Day Services Review with Appendix
North Ayrshire Council · 19 June 2025
Back to Integration Joint Board — 19 June 2025 and its agenda
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Integration Joint Board 19 June 2025 Subject: Older People’s Day Service Review Purpose: To present to IJB the outcome of the review of the delivery of day services for older people in North Ayrshire and to outline proposed options to IJB to identify a service model for day services that supports older people across North Ayrshire whilst meeting identified savings target. Recommendation: IJB to approve the recommendations: - (i) note the outcome of the older people’s day service review completed in February 2025 (ii) consider the option(s) detailed within this report for future delivery and provide approval for the preferred option, noting the described impact on service users and all other relevant stakeholders. (iii) note the requirement for a temporary pause on new day service admissions whilst teams reconfigure service delivery and where possible accommodate any service users affected by service change. (iv) consider and approve the preferred option between Option 1 and Option 2 as set out in the report. (v) Note that the revised service model will undergo a formal evaluation six months after reopening. This evaluation will assess the effectiveness of service delivery, the impact on unmet need, and identify any further areas for improvement. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership IJB Integration Joint Board PSMT Partnership Senior Management Team 1. EXECUTIVE SUMMARY 1.1 The current model of delivery of older people’s day services has been identified within the Health and Social Care Partnership’s transformation plan for review and has been allocated a target to achieve a recurring annual financial saving – this was initially identified as £200k however was increased to £307k as agreed by IJB in March 2025. This has been implemented so far in a phased basis, with £100k saving in year one
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and a further £207k saving now required in year two, over the period 2024/25 – 2025/26. The full review paper attached was completed prior to the final savings target being determined, and as such there are some variations in detail. 1.2 Year one savings were achieved by pausing the Partnership’s day services outreach development and by not recruiting to vacant outreach posts; as the future of the outreach service required to be considered as part of the full review. A recurring saving of £307k is required to be identified and achieved from year two onwards to deliver the full savings target. There are risks to achieving this full saving from year 2 due to timescales in implementing any service change. 1.3 Budget savings within older people’s day services totalling £126k have previously been implemented between 2019 and 2022 – these savings saw an overall reduction in day care provision at the time. It was always the intention to undertake a further phase of review particularly as the new service provision leaves an inequity of provision with two building-based services in the Three Towns locality. 1.4 A comprehensive consultation on day services was completed in 2021 to facilitate the remobilisation of day services (post covid). The most recent review of day services (2024/25) focussed on effective engagement with staff, service users, families and carers. In December 2024, service users were surveyed to gain an understanding of the quality of the day service intervention. Day service aims, outcomes and criteria for access were reviewed. Service demand, attendance figures and financial costs were all taken into consideration at this review. 1.5 Following the outcome of the review earlier this year, three options for Day service delivery were presented to the Partnership Strategic Management Team on 27 February 2025 for consideration. The full review document is included as Appendix 1, a summary of the options presented at that time is detailed below: Closure of Thistle Day Service (HSCP operated day service) • Thistle Day Service in Stevenston was viewed as an option for closure due to its proximity to the Alzheimer Scotland service in Ardrossan. • The closure of Thistle Day Service would result in the loss of 70-day service placements per week, reducing local support in the Three Towns locality, particularly for frail elderly residents who do not have a memory impairment. • This option would provide an annual saving of circa £145k. Discontinuation of Alzheimer Scotland Daycare Contract • This option proposed discontinuing the Alzheimer Scotland daycare contract at its expiry date (currently extended until August 2025), the service operates from a NAC owned property. This would generate current contract savings of approximately £276k per year and approximately £54K in income from service-user charges - this income is currently retained by Alzheimer Scotland. • This option would most likely result in the closure of the Alzheimer Scotland service in Ardrossan and would result in the loss of 63 commissioned day care places on a weekly basis. Redesign of both the Partnership and Alzheimer Scotland’s older people’s day service delivery functions This option proposed a significant shift and change in the delivery of both day services and dementia services in North Ayrshire.
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These changes would include: • Alzheimer Scotland would move away from a traditional day service model and instead focus on a model of delivery prioritising befriending services, dementia daycare outreach at home, and provision of increased support for carers of loved ones with dementia. • Outreach day services previously planned for Partnership delivery would now be provided by Alzheimer Scotland under this revised model only for adults with a memory impairment – there would be no outreach provision for frail older people. • All older people's (building based) day services would be delivered by the Partnership. • Saving of approximately £212k would be generated by not recruiting to Partnership vacancies identified for Outreach provision and a reduction in Alzheimer Scotland funding from £276K to £140K per annum. • Funding would be allocated to increase staffing levels within existing HSCP day services to mitigate some of the impact of the loss of 63 commissioned day care placements. The PSMT favoured the option to redesign the Partnership and Alzheimer Scotland’s day service delivery functions as it was considered that whilst there would be an overall reduction in day service provision and net reduction in weekly day care places available, this option served to both satisfy the requirement associated with savings and also maintain maximum service delivery within the financial resource available, whilst retaining the service and partnership with Alzheimer Scotland. After discussions at PSMT in February 2025, an additional £107k savings target was approved as part of the IJB budget in March 2025 from the Day Service budget and as such this report will provides alternative options to deliver the savings in full. 1.6 Taking the feedback from consultation and the full day service review into consideration, it is deemed critical that in-building day services remain available to older people that are locality based and in their own communities. 1.7 The HSCP has commenced initial discussions with Alzheimer Scotland on a proposed new model based on the feedback from the Partnership’s Senior Management Team and the alignment of this with Partnership operated day services. Further meetings are expected to take place with representatives from Alzheimer Scotland in the coming weeks to discuss options. The current contract with Alzheimer Scotland expires at the end of August 2025. 1.8 The IJB are asked to consider two Options presented in this paper and following the review: Option 1: Discontinuation of Alzheimer Scotland Day Care Contract in full from the end of August. Removal of plans to introduce any outreach day care opportunities in North Ayrshire, with some reinvestment of funding directed to enhance staffing within building-based day care resource. Financial Impact – delivers full year saving of £340k, above the £307k target. Option 2: Redesign of both the Partnership and Alzheimer Scotland’s older people’s day service delivery functions. Commissioned provider would transition from traditional day service model and instead focus on a model of delivery prioritising befriending services, dementia daycare outreach at home, and provision of increased support for carers of loved ones with dementia. All older people's (building based) day services would be delivered by the Partnership. Financial Impact - delivers full year saving of £212k, a shortfall of £95k and would require the recurring savings target to
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be formally reduced by the IJB with savings identified from other areas, this should be considered in the context of the wider financial challenges facing the IJB. IJB are asked to consider the two options presented and agree the preferred way forward, noting the financial and service implications of both. 2. BACKGROUND 2.1 Day services in North Ayrshire provide activities and support for adults assessed as requiring support who may feel isolated and lonely, have mobility issues and would benefit from regular social contact with others with transport provided from the person’s home to the day centre if appropriate. The aim of day services is: • to provide a safe, flexible, therapeutic and homely environment for service users, their families and significant others, according to their assessed care needs; and • to provide the highest possible quality social care and act in the best interest of people, by maximising their independence and helping them participate fully in their family and community. The Partnership’s in-house day service provision is delivered within identified day service premises which are open 9am to 4.30pm, Monday to Friday, staffed by specially trained professionals. These day services are delivered by social care staff from sites in Largs, Irvine, Garnock Valley and the Three Towns. Previously, a service was delivered in Cumbrae, but this service is no longer operational. Stronach Day Service on Arran, located within Montrose House Care home, has been closed since the pandemic. A recent review led to a pilot outreach model which ran from May 2023 to March 2024 and was conducted in two phases in two localities on the island. The pilot served a small number of users and received positive feedback for its social benefits and respite for carers. However, it relied on existing staff, making it unsustainable due to the current and ongoing workforce challenges on the island. It is therefore recommended to fully adopt an outreach model for day services on Arran, removing onsite day care. However, the service should only be provided when staffing allows thus addressing recruitment and resource challenges. A phased implementation should aim to serve up to six users by the end of 2025, noting however this will be entirely staffing dependent. It is suggested that a short life working group is established to develop detailed plans and oversee the phased implementation of this. 2.2 The 4 mainland Partnership day services provide supports from Monday to Friday and offer a total of 350 spaces each week. On average these units run at over 95% capacity and provide services to both frail older adults as well as older adults with dementia. The current capacity of the mainland in-house day service provision is detailed below: Day Service Locality Capacity per day Total weekly places
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Burns Irvine 22 110 Gowanlea Kilbirnie 20 100 Thistle Stevenston 14 70 Stevenston Day Care and Resource Centre Largs 14 70 2.3 In addition to the Partnership operated day services, there is one externally provided day service located in North Ayrshire which is operated by Alzheimer Scotland. This service is in the Harbour Centre, Ardrossan. This service is delivered 7 days per week and provides services to older adults with dementia. Day Service Locality Capacity per day Capacity per week The Harbour Centre Ardrossan 9 63 2.4 The Partnership currently funds the provision of this day service alongside funding provided by Alzheimer Scotland. The building is owned and maintained by North Ayrshire Council. Whilst no revenue is received by North Ayrshire Council for this property it should be recognised that Alzheimer Scotland have invested in this building which includes the installation of a new kitchen in 2024 and garden improvements. 3. CURRENT SITUATION 3.1 The Partnership is committed to promoting independence across all areas of service provision and seeks to ensure as many people live as independently as possible within their own communities. In line with the aspirations of the Partnership’s Strategic Plan, the Partnership is developing modern, flexible, financially sustainable approaches that will support people and their carers to remain independent and enabled to lead fulfilling lives. The demographic projections of the rise in older people, health outcomes for people living in North Ayrshire, the pressure on financial resource and changing expectations, means that services must be redesigned to meet demand and minimise unmet need within our older population whilst operating within the resources available. Services also need to ensure that capacity is aligned to meet the needs of the individuals who require to access services. Building based day services, while beneficial for some, may not be suitable for everyone due to barriers such as accessibility, transportation challenges, sensory sensitivities, or social anxiety. These settings can unintentionally exclude individuals who find structured environments overwhelming or who live in remote areas. Outreach day services offer a more flexible and person-centred approach by bringing support directly into the community or home. This mixed model allows for tailored engagement that respects individual preferences, cultural backgrounds, and unique needs, fostering greater inclusion. A mixed model of day service provision can ensure that support is accessible and inclusive for all. 3.2 Workforce There are 36 posts associated with the Partnership’s inhouse older people’s day services within North Ayrshire including transport staff who provide transport for the majority of service users to and from the day centres. The current Day services staffing compliment consists of: • Day Care Co-ordinator • Senior Day Care Officers
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• Day Care Officers • Drivers • Day Care Escorts 3.3 There are 9 posts associated with the delivery of the Alzheimer Scotland Day service. The impact of the proposal on these posts is not known currently as these staff are employed by Alzheimer Scotland. 3.4 Waiting List There are currently 103 people on the waiting list for the older people’s day services as outlined below however this can change on a weekly basis: 4 ASSESSMENT 4.1 This report, based on the findings contained within, would summarise that older people day services within North Ayrshire are a vital service and support in achieving the Partnership’s strategic aims of “all people who live in North Ayrshire are able to have a safe, healthy and active life”. 4.2 By ensuring building-based day service provision continues in all localities, across all groups for adults over the age of 65, travel time and associated barriers are significantly reduced, enabling easier and more consistent access for frail older adults and those living with dementia, whose needs could best be met by a building-based day service delivery model. These services foster stronger community connections, reduce isolation, and promote a sense of belonging and continuity for service users. In-house day services offer the most cost-effective model, delivering best value through efficient use of resources and robust waiting list management. Location Unit Provider Weekly Capacity Daily Capacity Spaces Allocated (May 2025) Ardrossan Harbour Centre Alzheimer Scotland 63 9 46 (73.0%) Irvine Burns Day Service In-House (NAHSCP) 110 22 104 (94.5%) Kilbirnie Gowanlea Day Service In-House (NAHSCP) 100 20 92 (92%)
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Largs Stevenson Day Service In-House (NAHSCP) 70 14 67 (95%) Stevenston Thistle Day Service In-House (NAHSCP) 70 14 66 (94%) Partnership day service staff play a critical role not only in direct care delivery but also in supporting wider service continuity plans, stepping in during periods of staff shortages or emergencies to maintain consistent care across the system. This integrated, community-based approach ensures resilience, responsiveness, and a high standard of care for North Ayrshire’s older population. 4.3 Alzheimer Scotland are Scotland’s national dementia charity and its work both nationally and throughout North Ayrshire is recognised and valued. Alzheimer Scotland have provided supports and services to older people in North Ayrshire for several years and are a key component in supporting people living with dementia in the North Ayrshire community. 4.4 In consideration of the recent review, and views gathered through the Partnership’s Senior Management Team, the below final recommendations are presented to the IJB for final consideration. 4.5 Option 1 Discontinuation of Alzheimer Scotland Day Care Contract in full - this option would see the end of the Alzheimer Scotland daycare contract at its renewal date at the end of August 2025 and would result in the closure of the Alzheimer Scotland day care provision within The Harbour Centre in Ardrossan. This option would require permanent removal of plans to introduce any outreach day care opportunities in North Ayrshire, with some of the funding for previously allocated outreach supports in the Partnership directed to enhance staffing within building-based day care resource. Pro’s • Potential to over-achieve full year savings target from 26/27 (dependent on additional income). • Will ensure retention of building-based day services (provided by HSCP) in each of the mainland locality areas to adults over 65 with both memory impairment and physical disability. • Streamline resources and ensure flexible, resilient in-house day service provision. • Opportunities to mitigate some of the risk of increased waiting lists and service closure by enhancing capacity in Partnership day services. Con’s • Negative impact on current provider, Alzheimer Scotland. • Impact on current users of the Alzheimer Scotland service and families/carers. • Loss of weekend provision. • No outreach supports. • Loss of specialist service and Alzheimer Scotland provision in North Ayrshire. • Loss of 63 weekly day care placements. • Increase in waiting lists and unmet need for access to day care provision. Mitigation • Funding will be directed to the Partnership’s inhouse day care centres to enhance capacity and offer building-based day care opportunities for adults
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affected by the Alzheimer Scotland closure – the has the potential to limit the impact of an overall reduction in day care places for older people to around 30 places on a weekly basis. • A review of day care support for any affected service users will be undertaken prior to any service change -which would include consideration of reinvestment in day services or our Dementia Support Service. • Alzheimer Scotland currently provides day services over a 7-day period whilst the Partnership’s day services are delivered Monday to Friday; however, uptake for weekend services has been consistently low, with poor attendance observed during these times. Given this trend, it is anticipated that the impact of discontinuing building-based provision over the weekend would be minimal. • Currently, in-house day services have a greater capacity and make more efficient use of available spaces daily – operating at 95% capacity compared to Alzheimer Scotland who have been operating at 73% capacity. Shifting to a fully in-house daycare service model will offer opportunities for enhanced flexibility in service delivery and staffing. Financial Implications • This would generate current contract savings of approximately £276k per year with potential for approximately £54k additional income from service-user charges if existing Partnership Day services can be expanded to provide additional day care placements - this income is currently retained by Alzheimer Scotland. • It is anticipated that 3 x additional part-time Day Care Officers would be required to supplement additional attendees within NAHSCP day services. Total cost for this provision per annum would be £87,000 and has been accounted for in savings projection. • Full in year savings are unlikely to be achieved for 2025/26 due to the part year impact of the service with a shortfall of around £90k. 4.6 Option 2 Redesign of both the Partnership and Alzheimer Scotland’s older people’s day service delivery functions - this option proposes a significant shift and change in the delivery of both day services and dementia services in North Ayrshire. Under these changes Alzheimer Scotland would move away from a traditional day service model and instead focus on a model of delivery prioritising befriending services, dementia daycare outreach at home, and provision of increased support for carers of loved ones with dementia. Outreach day services previously planned for Partnership delivery would be provided by Alzheimer Scotland under this revised model only for adults with a memory impairment – there would be no outreach provision for frail older people. All older people's (building based) day services would be delivered by the Partnership. Pro’s • Will ensure retention of building-based day services (provided by HSCP) in each of the mainland locality areas to adults over 65 with both memory impairment and physical disability. • Streamline resources and ensure flexible, resilient in-house day service provision. • Continues specialist dementia service. • Facilitates outreach and befriender service. • Support for family and carers. • Opportunities to mitigate some of the risk of increased waiting lists and service closure by enhancing capacity in Partnership day services. • Alzheimer Scotland would continue to retain use of the Harbour Centre as a
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base for which to deliver their services. • Savings would be made by Alzheimer Scotland in terms of transport and meal provision costs if the service were to move to an outreach model. • There are benefits of a blended approach to day service delivery through supporting more individuals via remote support and outreach visits which would reduce levels of unmet need. Con’s • Negative impact on current provider, Alzheimer Scotland who may not choose to enter a contract to deliver an alternative model. • Impact on current users of the Alzheimer Scotland service and families/carers • Loss of weekend provision. • Loss of 63 weekly day care placements. • Increase in waiting lists and unmet need for access to day care provision. • Would not achieve full savings target. Mitigation • Funding will be directed to the Partnership’s inhouse day care centres to enhance capacity and offer building-based day care opportunities for adults affected by the change in Alzheimer Scotland service – the has the potential to limit the impact of an overall reduction in day care places for older people to around 30 places on a weekly basis. • A review of day care support for any affected service users will be undertaken prior to any service change. • Alzheimer Scotland currently provides day services over a 7-day period whilst the Partnership’s day services are delivered Monday to Friday; however, uptake for weekend services has been consistently low, with poor attendance observed during these times. Given this trend, it is anticipated that the impact of discontinuing building-based provision over the weekend would be minimal. • Currently, in-house day services have a greater capacity and make more efficient use of available spaces on a daily basis – operating at 95% capacity compared to Alzheimer Scotland who have been operating at 73% capacity. Shifting to a fully in-house daycare service model will offer opportunities for enhanced flexibility in service delivery and staffing. • Savings would be made by Alzheimer Scotland in terms of transport and meal provision costs if the service were to move to an Outreach model. • If current provider does not choose to enter into an alternative model and funding arrangement through a revised contract from September 2025, alternatives will be considered including an open procurement process or through an in-house delivery model through day services and dementia support. Financial Implications • This option would generate savings of approximately £212k per year, £95k less than the identified saving of £307k – this saving would be generated by not recruiting to Partnership vacancies identified for Outreach provision and a reduction in Alzheimer Scotland funding from £276K to £140K per annum. • It is anticipated that 3 x additional part-time Day Care Officers would be required to supplement additional attendees within NAHSCP day services. Total cost for this provision per annum would be £87k and has been accounted for in savings projection. • Full in year savings are unlikely to be achieved for 2025/26 due to the part year impact of the service with a shortfall of around £107k.
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4.7 Discussions with Alzheimer Scotland have already commenced and in consultation with the Partnership, Alzheimer Scotland have agreed to provide an outline proposal for a potential future service delivery model within North Ayrshire in line with Option 2. 4.8 Considerations for future commissioning are ongoing and it has yet to be confirmed whether a full tender for the future provision of any agreed commissioned service would be required. This may have an impact on who the future provider of Option 2 is, should this be the outcome. 4.9 In order to ensure capacity within the Partnership’s day services for any service users affected by the service change it will be required to pause any new admissions to from end June 2025, with all non-critical referrals being added to a day services waiting list. 4.10 Anticipated Outcomes It is anticipated that this proposal will ensure a more financially sustainable model of day service provision within North Ayrshire, whilst protecting the delivery of crucial day service supports for residents of North Ayrshire and their carers. By continuing to work in partnership with all stakeholders, the described approaches will promote the ongoing sharing of knowledge and expertise and a more equitable approach to access to services across North Ayrshire. 4.11 Measuring Impact The service will continue with an ongoing programme of stakeholder engagement – including engagement with day service staff, service users, carers and care providers, to gather feedback on any changes made to the day service model. 5. RECOMMENDATIONS This report, in consideration of current needs across Health and Community Care Services, would recommend that the IJB: • note the outcome of the older people’s day service review completed in February 2025. • (consider the option(s) detailed within this report for future delivery and provide approval for the preferred option, noting the described impact on service users and all other relevant stakeholders. • note the requirement for a temporary pause on new day service admissions whilst teams reconfigure service delivery and where possible accommodate any service users affected by service change. • consider and approve the preferred option between Option 1 and Option 2 as set out in the report. • Note that the revised service model will undergo a formal evaluation six months after reopening. This evaluation will assess the effectiveness of service delivery, the impact on unmet need, and identify any further areas for improvement. 6. IMPLICATIONS 6.1 Financial Option 1 would deliver the full approved savings target for the day services review. Option 2 would not meet the approved savings target of £307k and would leave a recurring budget gap of £95k which would require to be added to the IJB overall gap with savings identified from other services.
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6.2 Human Resources There may require to be recruitment to address gaps in staffing in Partnership Day services. The effect on staffing within Alzheimer Scotland day service provision is not known at this time and would be managed as part of any exit from or change to contract. 6.3 Legal Potential impact in relation to Alzheimer Scotland workforce. 6.4 Equality An Equalities Impact Assessment has been completed in relation to these proposals. 6.5 Children and Young People None. 6.6 Environmental & Sustainability None. 6.7 Key Priorities This report, based on the findings contained within, would summarise that older people day services within North Ayrshire are a vital service and support in achieving the Partnership’s strategic aims of “all people who live in North Ayrshire are able to have a safe, healthy and active life”. 6.8 Risk Implications The risk implications are detailed within the report. 6.9 Community Benefits Revised model(s) of services will allow for continued opportunities to build strategic links between the Partnership including other Community Care Services, Housing and Connected Communities. 7 CONSULTATION 7.1 The options were considered and future provision discussed with stakeholders as part of the recent review of day services for older people in North Ayrshire. 7.2 The PSMT has been consulted on the options described within this report. 8. CONCLUSION 8.1 IJB are asked to consider the outcome of the day services review, and considering the two Options presented for consideration within the report advise on which Option is preferred to allow for an effective implementation period. For more information, please contact Kerry Logan, Head of Service, HCC on [01294 317805] or [klogan@north-ayrshire.gov.uk]
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February 2025 North Ayrshire Health and Social Care Partnership Older Peoples Day Service Review AN OPTIONS APPRAISAL
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1 Contents Introduction .................................................... 2 Engagement ............................................... 4 Landscape Review ........................................ 5 Service Overview .......................................... 6 Aims ............................................................ 7 Access Criteria .......................................... 8 Service User Experience.......................... 9 Feedback ................................................ 9 Transport .............................................. 14 Catering ................................................ 14 Referrals ................................................... 15 Staffing ...................................................... 15 Demand ........................................................ 16 Attendance ............................................... 16 Options Appraisal ........................................ 20 Status Quo / Do Nothing ........................ 20 Relocate Day Services to Community Hubs .......................................................... 20 Cease Outreach Daycare Provision ..... 20 Increase Charge for Service .................. 21 Three Towns Colocation ........................ 22 Permanently Close Thistle Day Service ................................................................... 23 Discontinue Alzheimer Scotland Daycare Provision ................................................... 24 Redesign Partnership & Alzheimer Scotland Service-Delivery Roles ........... 26 Appendices .................................................. 28 Charter of Rights ..................................... 28 Day Service Space Requirements ........ 29 References ................................................... 32
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2 Introduction 1. The current model of delivery of older people’s day service has been identified within the HSCP transformation plan for review and has been given a target to achieve a recurring financial saving of £200,000. This has been implemented in a phased basis, with £100,000 saving in year one and a further £100,000 saving in year two, over the period 2024/25 – 2025/26. Year one savings were achieved by pausing the day services outreach development and by not filling outreach posts; however, the future of the outreach service requires to be considered as part of this review. A recurring saving of £200,000 must be identified from year two onwards. 2. This paper will consider the day services model across North Ayrshire and describe the options appraisal exercise (see Chapter ‘Options Appraisal’) that evaluated several options to identify a sustainable service model for introduction in the short to medium term, one which would realise the necessary savings and ensure the ongoing provision of valued day service supports to older people in North Ayrshire. 3. The recommended option as an outcome of this review is to Remove Outreach & Change Alzheimer Scotland’s Role. This approach would achieve the necessary budget savings while continuing to offer a wider range of services and supports to the families of older people across North Ayrshire and specifically for those with dementia. Careful management on this proposal and resultant service change would be required to mitigate the negative impacts on service users, including familiarising them with alternative units and managing the transition smoothly. Further engagement with stakeholders is essential to ensure a successful implementation and to address any concerns that may arise. This option balances the need for cost savings with the goal of maintaining service quality and accessibility for users. TABLE 1: SUMMARY OF OPTION'S APPRAISAL RECOMMENDATIONS Option Summary Recommended Status Quo / Do Nothing Continue with current model of delivery inclusive of Daycare provision across all mainland localities and contracted Alzheimer Scotland provision with the full roll out of the Outreach service. This would not generate any financial savings. No Relocate to Community Hubs Move physical location of day service provision into the community hubs (within sheltered housing units). This may realise some building-based savings however this would be minimal, and a review has taken place confirming the physical layout of the community hubs do not meet the requirements for daycare provision. No
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3 Option Summary Recommended Cease Outreach Day care provision Continue with current model of delivery inclusive of Daycare provision across all mainland localities and contracted Alzheimer Scotland provision with the permanent removal of the planned Outreach service. This would not achieve the full financial saving and loss of this service will increase demand on other, more costly, services. No Permanently close Thistle Day Service Permanently close Thistle Day Service which currently operates in the Three Towns locality providing approx 70 day service places on a weekly basis. The cons significantly outweigh the benefits in this option and introduce the risk of negative publicity, increased demand on other more expensive services, increased social isolation for service-users and inequality in access to services for those living in the Three Towns locality. SMT Consideration Discontinue Alzheimer Scotland Daycare provision Alzheimer Scotland currently provide daycare services to adults with Dementia in the Three Towns locality. Whilst the cons of this option significantly outweigh the benefits, many could be managed and mitigated. This option would achieve the necessary savings however there would be significant impact on overall service provision moving forward. PSMT have agreed to a contract extension of six months, which will reduce Year 2 savings by approximately £121k. Conversely, discontinuing Alzheimer Scotland could send the message to local people that the HSCP do not feel it is necessary or appropriate to employ nationally recognised specialist Dementia care in the area. SMT Consideration Three Towns Colocation Co-locate Three Towns Daycare provision by merging day services provided by the Partnership and Alzheimer Scotland in the Thistle Day Service building in Stevenston. This may realise a level of savings due to economies of scale for example transport, meals and staffing however having scoped this it is unlikely to be viable. This is due to the layout of the unit meaning it would not be possible to operate two separate services using common facilities simultaneously whilst employing different policies and procedures. No
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4 Option Summary Recommended Redesign Partnership and Alzheimer Scotland delivery roles. This is the only option where the ‘pros’ outweigh the ‘cons’. Moving forward, this option would achieve the necessary savings and, if managed effectively, limit the impact on the displaced service users who would be introduced to alternative day services or receive alternative services from Alzheimer Scotland. This option allows the Partnership to offer a wider range of services to the families of people with Dementia, mitigating the loss of Outreach Support whilst offering a solution to those people who cannot access traditional Day Services. This option would also allow HSCP the opportunity to review current dementia service provision, minimising duplication of provision and offer a wider range of services to the residents of North Ayrshire. SMT Consideration *LIMITED INTRODUCTION OF THESE OPTIONS COULD BE USED IN THE SHORT-TERM TO ‘SHORE UP’ PREFERRED SOLUTIONS WHICH MAY FALL SLIGHTLY SHORT OF THE YEAR 2 SAVING TARGET 4. The paper also considers known challenges to service delivery, and where action is required to address these a ‘To Do’ icon is placed in the margin. 5. While this is a standalone project, its outcomes will link to, and flow into, forthcoming ‘Dementia Support and Respite Models of Care’ work. 6. This project supports HSCP strategic delivery stated in the Strategic Commissioning Plan, that “Our Transformation Plan sets out our key areas of focus for redesigning and improving our services and business processes… across all service areas with the aim of ensuring the Partnership continues to deliver effective and cost-efficient services.” Engagement 7. It is recommended that consideration is given to the preferred option and if deemed suitable, further engagement is undertaken with key stakeholders in 2025: Alzheimer Scotland, Carers Development Officer, Carers Service, Day Services Staff, Dementia Support Staff, Mental Health Team, SDS Policy Review Manager, Service Users and their families, Social Work. TO DO
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5 Landscape Review 8. A 2018 paper [1] found that “for older people with long-term conditions, regular structured activities within a community setting meeting others are thought to improve well-being and quality of life.” However, it also noted that “there is little known about outcomes of day care provision.” The study examined the outcomes of day care provision, focusing on three areas: Physical functioning: Findings from limited studies indicated a “trend for positive impact… when activities are incorporated into a day care programme.” Intergenerational provision: a “small number of studies suggest positive benefits.” Measurement of outcomes: One study suggested that “attendance at day care could reduce hospital attendance and admissions.” 9. Another 2018 study [2], found that “day centres are life-enriching gateways,” with benefits felt by attenders, their family carers, and centre volunteers. The paper notes that day centres “offer added value beyond the purposes for which they are commissioned or funded, beyond what may be assumed to be covered by an aim of improving quality of life or supporting people to remain at home, beyond what attenders may have expected, given their reasons for attending.” The study found that “day centres are not stigmatised or perceived as outdated.” 10. A 2020 [3] study states that day centres “were found to play a variety of roles for individuals and in care systems,” with most evidence pointing to “social and preventive outcomes.” The study found that “attendance and participation in interventions…impacted positively on older people's mental health, social contacts, physical function, and quality of life.” However, the report also noted that the research was based on evidence sourced outside the UK, and that the impact of day centres on “older people without dementia” is under-researched. 11. Given the limited evidence to support day services through research, it is imperative that consideration is given to service-user feedback for HSCP- provided day services (see page 9).
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6 Service Overview FIGURE 1: MAP OF NORTH AYRSHIRE WITH DAY SERVICE UNITS INDICATED 12. North Ayrshire Health & Social Care Day Services are currently provided at five locations across the area (Figure 1). The daily charge for service-users is £16.49, it is anticipated charge will rise to £19.79 from April 2025 with further increases anticipated throughout 2026/27. 13. Previously, a service was delivered in Cumbrae, but it has been confirmed that this is no longer operational. 14. The day service on Arran has been closed since the pandemic. A review led to a pilot outreach model from May 2023 to March 2024, conducted in two phases: Blackwaterfoot and Stronach Day Service in Montrose House, Brodick. The pilot served a small number of users and received positive feedback for its social benefits and respite for carers. However, it relied on existing staff, making it unsustainable. Burns Day Services, Irvine Stevenson Day Services, Largs Gowanlea Day Services, Kilbirnie Thistle Day Services, Stevenston Harbour Centre (Alzheimer’s. Scotland), Ardrossan
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7 15. It is therefore recommended to adopt a fully outreach model for day services on Arran, eliminating onsite day care. However, service should only be provided when staffing allows thus addressing recruitment and resource challenges. A phased implementation should aim to serve six users by the end of 2025. It is suggested that a short-lived working group is established to develop detailed plans and oversee the phased implementation. FIGURE 2: PROFILE OF MAINLAND SERVICES (SOURCE: HSCP DAY SERVICES TEAM) Location Ardrossan Irvine Kilbirnie Largs Stevenston Unit Harbour Centre Burns Day Service Gowanlea Day Service Stevenson Day Service Thistle Day Service Provider Alzheimer Scotland In-House (NAC) In-House (NAC) In-House (NAC) In-House (NAC) Hours 09:00 – 16:30 09:00 – 16:30 09:00 – 16:30 09:00 – 16:30 09:00 – 16:30 Days 7 day (less 2 weeks at Christmas) Mon-Fri (less 8 public hols per annum) Mon-Fri (less 8 public hols per annum) Mon-Fri (less 8 public hols per annum) Mon-Fri (less 8 public hols per annum) No of Staff (FTE)* n/a 8 7 5.5 5.5 Capacity (weekly) 63 110 100 70 70 Capacity (daily)** 9 22 20 14 14 Current Waiting List (and those waiting on 2nd day) on 26 Feb 2025 6 (1) 54 (36) 15 (14) 9 (5) 14 (6) Total Places Allocated (February 2025) 50 (80% capacity) 110 (100% capacity) 100 (100% capacity) 70 (100% capacity) 70 (100% capacity) Income Generated (current rate £16.49 per day) n/a £94,322 £85,748 £60,024 £60,024 Income Generated (new rate £19.79) n/a £113,198 £102,908 £72,036 £72,036 Expenditure £242,153 £338,640 £265,841 £208,207 £286,582 *ALL UNITS ALSO HAVE AN ADDITIONAL 2 BUS DRIVERS ALLOCATED TO THEM ** CAPACITY FOR BURNS & GOWANLEA IS UNDER REVIEW BUT IS LIMITED BY THE TRANSPORT AVAILABLE FOR SERVICE USERS WHO REQUIRED TO BE COLLECTED AND DROPPED OFF. STEVENSTON RESOURCE CENTRE, LARGS IS ALSO CURRENTLY UNDER REVIEW DUE TO STAFFING LEVELS AND BUILDING SPACE. THISTLE DAY SERVICES, STEVENSON IS CURRENTLY AT FULL CAPACITY. BUDGET CODES FOR DAY CARE INCOME ARE 10 218043/044/045 & 046 ACCOUNT CODE 60145. INCOME RECEIVED TO THESE CODES IN FY 2324 WAS £118,421 BUT ALSO INCLUDES COSTS FOR NON-PC - ANALYSIS AVAILABLE VIA BUSINESS UNIT [4] Aims 16. The aim of the Day Service is described in both the most current Policies and Procedures [5] and in the leaflets issued to service-users about the service. The leaflets offer the most current definition. TO DO
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8 TABLE 2: DEFINED AIMS OF DAY SERVICE & SOURCE OF INFORMATION Day Service Policy & Procedure Service-User Information Leaflet Maintain older people at home in their local community by promoting/maintaining their independence through therapeutic interventions which meet their physical, social, and psychological needs. Service provision should be of a high standard, flexible in its approach with an emphasis on value for money and delivered in a safe environment. Provides day services for adults aged 65 and over, offering a homely and therapeutic environment. We aim to support people to remain in their own homes and to be part of their wider community. Our objectives are: To assist people to remain in their own home To promote social stimulation and prevent isolation. To provide a source for social care and health To promote the maintenance of daily living skills To contribute to rehabilitation To provide specialist care for people with cognitive impairment To provide support and information to carers 17. Service delivery is centred on an established ‘charter of rights’ [5] for service- users. These rights are predicated on the belief that each person is an individual and that society should respect that individual and his or her fundamental rights as a citizen (see Appendices, page 28). 18. It should be noted that the Policy & Procedures governing Day Services should be refreshed, as the most current version dates to 2005. There is a need to ensure they continue to comply with current legislation, guidance, and corporate policies. Access Criteria 19. Clients referred to day services will be accepted if they [5]:: Are aged 65 years or over at the time of referral. However, younger clients may be considered if their needs can be met through day services activities on a short-term basis. Require reintegration into the community (eg. post-hospital discharge) Are in bereavement. Are recovering from a debilitating illness. Require rehabilitation in activities of daily living. Are socially isolated from their peer group. Are physically disabled, sensory impaired, or have poor mobility. Need promotion of mental health status (e.g., depression, low self- esteem) Are suffering from mild to moderate dementia. Have mild to moderate learning disabilities and suffer from one or more of the above conditions. TO DO
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9 Service User Experience 20. In December 2024, service users in each unit were surveyed to gain an understanding of the quality of the Day Service intervention. Service users were asked a series of questions by staff from their own unit and required to give those staff members their response in order that an e-form could be completed. 21. This approach could introduce some anomalies if service users were reluctant to criticise staff or the service they provide directly. This is potentially apparent in the analysis of the responses received, where only very occasional negative comments have been provided. However, care must also be taken not to assume that this is the case; it may well be that service users are wholly happy with the day service being offered. 22. It must also be noted that staff’s interpretation of people’s answers could also skew results. For example, service users were asked if they would be willing to transfer to a day service in another location. Most respondents answered yes or no, or gave a reason for their answer (e.g., lack of transport, wanting to stay in the town, etc.). However, 27 out of the 36 respondents at Gowanlea Day Service all referenced Gowanlea in their answers (e.g., "I’m happy at Gowanlea," "Not at the expense of Gowanlea," "I don't see the point in travelling a distance when I can get the best care here at Gowanlea"). There was a uniformity to these answers as well, with many people answering this question using the same phrases. The Gowanlea responses to some ‘free text’ questions are so different from those of other units that they stand out. Feedback 23. The feedback from the service-user survey carried out in December 2024 noted that when asked to rate the service, over 99% of all service users rated it as a four- or five-star service (Figure 3).
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10 FIGURE 3: SERVICE USER RATINGS FOR DAY SERVICES FROM 1 START TO 5 STARS (BEST) (SOURCE: DAY SERVICE SURVEY, DECEMBER 2024) 24. When asked to rate the service, the response from service-users was almost universally positive with only 1 person noting they disagreed with a single statement (Figure 3). 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Burns Gowanlea Stevenston Thistle All 5* 4* 3* 2* 1*
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11 FIGURE 4: SERVICE USER FEEDBACK ON A SERIES OF QUALITY QUESTIONS WHERE RESPONSES WERE MEASURES ON A 5-POINT SCALE FROM STRONGLY AGREE TO STRONGLY DISAGREE (SOURCE: DAY SERVICE SURVEY, DEC 2024) 25. When asked if they agreed with a series of questions with a YES/NO/Maybe answer, service users again responded in an overwhelmingly positive manner (166 respondents). FIGURE 5: SERVICE USER FEEDBACK ON A SERIES OF QUALITY QUESTIONS WHERE RESPONSES WERE MEASURED AGAINST YES/NO ANSWERS (SOURCE: DAY SERVICE SURVEY, DEC 2024) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100% I am encouraged to move around whilst at the Day Service I am treated fairly I am treated kindly I am treated with respect I feel the staff protect me by wearing their PPE when suitable I make my own choices with my diet and fluid If I am unwell, staff can recognise this and help me get the right help The staff are aware of the PPE they require to wear Strongly Agree Agree Disagree 0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100% Do you feel the staff support you to meet your goals and outcomes whilst attending the service? Is your care provided by staff who understand and are sensitive to your needs and wishes When attending the day service do you feel safe and secure in these surroundings? Yes Maybe No
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12 26. Most service users (88%) indicated they did not wish to move to another locality for Day Service provision, with 1 in 10 willing to attend an alternative location. The remaining respondents gave vague answers, making it unclear if they would relocate or not (Figure 6). However, it's important to interpret these figures carefully - many responses seemed to show loyalty to the unit they were attending. It could be that since respondents had to give their answers directly to staff in their units, they might have been reluctant to offend or hurt the feelings of people who provided care to them on a weekly basis. Furthermore, in the days following this survey, the service received several phone calls from service users who were clearly worried that their local service might close. FIGURE 6: RESPONSES TO THE QUESTION "WOULD YOU BE INTERESTED IN ATTENDING ANOTHER DAY SERVICE OUTWITH YOUR LOCAL AREA?" (SOURCE: DAY SERVICE SURVEY, DEC 2024) 27. Most respondents (90%) relied on supplied transport, though this varies slightly across each location. No Unclear Yes
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13 FIGURE 7: RESPONSES TO THE QUESTION "DO YOU USE THE DAY SERVICE TRANSPORT?" (SOURCE: DAY SERVICE SURVEY DEC 2024) 28. When asked if there was anything they would like to change or improve about the service, again service-users responded overwhelmingly in the positive, with only a few suggestions for improvements. Enhance Meal Variety 29. Several respondents indicated a need for more variety in meals provide, though none felt there was an issue with food quality. Burns Day Service: 5 respondents. Gowanlea Day Service: 3 respondents Stevenson Day Care & Resource Centre: 2 respondents Thistle Day Service: 4 respondents 30. It is recommended that more varied meal options are introduced to cater to different dietary preferences. This recommendation applies to all units, with Burns Day Service and Thistle Day Service having the highest number of comments. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Burns DS Gowanlea DS Stevenson DS Thistle DS All No Yes TO DO
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14 Diversify Activities 31. A small number of respondents commented about the activities. This isn’t a significant issue for any unit, but it is recommended that an ongoing programme of new activities are introduced to keep the day service engaging and stimulating for attendees. 32. During a self-evaluation away day on 30 April 2024, Senior Day Care Officers reviewed the main challenges faced by each unit. While they noted that the programmes of activities were good and the service model was adaptable to the needs of service users, they also identified several areas of concern including concerns about the poor quality of referrals being received and staffing challenges. Transport 33. Within the current model, each HSCP Day Service unit has two allocated bus drivers and two buses. However, any issues which arise with buses, and vacancies, directly impact the transport capacity within each unit. There is also a general lack of commercial buses available for hire, meaning if the corporate buses allocated to the Day Service units are being repaired, there is no scope for alternative transport. Additionally, the allocated buses have a large step into the bus, which service users can find difficult to manage. There is also limited space available, for example, the most recently procured electric bus can only accommodate two people if two wheelchairs are also required. The seats on the bus are covered in fabric, which introduces potential continence issues. 34. To scope options to address these issues, the team approached another Local Authority to ascertain if there was any good practice that could be adopted. A review of Day Care transport will be required going forward. Catering 35. Providing a nutritious meal to service users during their time in day service is essential for meeting their overall nutritional needs. A review of the catering within each unit was conducted, focusing on the 3-week rotating meal plan provided by HSCP Facilities Management. 36. The review found that, during a single 3-week cycle, the majority of meals were good. Thistle Day Service in Stevenston reported no issues with the food. However, the remaining units experienced several problems and there is ongoing engagement with relevant teams to improve catering provision. TO DO TO DO
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15 Referrals 37. During the April 2024 away-day Senior Day Care Officers also identified poor quality of referrals. A review of the forms during the Eclipse process has addressed this issue. Staffing 38. A number of staffing issues were identified; however, the management team have worked to address these and are monitoring the situation. TO DO
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16 Demand Attendance 39. Attendance figures (Jan 24 to Feb 25) indicate that in the main, the number of day care places being offered at each unit is fairly stable, after an increase in number during the first quarter of 2024 (Figure 8). FIGURE 8: NUMBER OF DAY CARE PLACES OFFERED JAN 2024 TO FEB 2025 (SOURCE: STATS DAY CARE 29/05/2023 DOCUMENT, EXTRACTED 19 FEB 2025) 40. Staff who manage the Day Services have indicated that referrals into the service are becoming increasingly complex, putting pressure on service delivery. The risk status of current service users shows that most have been assessed as at least a ‘substantial’ risk. It is important to note that at time of referral assessment of risk may be low however this often increases as service users’ conditions deteriorate. 0 50 100 150 200 250 300 350 400 01-Jan 08-Jan 15-Jan 29-Jan 12-Feb 26-Feb 11-Mar 25-Mar 08-Apr 22-Apr 06-May 20-May 03-Jun 17-Jun 01-Jul 15-Jul 29-Jul 05-Aug 19-Aug 02-Sep 16-Sep 30-Sep 14-Oct 28-Oct 11-Nov 25-Nov 09-Dec 23-Dec 06-Jan 20-Jan 03-Feb 2024 2025 Alz Scotland Burns DS Gowanlea Stevenson Thistle
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17 FIGURE 9: CURRENT SERVICE-USERS BY ASSESSED RISK ON 19 FEBRUARY 2025 (SOURCE: DAY SERVICES LIST, SHAREPOINT) 41. A high proportion of those attending day-services experience symptoms of dementia. In 2024, almost 2 in 3 referred to day services experience symptoms of dementia (Figure 11) 42. Figure 10). Though, this figure varies by unit with all of those attending Alzheimer Scotland’s Day Service experiencing symptoms of dementia, compared to around half of the service users attending Burns Day Service and a third of those attending Thistle Day Service (Figure 11) Alz Scot Burns Gowanlea Stevenson Thistle Total# (blank) 4 57 11 7 11 90 Low 1 1 10 7 2 21 Moderate 3 5 15 28 10 61 Substantial 71 230 132 135 129 697 Critical 14 26 9 4 26 79 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
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18 FIGURE 10: SERVICE-USERS WHO EXPERIENCE SYMPTOMS OF DEMENTIA BY REFERRAL DATE (SOURCE: DAY SERVICES LIST, SHAREPOINT, EXTRACTED 19 FEB 2025) FIGURE 11 CURRENT SERVICE-USERS WHO EXPERIENCE SYMPTOMS OF DEMENTIA BY UNIT (SOURCE: DAY SERVICES LIST, SHAREPOINT, EXTRACTED 19 FEB 2025) 43. On 19 February 2025, there were 101 people on the waiting list for a place in one of the day services units, and a further 53 people are waiting on a second day of day services (Figure 12). Demand is highest for Burns Day Services. 2023 2024 2025 (blank) 24 12 Yes 238 188 12 No 109 135 12 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% No Yes (blank) Alz Scot Burns Gowanlea Stevenson Thistle Yes 29 48 38 36 41 No 44 32 22 19 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
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19 FIGURE 12: NUMBER OF PEOPLE CURRENTLY WAITING FOR DAY SERVICES ON 19 FEB 2025 (SOURCE: DAY SERVICES LIST, SHAREPOINT) 0 10 20 30 40 50 60 70 80 90 100 Alz Scot Burns Gowanlea Stevenson Thistle
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20 Options Appraisal All options were firstly considered against the primary goal of this project, to achieve the necessary savings. Any which did not meet this objective were deemed unviable and not explored further. Status Quo / Do Nothing 44. The ‘status quo’ option is included as a baseline comparison for other options; to help understand the relative benefits and risks associated with a proposed change against the current level of service provision. 45. NOT RECOMMENDED: Doing nothing is not a viable approach as it will not achieve the necessary savings. Relocate Day Services to Community Hubs 46. A number of sheltered housing units have community hub spaces included. In the past, work has been undertaken to ascertain if relocating day services to these locations would be viable. However, there are a significant number of requirements set out by the Care Inspectorate, which must be met, before such a move could be made. It has been confirmed that the likelihood of achieving the required criteria has been discussed with PMI colleagues in the past, and it was established that none of the hubs met the required specification [6]. 47. NOT RECOMMENDED: Relocation to community hubs is not a viable option and has not been considered in any further detail. Cease Outreach Daycare Provision 48. This option considers placing a permanent pause on recruitment – effectively opting not to establish an outreach service. In 2024/25, the Outreach budget was £165k [4]. Therefore, opting not to introduce an Outreach Service would realise most, but not all, of the necessary savings from year 2 onwards, therefore, it this option were chosen, another option would also need to be partly adopted. Pros Cons Contribute towards the £200k saving requirement Would not achieve 100% of the required saving requirement. A number of people who would meet outreach criteria would have no service to access, and therefore demand pressure on other, more costly, services would increase.
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21 The work already done to develop the Outreach service for implementation would be abortive. People who are unable to attend mainstream Day Service would be negatively impacted, losing out on this potential care and support offer. 49. NOT RECOMMENDED: On its own, permanently pausing outreach is not recommended as it will not achieve all the necessary savings whilst also increasing demand on other more costly services and negatively impacting those who cannot attend mainstream day service, introducing an equality concern. Increase Charge for Service 50. At the moment service users currently pay £16.49 for day services, amounting to £300,118 per annum assuming 100% occupancy. The income generated by this recharge is not paid into the day service budget, instead being logged to the Charges to Users Community Care Service Delivery budget lines. 51. To achieve the necessary savings using this options alone, the charge would increase from £16.49 to £27.80 per session, This figure assumes 100% occupancy and charging may need to be varied to reflect a reduction in occupancy and account for anyone who is exempt from charging. It must be noted that an increase to charges is also being proposed as a separate 2025/26 proposal. Pros Cons Contribute towards the £200k saving requirement via income generation To achieve the necessary saving, the cost of a session would have to increase by at least c.70% - more when reduced occupancy and exemptions are factored in. It would introduce a potential equalities issue by presenting a barrier to those who cannot afford to attend The risk of negative publicity when increasing charges to vulnerable people during a cost of living crisis. If higher recharges resulted in lower attendance at Day Service, this would mean increased reliance amongst service-users for Care at Home and other interventions. Many service-users have multiple services involved in their care and support. They will already be impacted by planned increased via the charging policy. 52. NOT RECOMMENDED: Increasing the charge to c.£28 per session is likely to introduce a barrier to those on low incomes, and in turn would increase crisis situations, carer exhaustion and demand on other more costly services. [7]
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22 Three Towns Colocation 53. This option considers co-locating Thistle Day Services and Alzheimer Scotland in the same location – the Thistle Day Services unit. The unit could accommodate such a move. 54. It should be noted, however, that if Alzheimer Scotland is expected to provide the same service, with any contract savings arising from their lack of accommodation costs – this is unlikely to be achieved. This is because NAC own the Alzheimer Scotland building and covers the repair expenses. The rent is believed to be minimal, if not entirely waived [7]. If Alzheimer Scotland vacate the building, it will revert back to NAC. 55. Alzheimer Scotland have a staffing compliment as noted, they also have a few seasonal bank staff [7]: 1 x Practice Team Leader 2 Day Care Organisers (21hrs) 3 Day Care Support Workers (28hrs) 1 Day Care Support Worker (21hrs) Pros Cons Potential saving to contract but unknown how much benefit would be achieved. Unlikely to achieve the necessary level of savings required Service users would still have access to services in the same vicinity as previously. It is unlikely to be viable due to the layout of the unit that two separate services could be co-located and continue to operate independently. There is only one dining room, lounge etc, meaning both services would be seeking to use these at the same time. Furthermore, Alzheimer Scotland have their own policy and procedures and employment conditions that would differ from those used by HSCP. No job losses Alzheimer Scotland may not want to relocate Alzheimer Scotland employ different policies and procedures to HSCP and this may hinder service delivery The change of environment for service- users with a memory impairment could have a negative impact on their well-being. A number of people who would meet outreach criteria would have no service to access, and therefore demand pressure on other, more costly, services would increase (most significantly Day Services ) The work already done to develop the Outreach service for implementation would be abortive. People who are unable to attend mainstream Day Service would be
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23 negatively impacted, losing out on this potential care and support offer. 56. NOT RECOMMENDED: This option is unlikely to be viable. The layout of the unit means it would not be possible to run two separate services in this location, both functioning at the same time (ie. both sharing the same lounge, dining room etc), using different policies and procedures. Permanently Close Thistle Day Service 57. This option would see the current service, located in Stevenston, close. The rationale being the proximity of Alzheimer Scotland who are also based in the Three Towns locality (Ardrossan). NB: Alzheimer Scotland only service people with memory impairment and only have 9 spaces per day available. They could not compensate for the resulting shortfall of spaces in the Three Towns, with further detriment incurred by people living in the Three Towns who do not have a memory impairment as there would be no delivery of this provision within the Three Towns locality. 58. Whilst Thistle Day service has capacity for 24 spaces per day (120 spaces per week) these spaces are currently not filled due to current staffing levels implemented following previous budget savings. Instead, it would result in a loss of 70 day service sessions a week. 59. There is currently a £235K budget allocated for Thistle Day Service, however, the loss of income secured via recharging (at 100% occupancy) would reduce the saving by £60k based on 2024/25 charging rates. Therefore, at 100% occupancy, closing Thistle Day Service would achieve a saving of around £175k. Pros Cons Contribute towards the £200k saving requirement Closing Thistle Day Service would not achieve 100% of the savings requirement and other options would also need to be partly adopted. There would be no place for frail elderly service users in the Three Towns introducing an equality issue (based on postcode). Job losses for staff could be politically sensitive and result in negative publicity Negative publicity resulting from the closure of a second day service in the Three Towns. (previously closed Castleview). The current case load of service-users attending day services includes people who have attended for many years and realise significant benefit. The impact of removing the service from them is likely to also be significant (eg social interactions, nutrition, monitoring of situation etc).
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24 Service-users in the Three Towns are unlikely to want to travel to a unit in another locality. Loss of this service would increase crisis situations, carer exhaustion and possibility of more demand on more costly services. 60. FOR SMT CONSIDERATION: The cons significantly outweigh the benefits in this option and introduce risk of negative publicity, increased demand on other more expensive services, increased social isolation for service-users and inequality in access services for those living in the Three Towns. Discontinue Alzheimer Scotland Daycare Provision 61. This option looks at discontinuing the Alzheimer Scotland daycare provision contract at the point of renewal and transferring those service users into alternative HSCP’s Day Service units. Service users moving from Alzheimer Scotland would pay their Day Service charge to HSCP, resulting in an additional c.£54k via income from recharges . 62. Alzheimer Scotland provide services to people with a memory impairment. Our contract with the organisation provides 9 spaces each day of the week (63 spaces overall). The intention is that the contract ensures service provision for individuals across North Ayrshire, however restrictions in this regard are imposed by the organisation. 63. The current contract with Alzheimer Scotland runs to end 28 February 2025 with an annual value for 2024/25 of £241,471. There is a further 6-month extension option that would extend the contract to 31 August 2025; the value of which would require to be confirmed through the fee uplift process in 2025, but for planning purposes can be assumed to be around 50% of the 2024/25 cost (ie. C.£121k). PSMT have agreed to this contract extension. 64. It should also be noted that Alzheimer Scotland often decline to accept people who live within North Ayrshire, but beyond the area they deem viable in terms of transport (most recently in January 2025 a service user living in Springside). 65. There would be an impact on all Day Service units, as Alzheimer Scotland has a client group from across North Ayrshire, and these individuals would be eligible for continued service delivery in one of the HSCP units. Thistle Day Service is currently under capacity due to staffing, if they absorbed the displaced service- users, there would be a cost to HSCP that should be factored in. The cost of one Day Care Officer is £31,514, based on 2024/25 costs [4]. Additional transport costs should also be considered to support this option. Pros Cons Would fully achieve the £200k saving requirement from year 3 If this contract ceases, consideration must be given to increasing Thistle Day Services
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25 capacity to mitigate the shortfall in care provision that would result. This would mean additional staffing allocated to Thistle Day Services, increasing the cost of that service. There is capacity in Thistle Day Services to absorb the service gap that would result. The change of environment for service- users with a memory impairment could have a negative impact on their well-being. More income would be generated for HSCP from the recharge to service-users who would transfer into the HSCP Day Service (c.£54k per annum at current rates and 100% occupancy) There is a risk of negative social media fall out (reputational, political etc). Loss of a nationally recognised specialist service operating in North Ayrshire – for people with dementia Potential for job losses (could this be mitigated by offering employment in HSCP Day Services) The loss of weekend provision There is no guarantee that the displaced service-users would be able to secure an alternative place in their own locality (current lack of capacity) so additional transport costs may be incurred Service users, who currently enjoy Alzheimer Scotland service during a Saturday or Sunday would be required to change their attendance day to between Mon-Friday Does not achieve all necessary savings in year 2 due to the contract extension 66. FOR SMT CONSIDERATION: Moving forward, this option would achieve the necessary savings with minimal impact on overall service provision. Whilst the cons significantly outweigh the benefits of this option, many could be managed by increasing HSCP spaces to offset the loss of Alzheimer Scotland and seeking to employ staff faced with redundancy in HSCP services. The team could also consider ways of familiarising displaced service users with the HSCP unit they would move to. Nonetheless, adopting this option could send a message to the people of North Ayrshire, that employing the services of a nationally recognised Dementia provider is not necessary. Regardless, as PSMT have agreed to a contract extension of six months, it is further recommended that should this option be considered most suitable, that in Year 2 it is supplemented by another cost- saving measure.[7]
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26 Redesign Partnership & Alzheimer Scotland Service- Delivery Roles 67. A final option could be to review and change the specification of services being delivered by Alzheimer Scotland in North Ayrshire. The Partnership would no longer procure external Day Services or introduce an Outreach service. Instead all Older People Day Care services will be provided by in-house services with the remit of Alzheimer Scotland changing to a model which would include Befriending, Dementia Daycare Outreach at Home services and increased provision of services to support carers of loved ones living with dementia. This service specification change would enable a reduction in current spend to Alzheimer Scotland, as the service will see reduced expenditure in building costs, transport, and meal provision. This budget saving would be used to increase staffing levels within NAHSCP day services ensuring capacity for transferring Alzheimer Scotland service users and further potential increase in capacity from waiting lists. 68. The loss of Outreach would achieve over £100k per annum in savings, and when it is time to renew the Alzheimer Scotland contract, HSCP would offer a fixed price contract (set at a level within budget parameters) to seek a provider that could offer a more mobile service to both service users and their families/carers – effectively widening the scope of support that is available in the area to everyone affected by Dementia, and offsetting the impact of losing Outreach Support. 69. However, if this is deemed a viable and desirable option, a move should be taken immediately to ensure the accommodation of displaced service users resulting from changing the Alzheimer Scotland model. Work would also have to commence to familiarise those service users who would be displaced with the alternative units in their locality (ie. the HSCP run unit). This would also require a more significant adjustment for the service users who currently access Alzheimer Scotland at the weekend, as not only would the location but also the day of the week change for them. Pros Cons Would ensure the necessary budget savings are achieved. Alzheimer Scotland may not want to bid for a detailed and specific model of service delivery or deem it undeliverable within the budget parameters set. Service users would still have access to specialist service and day services There would be a loss of service delivery for up to 63 service users per week – who already enjoy day services with Alzheimer Scotland, including the loss of weekend provision. (It should be noted that a number of these service users already also attend an in-house Day service.
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27 No job losses The change of environment for service- users with a memory impairment could have a negative impact on their well-being. HSCP would avoid negative publicity around budget cuts The waiting list for HSCP run Day Services would continue to increase until 63 new spaces were available within the existing HSCP run units. This will be minimised by the increase in staffing within specific units. More support for those close to people with Dementia (eg. family, carers) in the area. A new service model which would include Befriending and Dementia Outreach Day services delivered via Alzheimer Scotland could offset the impact of losing a Partnership Outreach Service whilst also ensuring the specialist knowledge and skills held by Alzheimer Scotland are being optimally used. 70. FOR SMT CONSIDERATION: This is the only options where the ‘pros’ outweigh the ‘cons’. Moving forward, this option would achieve the necessary savings and, if managed effectively limit the impact on the displaced service users. It also allows the HSCP to offer a wider service to the families of people with Dementia, mitigating the loss of Outreach Support. It would offer a solution to those people who cannot access Day Services and who would have otherwise been suitable for Outreach.
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28 Appendices Charter of Rights SOURCE: NORTH AYRSHIRE COUNCIL: SOCIAL SERVICES POLICIES AND PROCEDURES, DAY SERVICES, JUNE 2005. The right to be treated with dignity at all times and to be treated as an individual, whatever disabilities and frailties one may have. The right to pursue independence, responsibilities, and choice where they do not infringe the rights of others. The right to privacy in relation to one’s own space, one’s own belongings, one’s own financial and personal affairs. The right to have one’s cultural and religious needs accepted and respected. The right to have one’s physical, sexual, and emotional needs accepted and respected. The right to care for oneself as far as possible and have appropriate assistance if required. The right to be informed of new procedures and have these made explicit, the right to comment and have one’s expressed opinions heard and listened to. The right to mix with other people in the community, either by going out or by inviting others into the residential home. The right to have assistance where necessary and practicable to access facilities available within the wider community, medical, social, educational, leisure and other services. The right to establish a service user’s group and freely nominate a representative to serve on such a group. The right to have free and clear access to the complaint’s procedure. The right to confidentiality in relation to medical and personal information, access to information on file and to know on what basis information is shared with others. The right to have a personal advocate (representative) to safeguard one’s interests if required. The right to take appropriate risks in relation to the exercising of one’s rights.
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29 Day Service Space Requirements SOURCE: KERRY RENNIE, TEAM MANAGER OLDER PEOPLE SERVICES/CARE AT HOME) Q1. The building and grounds are designed to comply with all relevant legislation and guidance documents. Certificates and commissioning documents with regard to engineering services and plant, approval letters and letters certifying completion of works and arrangements from other agencies and authorities confirm this. Q2. There are suitable car parking arrangements for service users, visitors, and staff. Q3. There is clear access to and egress from the setting for emergency and other vehicles, and there are suitably sized turning spaces for service vehicles using the site. Q4. There are areas for service users to get on and off transport safely that are illuminated and offer some protection against the elements. Q5. Where the day care setting’s programme includes outdoor therapeutic and leisure opportunities, the space is accessible to all service users. In settings registered to provide services to people with dementia, there is a secure perimeter. Q6. Front entrance doors are semi-automatic as a minimum and in facilities where people need assistance with walking or use wheelchairs, consideration should be given to having doors in activity areas fitted with hold open devices or that are free to swing and linked to the fire alarm. Q7. The doorways in activity areas used by service users have a clear opening width of at least 800mm, but in settings where service users need assistance when walking or use wheelchairs, wider doorways are recommended. Corridor doors have vision panels and in day care settings where service users need assistance when walking or using wheelchairs, there are level access thresholds at all doors. Q8. The minimum corridor width is 1.2m unobstructed between handrails, but in day care settings where service users need assistance when walking or use wheelchairs a minimum width of between 1.5m and 1.8m is recommended. Q9. All activity areas are accessible to service users through the provision, where necessary, of ramps, lifts (large enough to accommodate a stretcher), other facilities and signage. Q10. According to the service user groups offered services in the day care setting, there are suitably positioned hand and grab rails, hoists, communication aids and other equipment, including assistive technology, which meet the general needs of the service user group and promote independence in all the areas accessed or used by service users. Q11. According to the service user groups offered services in the setting, service user/staff call points, accessible to service users are provided in areas where service users are likely to be alone, toilets and washrooms. These are linked to a system that alerts staff a call is being made or assistance is required. Q12. There is both natural and good quality artificial lighting in all areas suitable for the needs of service users and any activities organised in each room. The artificial lighting in areas used by service users is sufficiently bright and positioned to facilitate activities. The recommended lighting level in toilets is between 100 – 200 lux. Q13. All activity areas used by service users are naturally ventilated, have opening windows with safety glazing and guarding where necessary. Window openings are controlled to a safe point of opening of no more than 100mm and cannot be overridden by service users. Frosted or obscured glass is fitted as required to ensure privacy. Q14. The heating system can be controlled within safe limits for the service users’ comfort in areas accessed and used by them and is able to provide a range of temperatures throughout the setting. Q15. Furniture and fittings are suitably designed for the activities that take place in the room and incorporate ergonomic design principles that promote user independence and safe handling.
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30 They, and any equipment or mobility aids, are positioned to take into account the mobility and overall needs of the service users, including those with sensory impairments. Q16. Floor coverings and wall finishes are suitable for the purpose of each room and meet health and safety and infection control requirements. Finishes that produce glare, dazzle and optical illusions are avoided, and where service users use wheelchairs floor coverings have non- directional pull. According to the service user groups offered services in the day care setting, for example those with a visual impairment, changes in the texture of floor coverings or other indicators should be considered to identify key areas in the setting, for example doorways or the top or bottom of stairs. Space for activities Q17. The minimum space per service user (excluding corridors and circulation areas) is 4.5m² in general activity areas, except for computer suites where 3.0m² is adequate. Where service users have high dependency needs, a minimum space of 7.5 m² is recommended. Q18. Having a range of size of rooms provides flexibility for organising activities and where the varied needs of service users can be met. According to the service user groups offered services in day care setting, this can include: • A room where meetings can take place. • A facility for service users to make or get drinks and snacks. • A quiet room with something suitable to rest on; and • A room where telephone calls can be made or received in private. Q19. The design of the dining space takes into consideration the number of service users who can eat comfortably together at one time. The space required for dining is at least 1.5 m² per person, but where service users have high dependency needs the space will be greater. Toilet and washing facilities. Q20. There are separate toilets for ambulant males and females, at least one wheelchair accessible unisex toilet that complies with the Building Regulations and a toilet facility identified for visitors. Q21. Each toilet facility: • is clearly marked and conveniently located to rooms used by service users. • is fully and separately enclosed. • has suitable hand washing and drying facilities to meet infection control guidelines; and • has a door that opens outwards. Toilets for ambulant, semi and assisted ambulant people are a minimum of 3m². Toilets for people who use a wheelchair independently or require the assistance of one person are a minimum of 4.5m² and at least 2m long. Toilets for people who use a wheelchair and require the assistance of two people are a minimum of 5.5m² and at least 2m long. Q22. Where the day care setting provides personal care there is an adequate number of bath and shower facilities. Bathrooms for ambulant people, people who require assistance and people who use a wheelchair independently are a minimum of 8.5m². Bathrooms for people who require the use of a hoist are a minimum of 16m². Shower rooms are 7m² (non-linear layout) or 7.5m² (linear layout) and are level access. Q23. Locks and handles on toilets, bathroom and shower room doors are easy to operate and allow staff immediate access in an emergency. Medicines Q24. There is an identified area where medicines can be stored, in accordance with the manufacturers’ instructions. This has:
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31 • cupboards conforming to British Standards for the storage of medicines. • space to safely store, access, and administer medicines and medicinal products. • sufficient work surfaces for the tasks required; and • hand washing facilities in close proximity that meet infection prevention and control guidelines.
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32 References [1] D. C. L.-W. M. Lunt C, “The role of day care in supporting older people living with long- term conditions,” December 2018. [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221434/. [Accessed June 2024]. [2] The Dunhill Medical Trust, Social Care Workforce Research Unit, Institute of Gerontoloty, King's College London, “Evidence briefing for commissioners: day centres for older people,” February 2018. [Online]. Available: https://www.ageuk.org.uk/bp- assets/globalassets/gwyneddamon/keep-well-keep-warm/day_centres_for_op-- evidence_briefing__for_commissioners.pdf. [Accessed June 2024]. [3] M. J. T. A. Orellana K, “Day centres for older people: a systematically conducted scoping review of literature about their benefits, purposes and how they are perceived.,” April 2020. [Online]. Available: https://www.cambridge.org/core/journals/ageing-and- society/article/day-centres-for-older-people-a-systematically-conducted-scoping-review-of- literature-about-their-benefits-purposes-and-how-they-are- perceived/8469C5AB75F8540BE4617E6B11E753C1. [Accessed June 2024]. [4] A. Braton, Interviewee, Snr Accountant. [Interview]. Nov 2024. [5] North Ayrshire Council, “Social Services Policies and Procedures, Day Services,” North Ayrshire Council, Irvine, 2005. [6] J. Davies, Interviewee, Principal Manager, Business Support. [Interview]. 30 July 2024. [7] K. Rennie, Interviewee, Team Manager. [Interview]. Nov 2024. [8] R. Bently, Interviewee, Snr Maanger, Arran Services. [Interview]. 2024.