Merthyr Tydfil Council would be unable to fund a scheme to create extra care bed capacity without extra money, a council report has said.
Full council on Wednesday, October 5, gave its backing to the plan to create more stepdown beds in the Cwm Taf Morgannwg area but voted in line with a recommendation not to approve the funding of the financial costs associated with it.
The proposal involves an expectation from Welsh Government that the Cwm Taf Morgannwg region creates additional capacity of 188 beds as part of the overall expectation for an additional 1,000 beds across Wales in a bid to ease pressure on the health service and social care before the winter months.
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The council report said: “Whilst we are supportive of the plan and proposals, we are not able to meet the financial commitment without additional resources. Unfortunately these resources are not included within existing budgets.”
The number of 1,000 beds across Wales is based on the number of delayed discharges reported.
What the options are
The proposals for the Cwm Taf Morgannwg area include the development of stepdown beds from hospital for those who require additional support to enable them to return home, mainly involving empty beds in council care homes.
They also include the provision of additional beds on the health board sites and additional capacity for early stroke rehabilitation beds, as well as the block purchase of beds in an independent care home.
The report said there are two potential options for the provision of stepdown beds in Merthyr Tydfil.
These are the re-commissioning of the beds located in a separate wing at Ty Gurnos, which can accommodate eight people, or the block booking of beds in an independent care home within the Merthyr area.
The additional costs
The Ty Gurnos option is said to cost £404,000, with £379,000 worth of staffing costs and £25,000 on costs like food and personal equipment.
Elements of the in-house service at Ty Gurnos such as the running costs would be met through the existing budget, the report said
It added that the second option would cost £105,000 with two beds, £157,500 with three beds, £210,000 with four beds and £70,000 for reablement workers
The numbers of people waiting for packages of care in the community has risen from two or three to 30 as of August 2022.
The report said: “Traditionally the request for health and social care services increases during the winter period, however the current demand is exceeding what we would normally experience during the winter months.”
Benefits and risks
The report highlighted the benefits as:
- People who are medically well enough are not waiting in a hospital bed waiting to move to the next stage of their care
- The risk of hospital-acquired infections is minimised
- Capacity within the hospital will be released to support people who require acute medical support
- People receive further rehabilitation in a safe environment that will enable them to return home rather than be admitted to a care home.
The risks include:
- Additional costs to the council should additional revenue funding not become available
- People who are supported in the stepdown facility are unable to move to the next stage of their care and support
- There would be insufficient people who were suitable to be supported in this facility
- The inability to recruit staff if option of Ty Gurnos is chosen
- The inability to block book the beds from the care home sector.
Cabinet member explains the financial background
Councillor Andrew Barry, deputy leader of the council and cabinet member for governance and resources, said it could cost the council £404,000.
He said a few weeks ago the council took the decision to move some of its borrowing from short to longer term at a value of £30m over eight, nine and 10 years at around 4%.
He said that over that weekend, the interest rate from the public works board jumped from 4.18% to 5.3%, which would have cost the council around £300,000 but it still has a £600,000 increase in committed borrowing costs and predictions in the current year.
Cllr Barry also pointed to wage increases in excess of £1.5m and energy costs in excess of an additional £2m and said “the economic forecast for public sector finances could not be bleaker”.
He added that inflation stands at 9.9%, a 40-year high, with predictions it could reach 22% by 2023, interest rates fluctuating in the council’s own borrowing mechanisms and that the Bank of England base rate stands at 2.25% and that would be increasing in an attempt to control inflation.
Cllr Barry said: “To say they’re turbulent times would be an understatement.
“With the political and economic turmoil that prevails at present, there appears to be a perfect storm brewing for the public sector and in particular all authorities in Wales not least because of the £18bn of savings UK-wide announced by the Chancellor a few days ago.
“Considering the fluidity of the current economic climate at the moment, we are talking of weekly and daily decisions on the most effective course.
“The recommendations appear to be a yes or no but in context, as I’ve outlined, members will understand the coming months are going to be difficult and we along with every other authority in Wales need both Westminster and Cardiff to step up financially to support our residents being talked about within this report.
“Westminster and the Tories have already stated their position, we now need clarity from the Labour government in Cardiff.”
The view of councillors
Councillor Clive Jones said it’s all very well for discussions to take place and for proposals to be made.
But he said: “It’s difficult to understand how this can be implemented taking into account that we’re only a matter of a few weeks away from winter pressures and I would suggest that winter pressures have already started.”
He also said there are “dire issues” for recruiting and retaining staff in social care and in health.
He said: “It’s a wonderful idea to have 1,000 stepdown beds throughout the country. But unless you’ve got the finance particularly and you’ve got the staff there to do it I can’t see how this is going to be implemented as it should.
Councillor Clive Tovey said he’s been told that there are 105 people between Mountain Ash and Prince Charles Hospital that could be discharged if there was somewhere appropriate for them to go and said it’s a “dire situation” where the hospital will never get rid of the waiting lists unless they can move people on.
Councillor Geraint Thomas, the leader of the council, said: “We are in dire straits going into this winter. We’ll find the beds for them but the cost of running it I’m afraid will have to go to the NHS and to Welsh Government.”
He agreed with Councillor Bill Smith who earlier suggested it go back to social services scrutiny committee.
Cllr Thomas said scrutiny needs to have a good look at what’s going on and said it would be good for residents to see the position that they’re currently in.
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