’ alternative service if Milton Grange Day Service closed. Additional independent sector day services would need to be developed to provide the additional capacity required;
· 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 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 for individuals may increase based on where the market capacity is available. Some adults may not want to or be able to travel further distances and the costs of such travel may increase;
· Most services provide meals; however, not all include this within the day rate and therefore some will incur an additional charge;
· The type of transport offered be some services may not be suitable to meet the needs of the adults at Milton Grange, most of whom travel via minibus which is wheelchair accessible and includes provision of escorts. Transport options would need to be reviewed when considering alternative day services.
5.5 Appendix 4 provides a map of where people attending day services at Milton Grange live in the county.
5.6 As part of the consultation process, several ideas and suggestions were put forward that it was suggested could generate similar savings to the original proposal.
5.7 In light of this feedback, and the wider feedback from the consultation, alternative proposals to closing day services at Milton Grange have been explored. This has resulted in a proposal that would enable the Council to keep Milton Grange Day Service open, but with a revised delivery model that can meet people’s needs, is financially viable and can deliver the required saving of £203,000.
5.8 Under the revised proposed model, provision at Milton Grange Day Service would reduce from the current six days per week to five days a week, Monday to Friday (excluding bank holidays) as occupancy on Saturdays is currently very low. If Cabinet agree to the revised proposal, adults that currently attend Milton Grange Day Service on a Saturday will be offered a service on another day during the week.
5.9 By stopping the services on a Saturday, this will deliver other operational efficiencies such as no longer requiring taxis for weekend transport. The revised model will also involve better utilisation of our existing transport fleet (busses and pool cars), including by grouping people who use the day service according to where they live.
5.10 Cost reductions will also be achieved through back-office changes to the existing staffing structure. Such changes will be subject to staff consultation, where required, prior to implementation.
5.11 Information on a proposal to cease providing day services for older people at the Phoenix Centre in Lewes is found later on the agenda. If Cabinet agree to close the day services at the Phoenix Centre, there is the potential for people to be offered a place at Milton Grange Day Service as one of the alternative options to meet their needs. Milton Grange Day Services are currently operating below capacity level and with a revised model can accommodate approximately ten additional places per day depending on the needs of the attendees.
6 Impacts and risks
6.1 This section explores the impacts and risks of going ahead with the alternative proposal set out in this report to keep Milton Grange Day Service open but with a revised operating model.
6.2 Financial implications:
The proposal to remodel the day service at Milton Grange corresponds to savings of £203,000 per annum, as set out in the table below.
|
Current Budget |
Revised Budget |
Total Savings |
||
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2024/25 |
2025/26 |
2026/27 |
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|
£'000 |
£'000 |
£'000 |
£'000 |
|
|
Expenditure budget |
767 |
526 |
526 |
|
|
Income budget |
(212) |
(174) |
(174) |
|
|
Net budget |
555 |
352 |
352 |
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|
|
|
|
|
|
|
Net savings |
0 |
203 |
0 |
203 |
The calculation of the revised budget assumes that:
· The number of people who attend Milton Grange day services remains broadly in line with the current service;
· Any 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 alternative proposal to retain a re-modelled Milton Grange Day Service would have on the health and care system, organisations, services and residents.
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Health and care system |
There should be no negative impact on the wider system as it is proposed that Milton Grange Day Service remains open with a remodelled service |
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Other organisations and services |
There should be no negative impact on other organisations and services as they will continue to be able to refer into Milton Grange Day Service
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Residents |
There should be little or no negative impact on adults who currently receive this service, or who will use the service in the future, as it is proposed Milton Grange remains open Those adults currently attending at Milton Grange on a Saturday will be offered another day during the week. |
6.4 The main risks of going ahead with the proposal are:
· Should there be an increase in demand for the service in the future, the remodelled service may be unable to meet this demand within the proposed budget;
· The remodelled service may not be able to offer as much flexibility due to the requirement to reduce transport costs by ringfencing geographical areas to specific days.
6.5 These risks are minimal and would be similar across the entire care sector including independent sector provision.
7 Outline implementation plan
7.1 If Cabinet agree to retain a re-modelled Day Service at Milton Grange in Eastbourne, all adults who attend Milton Grange on a Saturday will be offered an individual review to consider whether their support package, considering the service changes, continues to meet their assessed needs. Where it is deemed that the remodelled Milton Grange Day Service is not sufficient to meet the individual’s assessed needs, Care Managers will seek alternative support for those individuals.
7.2 As part of the individual service reviews mentioned above, carers would also be offered a carer’s assessment, or a review of their assessment, to determine whether support packages, using the revised Council offer, continue to meet their assessed need.
7.3 To ensure the timescales for delivering savings can be met, we have taken steps to begin consulting staff affected by the remodelled service offer at Milton Grange; 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 revised proposal.
7.4 There would be no changes regarding the building as the remodelled service would remain in its current location on the Milton Grange site.
7.5 It is proposed that, if agreed, the revised model will commence operation from 1 July 2025.
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 by ASCH were designed to contribute to the savings required by the County Council. It is clear from the feedback highlighted in the consultation that most respondents disagree with the original proposals to close Milton Grange and to support people to access alternative service in the community.
8.4 We have considered the feedback received and have been able to produce an alternative proposal that maintains day services at Milton Grange in Eastbourne and which still achieves the same level of savings.
8.5 Cabinet are therefore recommended to retain day services at Milton Grange which will continue to support people with a range of physical and mental health needs associated with dementia, and to agree that the service be re-modelled and operate five days per week instead of six, which will deliver savings of £203,000.
8.6 Cabinet members must read and have regard to the EqIA when making decisions related to this proposal.
Director of Adult Social Care and Health
Tel. No: 07748 931426
Email: Paul.welch@eastsussex.gov.uk
Local members
Councillor John Ungar
Background Documents
Consultation responses
Appendices
Appendix 1: Consultation Report
Appendix 2: Equality Impact Assessment
Appendix 3: Map of Alternative Day Services in East Sussex
Appendix 4: Map of Milton Grange Attendees Locations