The future of five Derbyshire centres which provide support for people with learning disabilities is in doubt.
There are five learning disability short break centres in Derbyshire, all of which are in the northern half of the county, currently supporting 60 to 70 families in need of high levels of care.
The NHS runs these facilities in Buxton, Chesterfield, Darley Dale, Eckington and Shirebrook with residential support led by nurses.
Three of these centres have already been temporarily closed, with the Eckington facility known as Amberley and Chesterfield facility known as Valley View closed because there were not enough staff “to give a safe service”; and the Buxton facility known as Robertson Road closed because it could not be made Covid-secure.
A report on plans for the five centres mentions that the Buxton facility is set to reopen.
This report was discussed in a Derbyshire County Council meeting yesterday (May 15) and councillors were keen to find out how often the centres were used and what was the demonstrated demand or need for them.
Officials from Derbyshire’s NHS said the facilities were now used by 60 to 70 families but use was decreasing significantly with occupancy currently at 17 per cent, around 900 bed days a year, and the services are costing £1.4 million – a set rate regardless of people using the services.
In 2018 there had been an occupancy rate of 43 per cent, they said.
They said some families had stopped using the facilities, while others only used them one or two times a year.
Meanwhile, officials shared that most of the families who currently use the facilities would no longer be eligible under the new Health and Care Act 2022.
They have already concluded that: “As currently commissioned and delivered, Joined Up Care Derbyshire NHS learning disability short breaks services do not represent fair and consistent use of NHS funding.
“Benefit is not at population level and does not represent good value for money for the integrated care system.”
However, they say the shore break services can continue to play a role in providing support, but this should be through provision closer to home in most circumstances.
Mick Burrows, director of commissioning for mental health, learning disabilities, autism, and children and young people at the NHS Derby and Derbyshire Integrated Care Board, said there was currently a clear “inequity of access” to the centres, with none in the southern half of the county.
He said NHS services needed to demonstrate fair access and value for money.
Mr Burrows said: “The vast majority of families do not require nurse-led services and do not meet the eligibility for NHS to be funding short breaks.”
James Lewis, head of joint strategic commissioning for learning disabilities and autism at the NHS Derby and Derbyshire Integrated Care Board, said the services were “significantly more costly than the private sector or county council”.
He based this assessment on the current cost per person using the service on reduced numbers, at £6,629 per week, making it appear 10 times more expensive per person than the private and voluntary and independent sector (£632-£655 per week) and five times more than the county council (£1,384 per week).
Councillors queried the £6,629 figure and felt this was an inaccurate and “dangerous” form of assessment
Mr Lewis said: “Having five services in the north of the county is not best meeting the needs of our population.”
He said patient engagement would be starting shortly, with councillors pushing officials to not just talk to existing users but also look to identify future demand and people who may need the service in the coming years, including those who may not be aware it exists.
Mr Lewis said there were a “handful” of patients who attended two to four days a year but most either have one attendance a year or have no annual attendance.
He said there were some exceptions with people using the facilities for longer periods of time.
Mr Lewis said: “A lot of this cost is wrapped up in a highly inefficient use of buildings.
“The move away from referring into a traditional building is a good one, reducing reliance on this service, they are services for people in urgent crisis and the way we are trying to do this is to be more person-centred and putting people into a building is not the only way to support them, it is about reflecting the shift in how we are trying to support people differently.
“It is probably not in the best interest of the families using it or in the best interest of the public sector to keep doing it in the current way.”
Cllr Peter Smith said users will be “fearful of change” and need to have consistency and be reassured.
Cllr Gary Musson said: “£1.4 million is a lot of money to anyone and is there to deliver quite a lot of service but is now looking like a very ineffectual service due to the decline in use.”
Cllr Mark Foster said that to have the figures for people using the service each year is crucial and said if that figure was 200 in 2018 and was now at 60-70 then it could be perceived that the service was “being run down on purpose”.
