Investigations & Analysis - Northern Ireland
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State of the art dementia centre almost empty

26 MARCH 2012 – NIALL MCCRACKEN

Gnangara opened in October 2011
Gnangara opened in October 2011 / Google maps

A STATE of the art supported living centre for people with dementia still lies practically empty a year-and-a-half after it first opened its doors.

The 15 supported living cottages at Gnangara in Enniskillen are part of a £2.5 million joint residential and assisted living home specialised for people with dementia.

When it opened it in October 2011 it was hailed as being at the forefront of dementia care in the United Kingdom. However The Detail can reveal that only two of the 15 spaces are currently occupied with tenants.

Gnangara operates as a three way partnership between the Western Health and Social Care Trust (Western Trust), Fold Housing and the Northern Ireland Housing Executive (NIHE). There is a contract in place between The Trust and Fold Housing for the provision of residential and housing with care (Domiciliary Care services) for older people and people with dementia.

As well as the supported living accommodation there are also 15 residential places, 13 of which are currently occupied. The Western Trust confirmed that there is still one client with dementia in the Western Trust area waiting on a residential placement.

The Detail’s findings come as a new report published by the Alzheimer’s Society has said that resources should be shifted from inappropriate acute and residential care for people with dementia into the community setting.

So why then is the Gnangara supported living facility, with its private gardens for each home, assistive technology and special access for staff assistance via an internal corridor, still largely empty?

The 15 supported living cottages are a mixture of one and two person self contained spaces, but they come at a price with a cost of £502.50 per week.

In a statement the trust said: “The trust is working with all the partner organisations to promote the scheme to people in the Fermanagh area. Uptake is entirely dependent on someone’s choice of accommodation and this scheme is regularly promoted by the Trust and its staff.

“With any new scheme there is a lead-in period and as the Supported Housing Units now have their first two tenants, the Trust is hopeful that this will encourage new clients to come forward.”

“A CRYING SHAME

In a recent assembly question to the the Minister for Social Development, Sinn Fein Fermanagh MLA Phil Flanagan asked the department to detail the number of referrals to Gnangara, since its opening, which were made by (i) self or family; (ii) care management; (iii) Community Social Work Teams; (iv) other elements of the Health Service; and (v) the Housing Executive.

In a response the department said: “One person self-referred for supported accommodation,17 referrals were made by Care Management /Community Social Work Teams, three referrals for the supported accommodation bungalows have been received through Western Health and Social Care Trust Community Teams / Care Management and there have been no direct referrals from the Housing Executive.”

Speaking to The Detail Mr Flanagan said: "This is a very disturbing and disappointing given the huge sums of money that have been spent developing this world class, specialist facility. It is deeply concerning that only 21 referrals have been made to it by statutory authorities since it opened.

“Questions need to be answered about the reasons behind this. I am due to visit Gnangara with Fold officials in the coming weeks to see first hand the excellent facilities that are on offer and to see how we can improve upon the current situation.

“It will take a combined effort, working with the statutory authorities and with the local community to make this facility work. It is a crying shame that when such a major investment is made in Fermanagh, that not enough is done to support it and make it sustainable.”

While the £426-a-week residential placements in the main building have been registered by the Regulation and Quality Improvement Authority (RQIA) since it first opened, it was reported in the first inspection of the premise in January 2011 that Gnangara was ready to provide care for 15 residential residents but that registration for the bungalow accommodation was still outstanding.

At the time the delay was attributed to “minor procedural” issues with RQIA registration.

RQIA confirmed to The Detail that the Gnangara domiciliary care service was now fully registered. All domiciliary care agencies are subject to a minimum of one inspection per year by RQIA. The inspection report of this service is due to be published in May 2012.

In a statement RQIA said: “There are currently no issues from RQIA’s perspective that would prevent occupancy of either the residential care or supporting people/domiciliary care accommodation at Gnangara. You may wish to seek clarity from the provider (Fold Housing) or the local health and social care trust to determine their position on these services.”

There are currently 29 staff working in Gnangara, including a manager, five team leaders, an administration officer, 16 care workers, four cleaners and two cooks.

In a statement Fold Housing Association said: “Fold was originally successful in winning a competition to provide a modern and innovative supported housing scheme for the people of Enniskillen and for those with dementia. However since opening the scheme, the number of referrals has been very low.

“In Fold’s experience it is unprecedented to have a scheme less than 50% full at this stage. The staff have had to markedly reduce their hours as the scheme has struggled to fill up. This is despite extensive advertising and promotion locally and engagement with the local care community. Fold has been working with the WHSCT and the HSCB in an effort to resolve this problem.”

A NATIONAL CHALLENGE

The number of people living with dementia is expected to increase faster in Northern Ireland than anywhere else in the UK.

The Dementia 2012 report recommended that a move away from residential and acute dementia care into a community setting would help ensure that the right support and focus would shift onto early intervention and prevention as well as respite care services.

The report also highlighted that a key issue was a lack of training for staff. A report by Laing and Buisson (Mitchell, 2009) found one-third of dementia specialist residential care homes did not offer their staff specific dementia training. The report found dementia-specific training was ad hoc and fragmented, ranging from informal training to fully accredited courses.

In Northern Ireland, there is no formal legal framework for making decisions on behalf of someone who lacks mental capacity although the principle of making a decision in someone’s best interest exists as a result of legal test cases. A bill on mental capacity is expected to come to the Northern Ireland Executive in 2012/13.

Last November The Detail reported that the Minister for Health, Social Services & Public Safety announced that there wasn’t enough money to fund Northern Ireland’s Dementia Strategy.

In an updated statement a spokesperson for the Department of Health, Social Services and Public Safety said: “The Strategy tasked the HSC Board and Public Health Agency with establishing and jointly leading a regional group to oversee implementation of the Dementia Strategy and its actions. A wide range of stakeholders in the statutory and independent sectors have a part to play in implementing the strategy.

“People with dementia and their families and carers also need to be involved in a way that they find acceptable. The Board and PHA are giving this careful consideration as they progress work to establish this group, which will report back to the Department on progress against the actions on a six-monthly basis.”

Northern Ireland is the only region within the UK without an implemented strategy.

SUFFICIENT NEED?

There are now 800,000 people with dementia in the UK and there are estimated to be 670,000 family and friends acting as primary carers. In Fermanagh alone there are as many as 650 people who suffer from dementia and at least one person with the illness on the waiting list for a residential place in the Western Trust.

In a story by The Detail last April the trust admitted the project would take time to reach its full potential. Gnangara is funded through the Trust’s primary and community care fund and at the time they admitted that the budget for the accommodation was “under significant pressure”.

We asked the Western Trust to outline how much funding it had contributed to Gnanagara and its service users since it opened in October 2010, but it said it could not provide us with a figure at this time.

In April last year, Gnangara only six residents overall between its residential and supported living accommodation, this number has now risen to fifteen over all, but many places still remain vacant. This still leave a further 15 places vacant, 13 in the supported living accomodation and two in the residential area of the centre.

Fold Housing Association confirmed at the time that it had spent £165,000 from October 2010 on running costs up to that point. We asked Fold for an updated figure but they claimed that they unable to give out commercially sensitive information relating to the Gnangara scheme

The Dementia 2012 report states that assisted living in a community setting is the preferred model of dementia care and while Fold Housing maintain that there is sufficient need in the Western Trust area to achieve full occupancy at Gnangara, for now the numbers speak for themselves.

© The Detail 2012