Hands off our Homes: Consultation Response – A Detailed Guide

Note: This is the long version of the consultation response. If you are in a rush and would like a short version, click here.

Background

This document, created by UNISON Southampton District and Unite Southampton and West Hampshire Branches working in partnership, is designed to help you complete the public consultation on the future of Holcroft House and Glen Lee residential care homes.

While the consultation is short and fairly self-explanatory, this guide contains background and examples to make your reply as powerful as possible. This way, the council will not only know the strength of public opinion against the closures, but they will know why, and what has happened in other towns and cities where the last council owned residential care homes were closed.

While using this guide we suggest having both the consultation form and this guide side-by-side, as this guide follows the same structure as the consultation form. You can access the consultation by clicking here or copying and pasting the following link into your web browser’s address bar: bit.ly/2Aq0Zmw.

UNISON and Unite’s position

UNISON Southampton District and Unite Southampton and West Hampshire Branches oppose the closure of Glen Lee and Holcroft House, be that both of them or one of them. We know that public services are best delivered by Council employees and not on a profit-making basis.

Other local authorities such as Reading Borough Council (which closed its remaining Council owned homes in 2013) found that the amount of money charged by privately-owned residential care homes increased. This meant that the Council did not make the savings it thought it would, and in fact spent more money.

Both unions also know that workers have better terms and conditions when they are working for the Council directly. Workers in the private sector get lower wages, less sick pay, worse pensions and temporary contracts with no guaranteed hours. Families have also told us that the amount of contact time and quality of care residents receive in the private sector is not as good and families have had to either move relatives out of poor-quality care or take on the role of carer themselves.

Question-by-question response

Question 1. To what extent do you agree or disagree with these commitments?

  • Suggested answer: C) Neither agree nor disagree

We believe that by selling Glen Lee and Holcroft House, the council is not meeting these commitments. However, the question is poorly worded and could be interpreted either as “do you, the respondent, agree with these commitments?” or “do you believe Southampton City Council is delivering on these commitments?”

For this reason, we suggest selecting option C, which prevents any unintended outcomes.

While Southampton City Council was the first local authority in the country to sign up to UNISON’s Residential Care Charter in May 2018, selling off the only two council-owned and run specialist dementia residential care homes shows a lack of commitment to the spirit of this charter. Below are just two reasons the closure of the homes goes against the council’s ‘commitments’.

  • Have the best quality of life and maintain maximum dignity and respect

Glen Lee and Holcroft House are specialist dementia care homes. UNISON and Unite understand that moving residents will damage – in some cases irreversibly – any work done to ease the symptoms of dementia among residents.

  • Stay healthy and recover quickly from illness

As noted above, the closures would mean residents would have to be moved and this possibility could negatively impact on residents’ health and shorten life spans through transfer trauma.

Question 2. To what extent do you agree or disagree with the preferred option to close both Holcroft House and Glen Lee?

  • Suggested answer: E) Strongly disagree

We disagree with a number of the Council’s justifications for closing both care homes, and believe there are multiple factors they have not considered that will harm both employees, and residents and their families.

UNISON and Unite support Option E for the following reasons:

  • We do not believe the demand for specialist residential care for those with dementia is decreasing – the number of people with dementia is rising as noted by the Alzheimer’s Society (Source: Alzheimers Society).
  • Extra care housing or living independently will not meet the needs of those living at Glen Lee and Holcroft House (or who would live there in the future). Secure homes and regular assistance are required, if these needs are not met there will be safety risks for individuals with dementia and those living nearby should a dangerous incident occur.
  • Moving residents will cause their dementia to worsen. This is called transfer trauma and it can result in “…serious depression, anxiety, illness, and even increased risk of death” (Source: Helping Hands).
  • Loss of employment for staff as there are no equivalent care jobs at the Council. Workers would have to work elsewhere, and won’t have the same good pay, pensions and holiday allowances.
  • Closing both homes will lead to other providers increasing their fees, and the Council will end up paying more and not achieve its predicted savings.
  • Savings can be achieved by other means outside of the Adult Social care envelope. The Council should work with unions to find an alternative.
  • Medium- and long-term savings could be achievable through reviewing how the homes operate and developing better, more efficient ways of working. Managers, workers and trade unions should be given the chance to work with senior management to find new ways of reducing costs.
  • Closing the homes does not ensure continuity of care, which is needed by adults with dementia.

Question 3. If the proposed changes were to be implemented, what impact do you feel this may have on you, your family or community?

  • Suggested answer:  G) A very negative impact

While we cannot pretend to know the personal impact this will have on every individual, we can state that this will have a very negative impact on the community for the reasons outlined below.

  • If (as predicted) private residential care fees increase, the council and individuals will have to pay more out of its budget. This money could be better spent by investing in Glen Lee and Holcroft House.
  • We know some private care companies (like Care UK) have avoided paying tax by registering their companies abroad, this means that public funds are being paid to profit making companies and not going back into public services (Source: The Guardian)
  • Terms and conditions for workers will be worse – most of the workers live in our local community.
  • Residents will suffer as they will struggle to get the same level and quality of care in the private sector as is currently provided by the Council.
  • Safeguarding risks could rise and/or go unreported:
    • Workers in the private sector don’t get the same amount of training and development opportunities, which impacts on the quality of care for residents.
    • Relatives lack confidence in reporting safety concerns to private companies for fear of repercussions for their relatives. Families said that they have greater confidence in the council to provide good and safe levels of care, but also that if they report concerns they will be addressed appropriately.
  • If the Council closes its council-owned care homes it might appear to save money in the short to medium-term. However, if it needs to bring contracts back under council control because a private business fails (for example), buy back homes or recruit new staff in the future, this is likely to cancel out any savings in short to medium-term. Surrey County Council is an example of where this has happened recently. There is a risk of paying contract cancellation fees and buildings costing more to buy back.
  • The private care sector in the UK is highly precarious (risky and unstable). The Council does not appear to have an emergency or contingency plan if a company or homes in the private sector fail. Every month last year more than 12 care homes went bankrupt. 75 care home businesses were declared insolvent in 2016, up from 74 the previous year. The failures mean that in total 421 care home businesses have collapsed since 2010. (Source: The Guardian).

Question 4. If you feel there are any impacts or equality issues we may have overlooked in the formation of the draft policy, please provide further details:

Suggested answers:

Sex is a protected characteristic in the Equality Act 2010, and we believe that the proposed closures would disproportionately affect women. We believe this for the following reasons:

  • The majority of employees who would be affected by the proposed closures are women.
  • The care sector is overwhelmingly run by low-waged women, and the private sector does not pay the same hourly rate as the council. It is unusual for the private sector to pay enhanced rates of pay for working irregular or anti-social hours.
  • Women are more likely to require local authority support for later life care due to living longer and having had lower-paid or part-time jobs. Closing these homes will not only impact on current residents, but it will remove a source of support for future residents also.
  • If the homes close, any unmet and informal care needs will likely be taken on by women. Women may give up paid employment or reduce their working hours to provide care. Alternatively, if they can’t afford to stop working their wellbeing will be badly affected by working ‘double shifts’ – going to their day job and then doing extra hours to ensure others are cared for.
    • Source: Coram research “Workers at risk of losing income to manage caring responsibilities – and women bearing heaviest burden”
    • Source: Office for National Statistics “The gender gap in unpaid care provision”

Age and Disability are also protected characteristics under the Equality Act 2010.

  • These residential care homes are for people aged 65 years and older (specific age group)
  • The homes provide specialist dementia care. Dementia is a long term and progressive condition which would meet the Equality Act’s definition of a disability.

We do not believe the proposals are based on ‘like for like’ care packages, so it’s possible that the costs and packages compared are unlikely to be equivalent. This means the level of care will not be as good, quality of life will be worse, and residents and their families (people associated with aged and disabled people) will have to pay more money and so be disadvantaged by the closures because of their Age and Disability characteristics.

In addition, service users are more likely to be in poverty, or come from a poor background; families will be impacted by the closure of local facilities with the possibility of driving further to visit relatives.

Those who would have been future residents may have to pay more for their care if there are no council-owned homes that offer affordable care, or the Council are priced out of the private sector. People who don’t meet the criteria for council-funded care may be pushed into poverty.

Question 5. If you disagree with the proposals, or have any comments, suggestions or alternatives you feel we should consider, please provide further details:

Suggested answers:

We hope that many of you have your own comments or suggestions for this section, but if you find you need help giving some, please use the below:

  • The preferred option to close both homes does not follow the Labour Party’s commitment to ‘insource’ our public and local council services.
  • Public ownership benefits workers, residents, families and the local community. It ensures that public interests are put ahead of shareholders’ and that there is democratic accountability for services.
  • Reading Borough Council – this council closed its council-owned care homes in 2013, the fees private providers charged then increased. Predicted savings were not achieved and expenditure on residential care services increased.
  • Surrey County Council – this council closed its last residential care homes in 2015 and is now ending its contract with Anchor Trust and bringing those care services back under council ownership for cost effectiveness reasons.
  • Extremely concerning tax arrangements in private care (Source: The Guardian).
  • The Council should scrap its plan to install solar powered bins, at a cost of £1 million.
  • The Council doesn’t have to cut services to make savings, it can invest and redevelop to achieve long term savings. The Council should involve workers and trade unions to advise on formulating alternative options at the earliest opportunity.
  • If the Council commissions services to private companies it will lack flexibility to respond to local needs – the stated reason for ending the Capita Services contract.
  • The preferred option goes against the ‘SCC First’ policy the Council has adopted, which provides a framework for considering appointment of in-house services to deliver council requirements before using external companies. External companies should not be used when Southampton City Council’s in-house services can meet the Council’s requirements and demonstrate ‘Best Value’.
  • The council’s Ethical Procurement Policy, which requires certain standards from companies the council outsources services to, is being totally ignored.
  • The Council should give Glen Lee and Holcroft House the opportunity to demonstrate value and financial management over a trial period of 12 months (minimum).

Demand & access
We believe the reason the demand for residential care appears to be decreasing is because older people with care needs are being directed to extra care housing and to remain at home. This is due to central government cuts to local government (Adult Social Care) and the NHS. When older people are expected to live at home or in Housing with Care or Shared Lives schemes, they are still likely to have falls, or make mistakes when using gas ovens, toasters and other home appliances. This means they then require nursing or other health care services due to their different and more complex needs. The Council’s statement about the decrease in residential care demand is not because this is genuinely what is needed or wanted by older people; it is a result of the way our health and social care systems are funded and structured that is forcing a change in the use of these services.

By not having a good number of residential care homes available that specialise in dementia care, pressure will be (and is) put on an already strained NHS. This is because it can be difficult for Adult Social Care Services to find appropriate residential care homes to discharge older patients to, meaning beds in hospitals are being used for longer than needed. Supporting this comment and the theory in the paragraph above, are Care Quality Commission (CQC) reviews of local health and care systems. The reviews found that ineffective collaboration between local health and care services can result in people not being able to access the care and support services in the community that would avoid unnecessary admissions to hospital, which in turn leads to increased demand for acute services (and therefore a decrease in demand for residential care). (Source: CQC)

The Council’s papers say that there are currently 36 residential homes registered to provide dementia care in (or near) the boundary of the city. What isn’t clear is what the admissions criteria of those homes is. Privately run homes are known to refuse those who have more progressed dementia, who are incontinent or whose behaviours are more difficult to manage. They also only accept a certain number of people who aren’t self-funding. If Glen Lee and Holcroft House are closed, affordable and good-quality care will be out of reach for those in the city.

The Council has a legal obligation under the Care Act 2014 to ensure it meets the need for care and support for adults who ordinarily live in the city. Although we appreciate that the Council does not have to own and run its own specialist dementia care homes, we do not believe that there will be enough availability to meet the needs of the city’s residents (based on their assessed needs) in the future if these homes were to close. We are concerned that some adults would be placed outside the city and this would take them away from their families and friends and out of familiar surroundings. If this occurred it would impact on their health and mean families and friends would pay more and spend longer travelling to visit relatives.

The CQC also notes that posing a threat to effective collaboration between health and social care is the continued fragility of the adult social care market, with private providers closing or ceasing to trade and contracts being handed back to local authorities. Unmet care needs continue to rise, with Age UK estimating that 1.4 million older people do not have access to the care and support they need. In two years, the number of older people living with an unmet care need has risen by almost 20%, to nearly one in seven older people.

Cost and savings
Surrey County Council has confirmed its decision to bring eight care homes currently contracted to Anchor Trust back under council control on 31st March 2019. The Surrey County Council Cabinet meeting minutes of 22 November 2016 state “upon expiry of both the care contract and leases for the eight refurbished homes, responsibility for the service delivery of these eight homes will transfer back ‘in house’”. The reason for this Cabinet decision was to “…continue to meet the needs of the residents in the care homes in the most cost-effective way.” (Source: Surrey County Council).

Staff
The National Minimum Data Set for Social Care reported in 2013/14 that the adult social care workforce remains one where women make up over 80% of the workforce, with 83% of direct care jobs being done by women. We believe that the percentage of women working in Glen Lee and Holcroft House to be greater than this. This would mean that it is overwhelmingly women who will lose employment as a result of any closures. (Source: Skills For Care).

Workers have better terms and conditions when they are working for the Council directly. The council can’t guarantee jobs for workers who currently work at Holcroft House and Glen Lee if the homes close. This means workers not qualified for any other kind of work or who want to do the same work in the city would have to work in the private sector. The private sector pays lower wages, gives less sick pay, has worse pension schemes and often uses temporary contracts with no guaranteed hours. This means workers could have less money to live on while in work but also when they retire, which will impact on their quality of life and reliance on public services. Loss of employment or worse terms and conditions will be something that women, in the majority, will suffer.

Residents & Families
Families have also told us that the amount of contact and quality of care residents receive in the private sector is not as good and families have had to either move relatives out of poor-quality care or step in and do some care themselves.

We are aware that care needs are fulfilled, on an informal basis, by women. During the 2015 to 2016 financial year, 8% of the UK’s private household population were ‘informal carers’ for someone, according to survey data from the Department for Work and Pensions. Nearly two-thirds (59%) of these carers were females. (Source: Office for National Statistics).


Once you have completed the consultation, simply click Submit. The consultation closes on the 16th January 2019, with a final decision made by full council on 20th February 2019.

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