Dolwen on the brink

I recently attended a public meeting organised by Denbighshire County Council (DCC) in respect of the proposed plans for our council-run care home in Dolwen. The meeting was reasonably well attended and the independent chairman was formerly the director of social services.

A brief presentation was given by Phil Gilroy, the lead officer for social services. He reiterated the content of the existing DCC documents, "Modernising the Provision of Care - The Case for Change" and "Consultation on the future of DCC's in-house care services". The latter document states that DCC has been looking at the future of in-house care services since March 2014. At that time, the Performance Scrutiny Committee requested that a Task and Finish group was established to "examine value for money options for delivering high quality social care services in the County". DCC goes on to justify the need for this because:-

1. DCC needs to respond to the changing expectations of Welsh Government and the wider population about what modern social services should look like.
2. DCC needs to focus its limited resources towards the areas of highest demand, because of the ongoing requirement to deliver financial savings.

Following the "listening and engagement phase" with individual service users and their families last year, the following conclusions were drawn:-

1. The services and support provided at all our council-run residential care homes and day centres are greatly valued.
2. The bilingual staff teams and the accessibility of the residential care homes, particularly to those without transport, are particularly important. It became apparent that many residents would be adversely affected if they were asked to leave their homes now.
3. Cabinet then agreed that "whatever decisions are made about any future changes, no individual service user will be asked to move from their current home unless a suitable alternative is identified where their needs can be met".
4. "It is evident from the pre-consultation exercise that location is critical for many people, and that many families and friends would find it difficult to visit residents who live far from their current homes".

DCC goes on to refer to the "reducing numbers of people needing to be supported in residential care homes" and "the waiting lists for Extra Care Housing (ECH)". DCC explains that "this is why we...aim to provide more ECH and fewer residential care beds in the future. ECH provides care and support to tenants. DCC also states that "we believe that there should be no need for anyone to live in a standard residential care home in the future". They go on to claim that the numbers being supported by DCC in residential care has decreased from 579 in 2012 to 499 in 2015.

In the meeting last night, it was divulged that there are plans to provide 60 more ECH places at the site of the former Middle Lane School within the next 2 years. For me as a local resident, this was a bolt from the blue. Last night, one member of the audience asked Phil Gilroy how DCC measured the need for residential care. He answered that this was measured retrospectively based on existing trend data. The Chairman stated that the information wasn't local and that the local need wasn't tracked by DCC. It was instead taken from a general, national research. This means that there is no tracking (evidence) by DCC of the local need for residential care services. Thus, there is no information available for future planning. The implication of not having insight in to a future need means that DCC are completely unprepared. Although we know that more people are getting older, DCC has a disproportionately high percentage of elderly citizens. In simple terms, Denbighshire has more elderly people in need of residential care.

So let us recap some of that. DCC refer to a reducing number of people needing residential care but by the same token admit that they have no system in place to track the existing local need for such care. The research being used is national and retrospective as opposed to local and current. How can DCC possibly expect a good outcome if this is the road they intend to go down?

But what are the options being presented to the Denbighshire public regarding Dolwen? Let me share them with you to remove any doubt:-

1. Enter in to a partnership with an external organisation and transfer the whole service to them, while registering for EMH care.
At last night's meeting, a member of the public asked what the cost would be to register for EMH care. Phil Gilroy did not have a figure available so we don't know what that would cost although he suggested a ball park figure of c.£250k.
i. Ensures individuals living there now can continue to do so supported by the same staff and accessing the local community as much as they do now.
Although Phil Gilroy publicly stated that "We're not taking to any external agencies", it is hard to believe that no preliminary discussions have already taken place given the content of the existing consultation documents and various points made last night. 
ii. There would be a revenue saving of £92k on the cost of care for the existing 22 individuals and £75k on maintenance costs as the new provider would be commissioned using standard rates (currently £465.90 per resident per week).
This point is particularly worrying. Where has this figure of £92k emerged from? Based on DCC's own figures, the gross total cost of care for Dolwen for 2015/16 is £747,374 based on an occupancy of 27 residents (so quite where the figure of 22 residents has come from remains uncertain). The current 27 residents cost £532.32 each per week and this figure would be £479.09 if it was being run at full occupancy. But it is still unclear where this saving of £92k comes from. Also, if DCC has to spend £75k per annum on maintenance, the same will presumably apply to the new provider while at the same time paying them less money per resident. It is really hard to see how the current excellent standards of care can be maintained on such an obviously decreased budget. We have a duty of care to elderly residents who have paid their dues in taxes in good faith over many years.
iii. It is unlikely that there would be a capital receipt (DCC would effectively give the facility to the new external provider) as the new provider would need to spend a lot of money to ensure the building meets minimum standards.
Exactly how much money would a potential new provider have to spend to ensure the building meets minimum standards? Presumably, there must be a figure otherwise it is hard to see what exactly "a lot of money" actually equates to. This is clearly important information which is missing in the context of potentially giving away a publicly owned asset to the private sector. This is public money.
iv. It would also develop a level of EMH (elderly mental health) provision in the area, a growing area of demand. Plans for the development of ECH within Denbigh (Middle Lane School site) will continue.
The growth in demand for EMH care is acknowledged although DCC have yet again failed to quantify this. As with the existing lack of procedure for tracking the current local need for residential care, this is another area where DCC have failed to provide sufficient information.

2. Another solution is to lease or sell Dolwen for another purpose. The home would close and the service users and their families be supported to find suitable alternative provision.
This option was not discussed in any detail at last night's meeting.
i. DCC claim that this would reduce the overall cost of providing residential care and contribute to the necessary savings in the service to address the current council savings targets. There would again be a revenue saving of £92k on the cost of care for the existing 22 individuals and £75k on maintenance costs.
Frankly, this is absurd. How can getting rid of the available beds in Dolwen (for which the need is obvious!) possible save money? Putting aside the lack of detail on the £75k and the discrepancy in the number of current occupants, this would clearly cost the council far more than it would save them although once again, the figures arrived at have not been explained.
ii. The cost of current vacancies within residential care centres means that current resources are not being used as effectively as possible. This would resolve this problem.
This point clearly underlines that Extra Care is cheaper than residential care and the quoted figures appear to confirm this (£276 per week for Extra Care versus £479.09 for Dolwen if it was being run at full occupancy). DCC states that in each instance, the average amount of care time is 17 hours per week. Be that as it may, there remains a cohort of patients for whom residential care is the preferred and most appropriate care. I repeat that DCC have failed to produce a current, local measure of the desire and need for residential care. Until they do this, such arguments remain lacking in key information upon which robust decision making can be based.
iii. The council accepts that this change would mean disruption for the residents and their families if this proposal was to be adopted. DCC would carry out further individual assessments of every service user and find alternative provision in a sensitive and timely manner with the involvement of service users and families where possible. DCC would ensure that it complies with all its legal duties to its service users. Views of attendees would be sought and they would be helped to find suitable alternative provision that meets their needs.
Given that the pre-consultation exercise established that many residents would be adversely affected if they were asked to leave their homes now, this proposal beggars belief. Putting aside the fact that Welsh language provision hasn't even been mentioned (despite this being cited as a very important issue in the pre-consultation exercise), the uncertainty of location would loom large for many residents not to mention their loved ones who might find subsequent visiting more difficult. While DCC acknowledges the effect of disruption, this would be of little or no consolation to those residents and families involved. While DCC allude to suitable alternative provision, they fail to detail how much alternative provision currently exists within the county. At the very least, DCC needs to do this if only to quantify the amount of existing provision in Denbighshire - even if the location, bilingualism and emotional effect on current residents would have a devastating impact. In short, this second option is quite unacceptable and would probably remain unacceptable even if the missing information was provided.

3. Any other option or Alternative.
i. No final decision has been made. DCC is open to consider any other alternative or option you wish to put forward that meets the demand for residential and any care places within the available resources. All alternative submissions will be evaluated for their viability before being considered with the options we have put forward.
This option was raised at the Eirianfa meeting last night. The Chair and Phil Gilroy were asked to confirm whether the status quo could continue with DCC continuing to provide excellent care at the existing locations. Their responses were unclear so we still don't know if we could request that DCC continue to run Dolwen as they do now with cost savings being found elsewhere.  But it was resolved on the night that there was sufficient appetite in the room to take this request further.
It was pointed out that DCC had not even considered the status quo as an option under point 3 (above). It is still unclear why that is the case. There is no doubt that from the mood of the room (as pointed out by the Chair), the mood of the recent meeting at the Plas Pigot (attended by 120 people), a facebook group with over 500 members and a petition with over 120 signatures that option 3 is quite clearly the preferred option.

Early on in the evening, Raymond Bartley (County Councillor for Lower Denbigh, Leader of Denbigh Town Council and Mayor of Denbigh) objected to personal criticisms levelled against him by unnamed individuals and cited his long association with and comittment to Dolwen. He was subsequently asked about the content of recent Denbigh Town Council minutes which stated that, "Councillor Raymond Bartley reported that Dolwen would become an EMI/EMH home run by a private company retaining the current staff. The staff and unions were happy". He accused the questioner of lying but the minutes still stand in the absence of evidence to the contrary. Councillor Raymond Bartley remains a member of the five person Task and Finish Group previously alluded to and will therefore play an instrumental role in the future of Dolwen despite having prejudiced the outcome of the entire consultation process. 

Another member of the public asked for a show of hands to reflect how many of those present wanted Dolwen to stay as it is. Although the Chair said that this was not in his brief, a show of hands was duly made and the vast majority were in favour of Dolwen staying as it is. It is interesting to note that the latter was a gentleman of wide renown in Denbigh. The most senior man in the room, he captured the essence of the meeting. On the one hand, the local council was arguing tooth and nail in favour of privatisation and changing the focus of care to extra care in favour of the existing residential care. On the other side of the fence, local people had turned out yet again to shout their support for an institution which represents something beyond the bottom line of an accountants worksheet. The former argued for cost. The latter argued for care. In a nut-shell, this is what the consultation is all about. Whether the chosen few of eight people on the Cabinet of Denbighshire County Council have their way in spite of so many public protestations to the contrary remains to be seen. But the portents do not bode well. That is the sad reality.

Summary

1. DCC admit that they have no process in place for monitoring the existing needs of the elderly infirm in the county who require residential care rather than extra care (they have instead used national figures from 5 years ago).
2. The task and finish group will include Raymond Bartley who, as leader of Denbigh Town Council, is minuted as saying that Dolwen would become an EMI/EMH home run by a private company retaining the current staff and that the staff and unions were happy.
3.The task and finish group was established to examine value for money. They will advise Cabinet.
4. If running at capacity, the cost per week per resident in Dolwen would be £479.09.
5. The current figure paid by DCC per resident per week in private homes is £465.90.
6. The latest CSSIW report for Dolwen is excellent. The corresponding reports for private homes in the locality make many recommendations for improvement.
7. Any future site of Dolwen is not detailed. As such, residents and their families will be compromised by dubious public transport reliability and no guarantees on Welsh language provision.
8. Extra care will inevitably lead to greater levels of loneliness compared to places like Dolwen, Awelon and Cysgod y Gaer.
9. Keeping Dolwen as it is was not even presented as an option in this consultation so it is hard to see how this can be seen as a proper consultation.
10. DCC's own pre-consultation exercise established that residents and their families were most concerned about bilingual language provision and potential transport challenges for visiting.
11. DCC allude to alternative provision but give no details on where that might be, how many places are available or whether that provision will stay in Denbigh like Dolwen always has been.
12. The consultation has failed to reflect the future need so can not plan for future provision.
13. One of the options is to effectively give the Dolwen site to a private provider so that they can save a purported £75k per annum on maintenance costs. No details have been given in relation to this figure and another county asset will be lost to the public purse.
14. Public opposition to DCC plans is well established with 120 people recently attending an open public meeting, a facebook group with over 550 members (for Dolwen alone), a petition with over 120 signatures (handed in), over 200 consultation forms completed and handed in (that we know of).
15. Many local people approached groups like Denbighshire Voice Llais Sir Ddinbych for help in completing the forms for a variety of reasons. Some couldn't access the form in their preferred language. Some couldn't access the supporting documents upon which the questions are based. Some just needed help trying to unravel the corporate language. We are quite sure that many more would have engaged with this had the forms been  more widely and freely accessible.
16. In short, there is no public appetite for these proposals. Dolwen remains a highly prized community asset which local people would rather remain under local authority control.

Will the Junior Doctors strike?

Having successfully averted a strike by junior doctors before Christmas, the Health Secretary arguably won the battle but not the war. It is evident that the BMA is doing all it can to stir up discord among the new recruits and this spells bad news for everyone. A junior doctor with a penchant for industrial action will go on to become even more militant as they sail through their subsequent careers.

But what exactly is driving this militant tendency? Is it really all to do with money? Well, from my own experience, I would say a resounding "yes". I can never forget the experience from my first week at Medical School in 2008. A First Aid trainer asked first year medical students off the record to give the main reason for choosing to pursue a career in medicine. To my utter shock and horror, the majority cited money as their principle motivator. Am I the only one to be horrified by that? I naively assumed that people were choosing a career in medicine principally to make a difference to people. Evidently, I was mistaken.

It is instructive to examine just how poorly paid a junior doctor really is. A basic salary of about £22,000 does sound pretty meagre on the face of it. With banded rotations in which they are expected to work the long hours of on-calls, week-ends and nights, that figure often increases to about £30,000. And the hours are very long with lots of stress and pressure having to work in sparsely staffed environments in which patient care is all too often compromised.

As far as I understand, the Health Secretary is proposing to address this by alleviating the strain on junior doctors. Given their obvious inexperience at this stage in their fledgling careers, one might expect them to be cock-a-hoop about such a suggestion. It is evident that too many have entered the profession first and foremost to earn with care coming a little while after that. As much as I have come to loathe the Machiaevellian approaches of the Tory Party, this is one area where they seem to have got things right. My advice to the junior doctors would be this: Careful what you wish for. If they go ahead with their threat to strike, they will ultimately alienate a public whose primary aim has changed very little over the years - to be cared for in their hour of need.

The junior doctors of today will soon enough become the surgeons, consultants and general practitioners of tomorrow with salaries beyond the comprehension of the many. Maybe the time has come to reappraise selection for medical school?