The Integration Joint Board has agreed to pause redesign work at Rothesay's Thomson Court and Dunoon's Struan Lodge for a period of six months.
At a special meeting of the IJB in the Council Chamber at Kilmory, Lochgilphead today (November 2), it was agreed that the redesign proposals for both facilities be paused to allow for a facilitated engagement and involvement process with communities, in addition to a staff consultation.
The redesign of the service at Thomson Court relates to the existing small dementia day service, with plans to move towards the provision of a wider range of community-based services for frail and/or elderly people through a 'befrienders-style' service.
Struan Lodge's proposals would see the end of residential care at the facility, with residents transferred to other care providers in Dunoon.
A lengthy discussion took place among board members, both in the council chamber and from Oban and Mull via video-conferencing, ahead of the final decision.
Allen Stevenson, Head of Adult Services (East), expressed his concerns that a pause in the works would incur a further financial burden. "If a decision is taken to pause, it would create a further cost pressure of £185,000," said Mr Stevenson. "The idea of Christina [Christina West, chief officer of the IJB] and myself going away to find another £185,000 is a very challenging task. It would involve policy decisions, and I would say going away to look at that would be a severe challenge, and I’d like to up front with the IJB about that."
Robin Creelman, vice-chair of the IJB and a director of NHS Highland, believed that the pause was necessary and was in the public's best interests. "We have to move quickly on this in fairness to the communities," said Mr Creelman. "We have to assume that this pause is bad for the mental position of service users and their families, and staff, so we can’t drag this out.
"This is about engaging to get the communities’ ideas to agree with our strategic direction, and to give them what best suits them and what they want.
"We have to have this pause."
Asked about what would happen going forward if the pause was approved, chief officer Christina West said: "The time-frame in my head is that November is about developing a plan with partners, led by a communication and engagement group.
"The results from that will partly inform the quality and finance plan for this year and next, and will inform the services at Struan Lodge and Thomson Court.
"I’m saying, genuinely, we need a shift in the balance of care, we need to talk to the communities about how that happens, and that’s what we’re going to do to achieve financial balance."
Heather Grier, service user representative, had concerns about the savings to be made from the proposed redesign of Thomson Court. She said: "We need to save £20m and the redesign of Thomson Court will save £20,000. I just can’t get my head around that. When there are much bigger things to look at, why are we concentrating on something with such a small saving?"
The topic of effective communication was also raised, with a number of board members expressing regret and offering apologies for the way in which the process had been carried out. Councillor Anne Horn said: "As a member of this board who has voiced her concern about lack of consultation previously, I share in this embarrassment. It’s not a good way to start the integration board, and I apologise for my part as I’m sure others do also."
Glenn Heritage, third sector representative, added: "We have failed from the outset in communicating the challenges and the savings. Maybe we were all swept up in a new strategic plan about shifting the balance of care, but we haven't articulated the savings behind that and we need to be a lot more honest with our public and communities."
Councillor Mary Jean Devon had concerns over the pause recommendation, stating: "We’re being asked to put the redesign on hold without the comfort and assurance of where the money’s going to come from. The council has a responsibility, but I as a board member want more assurance. What if we make a decision and can’t back it up - where’s the money going to come from?"
The following recommendations were put before the board:
1. Agree to a pause in relation to the implementation process related to Struan Lodge and Thomson Court for a period of 6 months.
2. Agree to a formal engagement and involvement process to be designed and implemented in December 2016 as detailed.
3. Agree to the Chief Officer taking forward action to identify other savings to meet the shortfall and as necessary approach Argyll and Bute Council to request the level of additional financial resource required to cover the cost/shortfall of implementing a pause to the proposals relating to Struan Lodge and Thomson Court. For 2016-17 this equates to additional financial resource of £0.185m.
4. Agree to consider the outcomes from the exercise to inform its decision on the redesign and transformation of services in Cowal and Bute as part of its Quality and Finance plan for 2017/18 and 2018/19.
The board agreed to the above with an amendment, put forward by Mr Creelman and seconded by Cllr Horn, to the third recommendation. The amendment includes that the board, without delay, write to the council requesting that they provide the £185,000 while the IJB continues to look for savings, which would be returned to the council if additional funds are found before the year end.