Agenda item

To scrutinise the day care service as part of the Council Plan 2023-28 – A Caring Gwynedd

The report was presented by the Cabinet Member for Adults, Health and Well-being. It was highlighted that the department was proceeding from the traditional model of day centres towards a more flexible and community service in its nature. It was noted that the individual person was central to the provision plan and there were many varied services available to suit various different needs. All were guided through the main matters in the report giving an update of the work that was ongoing. The proposal to modernise care resources under the heading 'A Caring Gwynedd' in the Cyngor Gwynedd Plan 2023-28 was highlighted to enable Gwynedd residents to live their best life within their local communities.  

 

An overview of the provision available in Gwynedd was given, including Traditional Day Care Units, Specialist (Dementia), Day care in the homes of the county's residents and respite care/short-breaks care.  Details were given of the priority to satisfy a wide range of profound needs and to provide varied and personal support to each individual, based on person-centred assessments. The need to be flexible to satisfy individual needs, to provide a resource that reflects a choice to people and community expectations today was emphasised. It was explained that it was essential to collaborate closely with partners in the health board and the third sector, as well as the community, to ensure that the care model thrives and that the more complex needs of individuals are addressed. It was noted that care and community expertise were crucial to be able to create successful person-centred care. It was reinforced that the partnership between the Council and the Health Board was key to meet with the comprehensive needs, such as Special day care provision (Dementia) at Plas Hedd, Bangor and Dolgellau Hospital.   

 

The continuous pressure on unpaid carers was acknowledged and the over-reliance on them to sustain intense situations across the county.  It was recognised that there were obvious challenges in the home care provision and that some areas were having difficulty to cope with the capacity. The priority to provide quality short respites to unpaid carers, and to also ensure value for the individual receiving care were also highlighted. The provision available to individuals with less intense needs was detailed, noting that there was a wide range of options and that they promote the use of activities in the community, such as keeping fit and Dementia Actif and to also meet social needs.

 

The future objectives of the service were outlined. Reference was made to the pilot procedure now in place in Dolgellau to develop a new model of day respite care. It was explained that the intention of the pilot was to offer a community opportunity within Cefn Rodyn Care Home, to provide respite for carers and social activities for individuals. It was noted that this provision would be for 2 days a week, in the home's lounge to support approximately 5 persons at a time. It was noted that Age Cymru will facilitate the activities, with Council staff providing the necessary care. It was hoped that a suitable site in Porthmadog would soon be identified to provide further support to individuals cared for by unpaid carers in that area. It was reiterated that this new model ensured that individuals have control, independence and greater choice to build on their strengths in their communities when socialising and receiving diverse and tailored care and support specifically for them as individuals.

 

Questions were welcomed from Members. During the discussion, the following questions and comments arose;

 

Referring to the ongoing work taking place to monitor and develop the provision across the county, a Member questioned how the department monitors and measures whether the provision is meeting demand and what happens when demand exceeds provision or when the Council does not have sufficient resources to respond to the demand? It was asked if there was any advanced planning in this regard and if there was any lobbying underway to secure more funding and support from the Welsh Government?

 

In response, it was confirmed that the Community Resources Teams meet regularly with the Management Team to identify the need and demand and ensure that any deficiency or needs that are not being met are brought to their attention on a regular basis. They ensured that they worked closely with the Well-being Team to boost and promote the use of the community hubs and activities being held there. It was noted that the department was very aware of specific situations in Gwynedd communities due to the number of staff working closely with families and carers. It was confirmed that the department gave serious consideration when information comes to hand of any shortcomings in the service. In terms of the budget, it was recognised that challenges remained as services continued to be dependent on short-term and temporary grant funding. It was noted that the pilot work in Dolgellau and Porthmadog was dependent on a short-term grant, and the provision would be monitored to see if an application for permanent funding may be submitted to maintain the service.

 

It was emphasised that the service's partnership with communities was crucial and that a lot of information comes before the department through community members caring for neighbours in the community. Attention was drawn to the good work being done by a worker out in the field, and reference was made to the use of technology that was being developed, such as the Helpu'n Hun resource. Reference was made to the Dewis Cymru programme, which was in the process of being developed, setting out the provision available to individuals within their own areas. Thanks were given for the information, reiterating the importance for scrutiny members to be able to visually see and analyse the measures as part of the scrutiny process.            

 

Referring to the recent engagement with over 200 people and service user feedback, a Member expressed that seeing evidence and examples of the feedback would strengthen the conclusions in the report. It was suggested that an appendix containing responses would support the report and help convey the community sentiments in terms of what work was going well and what needs to be improved. The comment was acknowledged, noting that it was hoped that measures would be in place soon.

 

Referring to the provision available to unpaid carers, a Member expressed that the provision available was not sufficient for unpaid carers and that an opportunity had been missed in the report to lobby for more government funding. It was recognised that there was more work to be done to improve the provision as a matter of urgency and that unpaid carers who sustain the community need to be credited. It was explained that regional work was underway to improve the provision and it was assured that this work would come before the scrutiny committee shortly.

 

In response to a question, it was confirmed that individuals living with Dementia fall under the Adults department, and not the Mental Health Department.

 

Reference was made to the map included in the report to show the geographical location of services and day centres, noting that there were noticeable gaps in provision in the rural areas of the county. In response, it was ensured that the map did not include all the available provision in its entirety. It was acknowledged that this was difficult to convey, but it was ensured that developments were underway to develop 'bespoke' care packages and provision in the areas where there was no centre nearby. It was ensured that support workers provided services and activities to people and transported them to Day Care centres when this was suitable.

 

A Member noted that it was vital that older and younger persons with various mental health issues receive more day care provision to ensure a provision for all Gwynedd residents. In response, assurances were given that departments were working together and sharing resources across teams to ensure that as many residents as possible benefited from the services and provision available. It was noted that a vulnerable adults forum was held monthly to discuss how to meet the demand for services for people who do not (necessarily) reach the threshold. It was mentioned that they were discussing what resources were available to them to be able to sustain some kind of provision for all those with needs. It was reiterated that challenges remain and that resources were scarce, but members were assured that the developments of integrated community teams who were doing valuable work as experts from all areas discussed individuals within the services and what resources were available to them. It was emphasised that integration and pooling of resources was the best way forward to ensure provision for Gwynedd residents.

 

A Member expressed disappointment that there was a lack of data and figures in the Day Care Services report noting that it did not convey a sufficiently comprehensive picture of the situation in Gwynedd. The way the figures from 200 potential users were collected for the consultation was questioned and concerns were raised that over-reliance continued to put pressure and strain on unpaid carers in the community. It was asked how the systems in place could be improved to ensure consistent quality across the county. In response to this, the data collection systems were acknowledged to be flawed, and an apology was given for this. It was ensured that there would be better current data in the next reports in this field.

 

In response to an enquiry, more details of the pilot work at Dolgellau and Porthmadog were given. It was explained that this prioritised individuals who were cared for by a family member and unpaid carers. It was noted that it was about to start in September with a maximum of 5 people receiving respite care for 2 days a week. It was mentioned that the Community Resources Team promoted this and worked jointly with Dementia Actif. In response to a question, it was confirmed that unpaid carers would transport individuals there in accordance with the policy and this would free them up to have their own respite. However, assurance was given that transport may be arranged through alternative resources for individuals who were unable to travel to the respite care service themselves. It was confirmed that the Age Cymru Co-ordinator would co-ordinate and run the activities, with the support of Cefn Rodyn staff providing the necessary care. It was noted that Age Cymru was in the process of working to try and ensure that transport was available to bring them to the home. It was explained that the pilot would be evaluated in 6 months to see if an application for funding could be submitted to continue with this resource.

 

A Member mentioned that transport continued to be challenging for individuals who were unable to travel to centres to receive respite care. Concern was expressed about the individuals living in the countryside who were often unable to socialise and feel isolated due to the lack of transport provision in the rural areas. It was noted that support workers were doing a good job to ensure that individuals were able to attend respite activities, but it was recognised that this was challenging and every individual living in rural Gwynedd cannot be reached.

 

It was asked what happens after the Council Plan 2023-28 comes to an end? Reference was made to the work that was ongoing in the Llechen Lân report to anticipate the situation in the future. It was emphasised that preventive work was crucial to address the need for care in the future.

 

The work to develop new models of care was welcomed and the use of libraries across the county was praised through the Age Friendly Hour activities and a cuppa and chat. It was asked if there was a waiting list to attend the day care centres and what was the capacity? In response, it was explained that the situation varied on a case-by-case basis.

 

More information was requested about the residential care homes. A detailed and comprehensive future map reflecting all the diverse provision available was welcomed. A desire was expressed to work with the department, and it was asked whether the department could update Councillors regularly on the activities that were taking place so that they could promote the services and events in their communities. It was asked if it was possible to carry out a consultation at a more local level in the villages? It was understood that this was dependent on volunteers and resources – and it was sympathised that resources were scarce.

DECISION

 

1.     To accept and note the report and welcome the availability of a range of services but to express concern

 

• About the sustainability of a service by volunteers

• the lack of rural transport meant that many were unable to attend or get to a service

• there was no fair access to provision across the county

 

2.     To ask the cabinet member to

 

• review how the department monitors customer demand and satisfaction, by collecting quantitative data, and demonstrate the true impact of the service on the well-being of individuals and their carers

• lobby the Welsh government to fund the service for the long term rather than providing grants

• Consider how collaboration can be undertaken across the Council and with partners to improve day care provision for unpaid carers and those with mental health conditions and report back to the care scrutiny committee

• Consider how the quality of service received by volunteers can be monitored and ensure the sustainability of the service

• Provide an evaluation report on the day care respite pilot scheme starting in September at Cefn Rodyn, Dolgellau, when timely

• Ensure that there was equitable access to the provision across the county