This report contains the results of the Base Budget Review exercise undertaken by Leading Members and officers over the last 3 months in response to reducing public funding and the Council’s aim of minimising Council Tax.

Report of the Director of Adult and Community Services attached.

Councillor Urquhart addressed the committee; she gave a political steer on the information contained within the report.  She referred to the national agenda and the economic era of austerity which we had unfortunately entered.  She emphasised that although there would be changes to the care provided by Richmond Council which until now had been generous and above statutory requirements, the council would continue to provide for those most in need and their carers.  She also stressed that the budget proposals before the committee tonight were for consultation and comments and ideas would be taken very seriously and each one investigated.

Cathy Kerr, Director of Adult and Community Services addressed the Committee, she guided committee members though the information contained in the report and in particular referred to the three main changes:

(i)      Changes to SDS payments in particular the removal of the current cap (£320) for those with the financial means to pay more and changes to take disability benefits into account when assessing a person’s financial contribution.  

(ii)    Changes to eligibility criteria and reduction of eligibility bands from 3 (moderate)to 2 (substantial).  Comparisons with other local authorities showed that Richmond had been particularly generous in the past.

(iii)   Rationalisation of intensive day care centres which would result in reducing sites from 4 to 2 specifically closing Tangley Hall and Twickenham Day Centres and providing additional care at Sheen and Ham Day Centres.  These sites had been chosen as they had room in which to incorporate care for those displaced from the closures and also to create additional services in environments that could become centres of excellence for these types of care.  The level of service would not be affected only the place in which it was provided.

Other savings would be made from work underway already where efficiency measures suggested by PWC and internal investigations had been put into practice.  These were not part of the consultation and did not affect front line services. These additional savings would contribute to the total 26% savings that the council must make in the next 3 years. 

The Director repeated the message of the Cabinet Member and reminded the Committee that the proposals outlined were all subject to thorough and genuine consultation which would continue until December 10^th 2010 with re-worked proposals being considered by Cabinet on the 17^th January 2011.

[Please note: Cabinet meeting will now take place on 24^th January 2011]

Representations were heard from members of the public:

Mrs Alison Swift addressed the Committee

·         Mrs Swift informed the committee that her mother was a user of Tangley hall.  She asked the committee to consider how the closure would sit within the national agenda of individual care.  Her mother received a very personalised service at Tangley and she didn’t consider that this would be possible in the larger environment that would be created at Ham.  The care her mother had received at Tangley Hall had seen a dramatic improvement in her mood and ability to communicate.

Following questions from the Committee Mrs Swift gave the following answers and made the following additional comments:

·         That this was the first experience that her family had had of intensive day care centre care and that they had been hugely impressed.  The respite it provided for a family caring for an elderly relative at home had been invaluable.

·         That her mother had a key worker who oversaw the care provided by a small group of carers.  There was a continuity to the care that was important for her mother and for the family in being alerted of any issues or problems that had occurred during the day.

·         That her mother attended the Centre everyday between 10am and 4:30pm and that the journey time was roughly 45 minutes.

Mr Richard Hunter addressed the committee

·         Mr Hunter informed the Committee that he had no current vested interested in Tangley Hall remaining open but that his mother had attended the centre before she passed away the previous year.

He argued that there was a high need for such a service in the particular location due to there being a very high proportion of people over 65 in the Hampton area of the Borough and that transporting these elderly people by bus was not a financially viable or client friendly option.  

Mr Hunter also maintained that it would be possible to make Tangley Hall more viable and even for it to create income for the council.  There were opportunities to expand the care given. That it provided the best value for money and was the cheapest to run of all the centres with the highest take up.

Following questions from the Committee Mr Hunter gave the following answers and made the following comments:

·         That his mother had attended Ham during a brief closure at Tangley and the journey had been too much for her to cope with as it took too long.  In addition the transport costs were high, to suggest it would save money was debatable and should be investigated further.

·         That as a taxpayer in the borough he understood and welcomed the efforts made by the council to freeze council tax but that he did not believe the plans before the committee were financially sound.  In particular he expressed concern that the income generated by each centre was combined in a central pot making it difficult to assess each centres financial merits and potential for income generation.

Mrs Sheila Scorer addressed the committee

·         She reported that her husband had attended Tangley hall until ten days ago when he had unfortunately had to be moved to residential care due to the severity of his dementia.  He had been attending for 3 days a week.  She praised the care that he had received at Tangley Hall.  She believed that the environment at Ham would not have been as beneficial to her husband, in particular open spaces confused him and therefore the smaller environment at Tangley Hall had been beneficial in addition the travelling time to Tangley Hall had been difficult for her husband and this difficulty would increase with any additional travelling time.
She praised the staff and manager at Tangley Hall and warned the council against losing them; they had helped not only her husband but supported her in her role as carer.  In closing she expressed her incredulity that the current administration could prioritise funding for free parking initiatives whilst taking funding from vulnerable adults in the Borough.

In response to questions Mrs Scorer made the following additional remarks:

• that she had used the services of Homelink in the past who she rated very highly but who could not accommodate those with more severe dementia. 
  
  
• That Tangley Hall had been particularly good in relaying small details back to her as a carer which made her role easier.

Mr Skilling addressed the Committee

·         Mr Skilling had been a volunteer at Tangley Hall in the past.  He reported that some of the users had come by bus to the facility and others had been brought by their families.  These families would often stop a while and receive advice and support, which was invaluable to them.  He stressed that for the carers and the users the upheaval of a move to Ham would be very difficult.  He asked the committee to consider carefully the human effects of such closures and described a personal experience where this care had not been available and the difficulties that might have been avoided if it had. 

Mr John Robertson addressed the committee

·         He told the committee that although his father had used Tangley Hall he wanted to talk generally about the importance of Intensive Day Care and how it could save or delay dramatically the need for dementia sufferers to go into residential care.  He felt that this type of care, where appropriate, was better for both carers and users and was better value for money for self funders and also for the Council where it funded the care.

Mrs Robertson addressed the committee

·         She explained that she had been a carer for four years to her husband who had suffered from dementia.  She told the committee that she was concerned that any re-evaluation of those needing care should be done over more than one appointment as dementia sufferers could often make efforts to appear more well when new people were present.
In relation to Tangley Hall she felt that it was necessary for the users and carers that this service remained.  She referred to the high level of care provided and provided anecdotal evidence for the committee of times when Tangley Hall staff taking an extra interest had avoided problems. 

In response to questions Mrs Robertson reported that her husband had travelled from Kew to Tangley without issue but that travelling was not a particular concern for him.

Mr Walker addressed the committee

·         He explained to the committee that although he was not a resident of the Borough at present, his mother and father lived here and his father attended Tangley Hall on 3 days a week.  He said that there had been a marked improvement in both of his parents health since then.  He argued that the 98% capacity of the service showed its popularity.

He praised the services provided and the freshly cooked meals received by users.  He also suggested that the need on this side of the Borough was higher than that on the other side.  Ham was running at 58% capacity and to ask users of Tangley to support it by taking unacceptably long journeys was unfair.  In addition Ham was not purpose built and when Tangley had closed briefly attendance of Tangley users at Ham was reduced.

He urged the council to think creatively and in the long term about how to care for people with dementia and other needs and there were, he argued lots of people both in the Borough and outside prepared to help financially and with expertise to achieve that end.

In response to questions from the committee Mr Walker asserted that:

• His father had been reluctant to take help from the local authority despite paying in to the system all of his life and this was a stigma that should be overcome. 
  
  
• His father had used the services provided at Elleray Hall for a time but as his dementia had become more severe it was not secure enough to cater for him. 

• That as a younger member of society he was prepared to pay more in taxes to support the elderly and vulnerable and did not believe he was alone in this Commitment.

Mrs Nixon addressed the committee

·         She reported that her husband had attended Tangley Hall for 7 months before his death in June of this year.  She praised the service she and he received and argued that without it her mental health would have suffered.

·         Previous to his attendance at Tangley Hall the service she had received had been distressing for them both and although he had attended Whitton for a time this did not provide her with a break as she had to stay with him.  It was a huge relief when he was finally referred to Tangley Hall.  He had difficulties travelling to Tangley and these would only have been exacerbated by a longer journey to Ham.

Councillor Urquhart responded by thanking those who had spoken for taking the time to attend and give their views and assured them that their comments would be noted and considered. 

The Director of Adult and Community Services, Cathy Kerr echoed the comments of the Cabinet Member and assured those present that the consultation was a genuine one and that all proposals were subject to review and consideration in light of the results.  However the savings were not negotiable and any alternative proposals would have to address them whilst maintaining the highest levels of service for users and carers possible. 

The following answers were received in relation to points raised by speakers:

(i)      That the national agenda did focus on individual care and that it was hoped that the proposals would not jeopardise this type of care.  Users would receive the same level and type of care but in a different place. 

(ii)    With regard to personal service – it was hoped that many of the carers who worked at the centres earmarked for closure in the proposals would move with their clients and that levels of individual care would be maintained.

(iii)   That the savings proposed were cautious; for example no savings were tabled for transport so although there would only be two centres there would be the same amount of transport available.

(iv)  For those who did not want to travel it was hoped that other services would be provided this side of the Borough, possibly by voluntary sector organisations

Councillor Urquhart responded to questions regarding the political will behind the proposals.  She acknowledged that any political administration must make difficult choices and that these proposals were part of those choices.  She also confirmed that she had visited the centres but was unaware if other Cabinet members had done so.

The Committee held a debate during which Brian Castle, Assistant Director of Housing explained the transport element of the budget and that it was considered that it would be cost neutral. 

In addition the committee considered

(i)      the percentage of the savings the council must make as a total that would fall within the ACS budget, although the monetary value was high it was a relatively low percentage of the total budget.  Caution was urged however as there would be more savings required in the future and it had not been decided where these would be made as yet.

(ii)    The wider social reasons for low take up of services and the financial pressures on carers in general

(iii)   That any changes to the provision of service for individuals under the new eligibility criteria be handled with the greatest care and phased to avoid distress

(iv)  That the reablemement agenda would be important to the future of the ACS budget and the care of residents of Richmond in the future.

(v)    That some preventative measures had proved not to give value for money in the long term and this would be addressed within the budget proposals

Various other themes were debated from which the following resolutions were agreed

1. That the staggering of opening hours at intensive day centres as a possible alternative to closure be investigated.
   
   
2. That the results of quality assessments carried out be reported back to the committee.
   
   
3. That financial information including details of cost and income for each day centre be provided.
   
   
4. That the possibility of providing carers to accompany users who travelled to day centres be investigated
   
   
5. That whether members of the cabinet had visited the centres be confirmed
   
   
6. That the possibility of retaining Tangley Hall and Ham be investigated
   
   
7. That an explanation as to why the attendance figures were provided as an average of the 4 centres and not individually be provided
   
   
8. That anecdotal concerns raised at the meeting be reported via the Director of Adult and Community Services to the appropriate care teams
   
   
9. That an independent evaluation of both Ham and Tangley Hall, by a psycho-geriatrician, be conducted.
   
   
10. That the exploration of options to prevent the closure of Tangley Hall be continued.
    
    
11. That the high level of care provided at all four centres be noted and efforts continue to be made to see that it be maintained.