Savings programme 2024-25 – balancing the care home estate interim integrated impact assessment

Balancing the care home estate – interim IIA

This proposal involves balancing the care home estate by closing two residential care homes operated by the EHSCP by March 2025. The proposal has been developed in close consideration of the wider strategic review of older people’s pathways. Clovenstone and Ford’s Road care homes are in scope, both in the South West locality. The newer 60 bed care homes are out of scope. These homes have 71 beds in total for residential level care. At the time of developing this proposal there were 68 residents accommodated across both homes.

Our biggest demand remains for nursing and dementia care home places which can only be provided in the larger 60 bed homes that have registered nurses on site. Clovenstone and Ford’s Road care homes are older buildings and have reached the end of their design life expectancy. They provide excellent care to their residents and consistently receive good grades from the Care Inspectorate, but due to environmental limitations can only offer residential level care which means that the buildings are not suitable for people with nursing and/or dementia care. Any care home closure follows a well-established process. The Residential Review Team would support residents and families throughout the transition and where possible, we would look to move residents in their friendship groups. Staff are fully engaged with along with their TU representatives and if possible, matched to vacancies at their preferred choice of alternative care home.

The council owns the properties but there is potential to work with them on the future purpose of the buildings, developers have expressed interest in the sites which could be developed to offer accommodation for service users with learning disabilities, however this would need explored further.

This proposal should be seen in the wider context of an Older People’s Pathway programme, presented to EIJB on 9 February 2024, where the proposals to commission a feasibility study to reopen Drumbrae as a care facility and a costed proposal to operate 40 – 50 additional nursing and frailty beds within the EHSCP’s Castlegreen and North Merchiston Care Homes were both agreed. These proposals will meet the needs of people requiring nursing or dementia care. In addition, we would open the empty beds at Ferrylee Care Home to offer more accommodation options to residents. Opening these beds requires a budget transfer of £1m but maximises the remaining residential care capacity within the estate.

As there are staff vacancies within our existing care home estate, staff jobs would be protected, while also reducing reliance on agency staffing.

There has been no public involvement in the proposal to date due to the sensitive nature.

The Fairer Scotland Duty

No

1 March 2024

Name Job Title Date of IIA training
Jacqui Macrae Chief Nurse  
Hazel Stewart Programme Manager Feb 2020
Shirley Middleton Care Booking manager  
Jane Brown Senior Care Home Manager  
Siobhan Murtagh HR representative  
Karen McErlean HR representative  

Evidence Available – detail source Comments: what does the evidence tell you with regard to different groups who may be affected and to the environmental impacts of your proposal
Data on populations in need Resident profiles and care inspectorate registration Over 65s currently residents within the residential care facilities in question, staff within both homes and residents’ families
NRS: Projected population of Scotland (2020-based) Demonstrates population projections in Scotland with an ageing population evidenced
Joint strategic needs assessment – Edinburgh Demonstrates population projections in Edinburgh and at locality level
Data on service uptake/access Resident profiles and staffing establishments including vacancies 67 residents and 74.42 FTE staff
Data on socio-economic disadvantage e.g. low income, low wealth, material deprivation, area deprivation. Current funding status of residents from financial assessments 6 interim residents, 4 emergency placements, 53 local authority funded residents and 5 self funding residents.
NRS: Projected population of Scotland (2020-based)
Joint strategic needs assessment – Edinburgh
Data on equality outcomes Equality act 2010 – guidance

Fairer duty Scotland: Guidance for public bodies
Research/literature evidence Condition reports for the care homes (completed by CEC building surveyors) Evidence of the condition of the buildings and potential repairs needed at point of last survey
Care Inspectorate: Care homes the design guide Evidence of best standards for care home design
Care home census report 2013-2023 Data on care home in Scotland over a 10 year period
Public/patient/client experience information Updated resident profiles required If proposal was to proceed, the Residential Review Team (RRT) would update the resident profiles to understand frailty, capacity, guardianship and power of attorney status
Day of care audits If proposal was to proceed, day of care audits would be useful to understand the level of need in each home
Evidence of inclusive engagement of people who use the service and involvement findings Not at this stage, would progress if proposal was to proceed
Evidence of unmet need Health delay list, CEC daily delayed discharge list Reviewed over an extended period to understand waiting lists and high demand
Good practice guidelines Care Inspectorate: Care homes the design guide

CoSLA – Good practice guidance on closing a care home

 Further guidance to complement any HSCP guidance in place, to help plan for the closure of a care home
Carbon emissions generated/reduced data Condition reports of buildings The age of the buildings is a cause for concern, the internal layout of the homes are challenging and it is difficult to place people into the homes because of environmental limitations
Environmental data As above
Risk from cumulative impacts
Other (please specify) City plan 2030 The city plan already shows one care home as a recreational park and work has started in the immediate area to redevelop the surrounding buildings
Additional evidence required

Impacts will mainly be felt by the existing residents and their families of the care homes identified along with the current staff group. For residents, these are people aged over 65 in need of 24-hour residential care. If these proposals were to progress, the residents would need alternative accommodation elsewhere in the city, that may be within one of the remaining residential care homes operated by the Partnership or within the third, independent and private sector. This would be an anxious time for residents and their families as any move comes with an element of risk, where possible the Partnership would seek to move people within their friendship groups to ease the transition to new accommodation.

For staff, the impact is the ongoing uncertainty of the future of these homes. There have been proposals in the past and this has destabalised the staff group and morale is low. These proposals could be positive in that staff would have confirmation of the plans for the homes and certainty on where they will be employed in the future.

Equality, Health and Wellbeing and Human Rights Affected populations
Positive

  • Where possible, residents would move in their friendship groups to help their transition to their new accommodation.
  • Where possible, some staff will also move with residents to help them settle into their new environment and offer familiarity to the residents.
  • The Residential Review Team would support all residents and families throughout any planned move offering support with onward choices.
  • The Partnership have successfully moved people to alternative care homes in the past with good outcomes.
  • Could improve staff morale and retention by removing the uncertainty of the future of the homes.
  • Residents would be reviewed and reassessed and may be assessed for higher level care offering more choice in onward accommodation within the Partnership managed care homes
  • Particularly for Ford’s Road – onward accommodation would offer a better environment.
  • Short of suitable settings for accommodation for working age people, there is a provider in the City that buys old stock and can retrofit them for alternative use (housing), there is already 1 flat in the grounds of Ford’s Road care home that is used for people with Learning Disabilities – struggle for mental health short term accommodation when people are in crisis
  • There is a level of anxiety in communities as people are aware publicly that there are potential care home closures, if approved this would resolve general anxiety on the plan for the care homes.
  • 1-2-1s with staff would identify their future employment choices, some may wish to move role or retire and this would enable those discussions to take place.
  • If residents, following assessment, were identified as having higher care needs, there is the potential to protect some beds in a care home with nurses in the South of the city, giving the option to some residents of remaining within their locality.
  • Improved living conditions for residents in Ford’s Road if moved to alternative accommodation, they would have better access to outdoor space in the surrounding area due to the condition of the pavements/road
  • There is a very good team in place that manages care home closures well, work together well and provide seamless closures.
  • More than enough vacancies and opportunities across the Partnership to match staff into (they would be mentored throughout)
  • Any communications would be completed accessibly so as to not discriminate against staff / relatives with protective characteristics.
  • Older people over 65
  • Families of residents
  • Staff.
  • Providers.
Negative

  • Overall capacity of residential care places would reduce, which could result in more people needing to remain at home with packages of care.
  • There would be an impact on interim care placements as the smaller, older homes accept more people on an interim basis than the larger nursing homes, where there is competing demand for beds.Could negatively impact on emergency care placements – if we don’t have that capacity people will be placed in costly care homes in the third, independent and private sector or would end up as a hospital admission.
  • Older care homes provide a range of services (interim/residential) and deliver the highest standards of care across the estate compared with the larger 60 bed care homes.
  • Would move existing care home residents out of their home and into a new environment which may be out with their local area.
  • Both homes are in the South West of the city, reducing residential care home options in that locality.
  • Increased risk to existing residents’ health and wellbeing through moving home when they are frail.
  • Uncertainty on job security for staff from these care homes
  • Staff could have financial concerns due to increased travel costs – could be mitigated by additional payments.
  • Impact on family members due to the potential of increased travel time and cost.
  • Could discriminate against people requiring residential care without the means to fund their own care.
  • May increase risk for relatives, particularly husbands and wives that need to travel by public transport to visit their relative, due to longer journeys across the city, potentially to areas that are unfamiliar to them.
  • Limited options for existing residents to move into an alternative local authority care home, with the two remaining local authority residential care homes located in the North East of the City.
  • Any resident who has a relative with a disability could be impacted by extended travel to visit, reducing the frequency of visits.
  • Staff are very fond of their residents and moving away from them could have a negative impact on staff and resident wellbeing.
  • Potential to lose staff due to low morale and uncertainty over future placements.
  • Some residents may have moved from previous care homes that have closed resulting in multiple moves.
  • Some staff may have moved from previous care homes that have closed resulting in multiple moves.
  • Moving residents and staff into Ferrylee / Jewel House may sustain uncertainty for residents / families and staff as these are older homes too.
  • Adverse publicity
  • Residents/relatives may automatically think they would be moved to another home in the South when that option may not be available to them.
Environment and Sustainability including climate change emissions and impacts  Affected populations
Positive

  • A reduction in the overall care home estate will have a positive impact on our carbon footprint particularly as these are older care home stock.
  • We would be more carbon efficient with less buildings.
  • By reducing the number of older care homes, we would be more sustainable in the future.
  • Less building-based procurement
  • Some relatives may have less travel post move, reducing their travel time and cost.
  • Some staff may have less travel post move, reducing their travel time and cost.
  • Particularly for residents of Ford’s Road, new accommodation would likely be an improved environment more suited to providing care.
  • Particularly for staff of Ford’s Road, an improved working environment in one of the remaining care homes that is more suited for the provision of care.
  • Better use of the remaining estate by operating Ferrylee to full capacity.
  • May be better parking options for staff and visitors from Ford’s Road as there are limited options on street and in surrounding area.
  • Older people over 65
  • Older people over 65
  • Families of residents
  • Staff.
  • Providers.
Negative

  • The other two care homes for residential care (Ferrylee and Jewel House) are also older but the environments are better than the two marked for closure.
  • May increase emissions with staff and families having to travel further.
  • May see relatives of residents (particularly husbands and wives) having to travel on multiple forms of public transport to visit their relative if their new care home is not on a direct transport route.
  • The Care Inspectorate suggest that smaller care homes can offer better care and a more homely environment.
  • Increased mileage if seeking to avoid the newly introduced LEZ zone if relatives or staff are traveling by car.
  • Older people over 65
  • Families of residents
  • Staff.
  • Providers.
Economic Affected populations
Positive

  • Reducing the number of care homes the Partnership operate makes the internal provision more economically viable.
  • Increasing the beds in Ferrylee will maximise the capacity in that home.
  • Reduces the number of ageing properties across the estate.
  • Potentially less reliance on agency across the care homes, with staff redeployed to vacant positions.
  • Potential for capital receipts for both properties – benefit to CEC but opportunity to work with them to identify best use of receipts.
  • Potential alternative use for properties working with external providers.
  • Any major repairs or maintenance required to either home would be the responsibility of the Partnership to fund – could result in a temporary or permanent closure and would require reprovisioning of residents in a costly placement (there is a significant risk with the baths in Clovenstone as they will likely be condemned at next inspection and will need replaced, maybe June this year)
  • Older people over 65
  • Families of residents
  • Staff.
  • Providers
Negative

  • Potential that some staff would not be able to be redeployed and may need to consider VR and medical retirals.
  • Reducing the number of local authority residential care beds reduces the choices available to people assessed as needing this type of care, this could mean they would have to consider care homes in the third, independent and private sector.
  • Although these care homes are older stock, the proposal has been developed as part of the savings proposals for 24/25 and is seen as financial driven.
  • People that are socio-economic disadvantaged are less likely to be able to afford private care and are therefore, dependent on the provision offered by the local authority. These proposals could disadvantage a large proportion of the population by reducing the number of residential local authority beds available.
  • Local communities could also be disadvantaged by these proposals, particularly as there is no indication of what would become of the buildings and future use.
  • The potential for increased travel time and costs could negatively impact on staff and residents’ relatives.
  • Could be a negative financial impact, if no available residential placements available and need to buy increased care at home provision to keep people safe at home
  • Could create inflation of residential care home places due to reduced capacity.
  • Older people over 65
  • Families of residents
  • Staff.
  • Providers

Yes, this is captured in the impacts identified above.

Should this proposal be agreed, a communications plan will be developed to inform staff of the changes to the existing procedure. This would be         developed in collaboration with communications colleagues and would meet all accessibility requirements.

If yes, it is likely that a Strategic Environmental Assessment (SEA) will be required and the impacts identified in the IIA should be included in this.

No

If further evidence is required, please note how it will be gathered. If appropriate, mark this report as interim and submit updated final report once further evidence has been gathered.

Specific actions (as a result of the IIA which may include financial implications, mitigating actions and risks of cumulative impacts) Who will take them forward (name and job title Deadline for progressing Review date
The IIA and savings proposal will be shared with trade union colleagues for comment Hazel Stewart 4/03/24
Specific consideration is needed by the savings programme on the communications plan for these proposals, due to the sensitive nature of this proposal, there is a reputational and business risk if not communicated sensitively Chief Officer 8/03/24
The IIA is interim at present and should be revised if the proposal is to progress to include a wider group of stakeholders including staff and relatives from the care homes identified Hazel Stewart 31/3/24

Not at this stage as this is still a proposal, should this be approved, this question should be revisited.

Should the proposal be approved, this will be monitored through the implementation plan. The Residential Review Team would be in place to support residents and families and would monitor the affect of these changes on people. Staff will be supported by the management team and their trade union representative who will monitor the affect on them of these changes.

Mike Massaro-Mallinson's signature

Name: Mike Massaro-Mallinson

Date: 08/03/24

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