Dear David
 
Thank you for your letter, it is difficult to disagree with the direction of your comments, the position we are in isn’t something that I would, or have chosen. Having been fighting to maintain budgets and to deliver new services for the last five years it is very hard to find that the money available is no longer there having been taken away by circumstances out of our control.  I could not agree more with your comments about looking after very elderly frail, vulnerable people. These are very difficult and emotional decisions which nobody should have to consider, however, if we want to continue to fund as many people as possible for as long as possible then we cannot carry on the way we are.  If you remove a third of the money from your pocket what are you going to do if you want the same things you have worked for but find some of them are costing twice as much as they would if you bought elsewhere.  
 

The coalition had previously reduced the money available to Devon CC by £100m and with some significant re-structures which removed 3000 staff we were able to maintain front line services with minimal changes.  I was able to make the case for not having significant reductions in the Social Care budget.  However, last autumn we were told that we had to find a further £110m of savings by 2017.  The cumulative effect is that we will see our finance allocation from government reduced from around £600m to around £400m and to be able to continue looking after people without changing the eligibility criteria i.e. we will still provide service to anyone with an assessed need we have to make changes.  There was an alternative which would have meant increasing the threshold for support from substantial to critical but this would have seen many people having to find their own care, this was unacceptable to me and was not considered because it would not meet the need to continue care at the present levels.
 
The important issue is that we are not reducing or taking away any current support for people who will continue to get the same services in the future that they receive now.  The difference is that Devon CC will not be the provider as this will transfer to the independent or third sector providers.  We currently purchase 90% of the places we need for residential care from the independent sector, this is a £70m budget.  The problem is that the remaining 10% of people, approx 260, are in Devon homes but the cost of this provision takes up 30% of the budget.  It is by transferring the remaining 10% of places we need to the independent sector that we can afford to maintain the current threshold of eligibility.  We currently purchase around 45% of the total bed capacity of the independent sector for residential care in Devon.
 
No one will lose their care package and no one will be financially disadvantaged by the change.  We have budgeted to provide an alternative placement at the home chosen by residents and their families.  I have negotiated a budget that has a limit which should enable any resident to be able to select a room of their choice, in many cases it will enable a larger en suite room. Some people have decided to change location choosing to move closer to their families, about 55% of people actually choose a home near to where they lived.  We have also agreed that if nursing care will be necessary within the next year then we will consider a transfer to a nursing home so that there isn’t another move.  Devon CC is not legally able to provide nursing care and employs no nursing staff so we always have to look for transfers from our homes when anyone’s condition changes to needing nursing care.
 
There are good guidelines about reducing the risks of moving provided by the Association of Directors of Adult Social Services which followed research by the University of Birmingham which included post move research.  This is the minimum standard that Devon CC apply.  We have successfully moved many residents and have commendations from families following moves where they say that the outcome was much better than they anticipated and that their relatives had actually improved since leaving DCC provision.  We do not underestimate in any way the enormous responsibility events are placing on our staff.  Each resident will have a dedicated member of staff to support them in their choice and to help them with day visits to potential homes and even possible overnight stays so they can try homes before making any decision. Staff will also make follow up visits to check everything is as good as it can be after a move.  In some cases we are expecting to be able to move small groups together so they can retain a friendship group. In Exeter and Sampford Peverell there are currently new homes under construction and we will be talking to the owners around taking a significant number of their rooms, possibly 50%, to keep many resident together.  In Exeter this would accommodate all current residents in our Exeter homes.  
 
I agree that there is risk in any move, Devon is very experienced in moving people because transfers are happening all the time.  We do not move anyone with an end of life prognosis within a reasonable time frame, we do not move anyone where the assessment shows there would be a risk due to their frailty or condition.  Most of our homes do not have rooms fit for future care needs.  The current standard is a room 4mtrs square, most rooms in Devon homes are 3mtrs square.  I hope you will appreciate that most people going into residential care now have complex needs which usually means that hoists and other equipment are necessary.  This is difficult to achieve in small rooms because the hoist has to get through the door and it needs care staff to be able to access both sides of the bed.  I have visited a Devon CC home where the staff had moved the furniture and clothes to another room because there was insufficient room for the hoist – I don’t consider this treats people with the dignity and respect that they deserve from a care system. We have also had to close rooms because the physical need to carry hoists up and down 2/3 short flights of stairs meant pressure on staffing.   
 
In conjunction with Health colleagues we have been investing in new community services which have been showing great benefit to residents.  We have plans to extend the most successful of these across the county.  The East Devon scheme where people are discharged to home and get the availability 24/7 nursing care for the first few days and then transfer to our re-ablement teams for up to a month is showing very good results at re-facilitating people back to a normal life in ways which residential placements couldn’t achieve.  The oversight has been with the consultant geriatrician to ensure that the patients needs come first. The result of this intervention has been a surprising reduction in the number of people needing care packages and still not needing one after six months.
 
It is difficult to see any difference between the various parties at Westminster.  The current care minister is Norman Lamb and he has agreed in answer to questions that Local Authorities should be commissioners not providers of residential care.  I have been present when the Shadow Minister has said that community care services should be the province of the NHS – you will know that there is currently a move for Torbay Hospital to take over the Torbay Care Trust.  I’m not sure when you retired but it was the last government that set in train legislation which delivered Transformation of Care Services in the NHS and which dictated that the NHS ceased being a provider of services to become commissioners, the previous NHS children’s service now delivered by Virgin Care is the local product of this.
 
We are not going to sell off properties in the way you have described. It is our intention to explore if any sites can provide extra care housing which will help people with care needs to contain their costs when the new Care Bill comes into being.  We have also had some expressions of interest in either taking over some of the homes or redeveloping the sites with bigger care homes.  With the care bill discounting the hotel costs from peoples individual care account, and the cost of care being determined by the authority, there is going to be a significant need for this latest way to provide onsite 24/7 care whilst letting people have their own flat and the extra space and facilities this brings.
 
It isn’t the case that private providers are more or less good than public run establishments.  The incidents in the midlands which are driving a lot of current government guidance were run by the NHS, last year we had a serious incident with a Devon CC home which meant we have to move nearly half the residents to other homes very quickly, we achieved this within two weeks of the Care Quality Commission concern being reported. Whilst it has passed subsequent inspections following a change of management and some staff it cannot return to having more than around a dozen residents because of the physical difficulties with the property.
 
This is not a good time to be a councillor, I certainly didn’t foresee having to deal with these issues when I agreed to be responsible for Care services 5 years ago.  My aim now is to retain as much support as possible and to find ways to ensure that no one is excluded from care if they have the same eligible needs levels we have applied for the last four years. Governments will come and go and if I could see a chink between them in terms of local government funding then there might be some hope of being able to preserve some services.  The reality is that there is no difference between any of the parties over the future funding of local government.  They have all said that after the election they would continue with the same austerity measures which pressures local government funding now.  Being at the end of these national decisions we just have to find solutions which will enable us to continue support and realise that the only solutions will be local ones and that some of those will be quite painful.  We have looked at increasing council tax but government places caps on that. We raised council tax by a fraction under 2% this year to comply with the capping regime. This raised just over £6m but we lost £3m because by raising council tax we lost the government council tax support grant so the net gain was just over £3m – it doesn’t go far towards the £110m.
 
Regards

Stuart