We provide services to some of our most vulnerable residents through our three Community Resource Centres (CRCs):
- Combe Lea in Midsomer Norton
- Cleeve Court in Bath
- Charlton House in Keynsham
We are currently considering plans to change how and where we provide these care services.
Why we are consulting
We established our CRCs around twenty years ago, and during this time we have both managed them directly, and through the outsourcing of care provision to Sirona Care and Health. Since the establishment of our CRCs, there have been big changes in the nature of care needs. We now need to consider how best to use these community facilities, so they can continue to deliver our priority of securing safe, effective services that meet the needs of our changing population.
The most important changes are as follows:
- people are now staying in their own homes for longer, so when they do need care, their needs are higher
- people are entering care with higher needs. There has been an increase in the demand for specialist dementia nursing care, and a reduction in demand for the “traditional” nursing and residential care places provided by our CRCs
- the marketplace for care is increasingly challenging and complex, with higher costs, constrained funding, difficulties in recruitment, and the need to ensure constant maintenance of the quality of provision
We are putting forward an approach to how our three Community Resource Centres can respond to these challenges, plan ahead, and continue to serve our local communities, within the funding we have available to us.
Services we currently provide at our Community Resource Centres
We currently have 105 beds at our CRCs, made up of:
- Combe Lea, Midsomer Norton: This is a residential home that provides 30 beds for people living with dementia
- Cleeve Court, Bath: This is a residential home that provides 45 beds for people living with dementia
- Charlton House, Keynsham: This is a nursing home that provides 30 nursing beds. There are currently 11 residents in the home and 15 beds are closed
All of these CRCs also have spaces for day provision which have not been used since the pandemic.
We provide Extra Care Schemes, in partnership with housing providers, on the sites of two of the CRCs:
- Hawthorn Court, Keynsham: 30 flats for people aged 55 and over
- Greenacres Court, Midsomer Norton: 30 flats for people aged 55 and over
The proposals we are consulting on will not affect Extra Care and sheltered housing provision.
Our aims
As we have developed our approach to service provision at our CRCs, our aims have been to:
- improve services to the most vulnerable and ensure we are focusing on areas of highest and most complex need: In particular, this means addressing the gaps in the availability of dementia nursing placements. At present, none of our 105 CRC beds provide the complex dementia nursing care that is increasingly needed
- align the costs of providing care with the funding available: Funding comes from service commissioners and from self-funding residents. Balancing the costs with the available budget will contribute to the stability and viability of these services over the longer term. Occupancy across the CRCs is currently only at 67%. The current operating budget is under pressure, due to the gap between the costs of running the services and the current market rates that commissioners can pay. Operating the CRCs on their current basis is expected to cost £6.8 million in 2023 to 2024
- reduce the number of out-of-area placements: There are a significant number of these remote placements, both for complex dementia nursing care and for people of working age. Out-of-area placements to meet these needs cost us up to £1,400 per bed, per week. They can also break the links between people and their support networks, including family, friends and community
- increase inter-generational living: This will mean that older people and people of working age can have their needs met together, where appropriate
- enable more activities at our CRCs to be delivered by voluntary and community organisations: This will bring life and activity to these settings, and help to make them true community resources
As we consider these proposals, we are aware that we are talking about people’s homes. We will consider views received as part of this consultation before we make any decisions. If any decisions are made which mean residents have to move to another home, we will work with residents, relatives, staff, and others to ensure a smooth transition, subject to the best interests of individuals.
What we are proposing
We cannot deliver our aims without making some changes to the specific services that each CRC provides. We want to see each CRC offer a specialist focus on a particular area of need, to allow for improvements to services, and make much better use of the resources available.
In particular, there is a pressing need to establish a new facility for cost-effective, complex dementia nursing care, something which the CRCs can not currently provide. This type of service is complex, and needs to cover a wide variety of situations. For example:
- specialist nursing care for people living with complex dementia, including early or young on-set dementia
- dementia patients who also live with a long-term illness or disability, and need more complex clinical support
We propose to establish this new service on a single site, rather than spread across the existing sites.
This would allow for the following opportunities:
- greater investment in modern facilities, such as telecare, and ensuring the services operate in line with national guidance
- more cost-effective staffing and supervision, with more attractive jobs and better career progression opportunities
- more opportunities for Bath and North East Somerset residents with specialist care needs to remain within the area, closer to family and friends
- better use of bed space and increased occupancy levels
- reduction in our use of temporary and agency staff
All three CRCs will continue to be used wholly for care, but we are proposing the following changes to the range of services at each site. Expand the sections below to find our detailed proposals for each site.
We are proposing that Combe Lea, which is a 30-bed residential home, remains as at present but that it is further used to help younger people with more complex needs to remain closer to home.
Our staff support several people under the age of 65 in this home. We are proposing to further extend this offer, in line with our aspiration for inter-generational living. This would see flexible spaces that can meet the care, support, and environmental needs of both older people and those of working age, reducing demand for care out of our area. A key benefit of this would be to reduce out-of-area placements.
We are proposing that the new dementia nursing beds should be at Cleeve Court, with 25 specifically designed beds on one floor of the care home. Cleeve Court would become a “centre of excellence” in this fieldn consolidating specialist services in one place. This would allow for improved staffing ratios and offer a high quality of service for residents with complex dementia needs.
The costs per bed space at this new facility would compare favourably with the external market, who charge up to £1,400 per week for a dementia nursing bed.
This would also mean that Cleeve Court residents would no longer need to move out of our area, if they develop other nursing care needs in the future.
We are proposing to close the 11 places which remain at Charlton House. If we go ahead with this option, we would ensure that the current 11 Charlton House residents would get support to identify new accommodation to meet their needs. We would hope that people would want to remain with B&NES, at either Cleeve Court or Combe Lea. This would offer continuity of care, as many of our staff would also move to one of our other locations. Moving existing permanent staff across from Charlton House to Cleeve Court would also reduce some of the recruitment issues we are facing, and reduce the amount we are spending on agency staff.
We would retain Charlton House for other community provision to meet the current and future needs of the local community. The premises remain suitable for community and care uses, and discussions are underway with the RUH hospital, to use the building as a step-down ward over winter. If we choose this option, we would do further work and consultation on the type of provision that Charlton House would specialise in. This plan would not affect the Extra Care service at Hawthorns Court, which is also on the Charlton House site.
We are proposing to make these changes because the Cleeve Court environment, unlike Charlton House, has been specifically designed to support people with dementia. It already has support from community mental health teams and relationships with our voluntary sector partners.
We would make every effort to minimise the disruption of any move. We recognise that we are talking about people’s homes, and we would work closely with the current staff, service users, families, and carers, together with external support agencies, such as health professionals, to ensure a smooth transition.
The staff at Charlton House already work as a team across the B&NES area and we would support them to continue to do so, if they wished to. We do not anticipate that the proposals would result in any compulsory redundancies. We will of course be keeping all staff affected by these proposals fully informed at every stage, and we are especially keen to hear staff views.
We want our CRCs to be the resources for the community they were originally designed to be. Following the pandemic, there has been a reduction in day activities in our CRCs, and we want to work with voluntary and community groups to try and reverse this trend. We will consider allowing groups to use the day centre spaces at a reduced rental rate, if the organisations offer services that are accessible to the care home residents and the community.
Take part in the consultation
We have not taken any decisions yet about this issue. We welcome responses to the proposals in this document from any individual or group with an interest in this issue. You can respond to the consultation in a number of ways.
The consultation is open from Thursday 9 November 2023 to 5pm on Monday 18 December 2023.
Responding to the consultation should take no more than 5 to 10 minutes, depending on how much you want to say.
Other ways you can respond
If you require urgent support, a printed survey, information in another format including audio, braille, large print, Easy-Read or in another language, please contact the CRC Consultation team. You can contact the CRC Consultation team by emailing CRC_Consultation@bathnes.gov.uk, or by calling Council Connect on 01225 39 40 41.
Community drop-in event
We will be holding a public drop-in event on Thursday 23 November 2023, at 11am, at Charlton House and people will be able to find out more about our proposals, speak to our officers about them, and share their views face-to-face.
Specific consultation with residents of Charlton House, their families, and advocates
We are committed to ensuring all residents and their relatives and carers are the centre of our decision-making. If you are a resident, or the relative or carer of a resident, then our staff should already have contacted you. If you have not heard from us, then please let us know by emailing CRC_Consultation@bathnes.gov.uk and we will be in touch as soon as possible to explain the support available.
All residents and family members can have advocacy support from trained, independent, professional advocates, if your request it. We want to make sure that everyone affected has the chance to fully participate in this consultation.
As a resident, carer, or family member you can also let us know your views by taking part in this public consultation. We look forward to receiving your views and comments.
What happens next
We will collate all responses and feedback to this consultation into a report, and will publish this on this web page. The lead member for Adult Social Care will consider and discuss this report not before Tuesday 16 January 2024 and we will publicise any decisions.