Debate on day care centres

    We asked:- Are day centres relics of a bygone age or
    should more effort be made by staff to make them more stimulating
    for users?

    Here are some of the comments we received.

    “Definitely not!

    In 2005, modern mental health day centres can support people on
    their recovery journey. They do this by creating an atmosphere of
    empowerment for the client group, having creative activities that
    are individually goal focused and skills based. The programmes of
    activities offered must be determined by the clients, stretch the
    mind and body while keeping a sense of fun with a social aspect.
    They are places where once isolated people feel they belong and
    gain strength from the support of their peers. They are places that
    form active links with local communities engage with educational
    and leisure facilities.

    Mostly they are places that inspire confidence in people to help
    them return to mainstream society.”

    Glenda Munoz Cano
    Senior Manager, Solent Mind, Southampton.

    “As an Implementation Team we have been tasked with reviewing
    and implementing a flexible and dynamic model of day provision
    across the borough. Currently we have three traditional day centres
    and an adult education centre that are not presenting as value for
    money or responsive to the needs of service users and carers.

    One particular initiative which we thought would be of interest
    to you is the development of a Joint Assessment and Resources
    Centre within Torfaen. This will be a joint provision with health
    offering specialist facilities providing a multi-disciplinary
    approach to high level intervention.

    The centre will offer a base for access to clinical and
    therapeutic services, one-stop assessment, re-enablement and advice
    to service users and carers.

    The centre will aim to provide a fully joined-up health and
    social care service focussing on the whole person and will include
    a range of therapies. This will support people with a range of
    complex needs and complement the continuum of new day activities
    delivery across the borough.

    We would like to share our initiatives with you because we
    believe it demonstrates an innovative and integrated approach to
    day activities service delivery.”

    Amanda Phillips
    Implementation Team

    “As a manager of a social services mental health day centre,
    I fully endorse the new approach to day centre provision.
    Social interaction and meaningful relationships are the main focus
    to which we as a team are pushing forward the ‘recovery’ theme and
    reducing the main focus on medical intervention only.

    Initiatives and practical support help each service user reclaim
    significant, critical aspects to their lives.
    In my experience, day centres have moved on, improving their
    function to include; preventing relapse, limiting re-admissions,
    facilitating access to employment opportunities and other
    meaningful community provisions.

    Consultation and liaison with service-users and other professionals
    provide the framework in which we become cognisant of mental health

    Catherine Chew
    Manager of Bacup Road Resource Centre

    “The recent article, “Can a new day centre dawn?”
    certainly reflects the dichotomy of views that I have experienced
    in Bristol. Logically, properly constituted day services should
    form an integral part of community care for older people, but for a
    number of reasons, including the fact that they are rarely visible
    in policy and research literature, day services seem to have a low

    As stated in the 1999 Royal Commission report on Long Term Care,
    “the culture of services designed for older people
    has….barely changed over the past 10 years.”

    Of course, the expression, “day centre”, does not
    help, indicating that it is not a client driven, person-centred
    service. Older people want to remain in their own homes as long as
    possible and the aim of the day services should be to assist people
    in achieving that aim, as well as offering an enhanced quality of
    life. The effects of marginalisation, social exclusion and loss of
    autonomy on healthy ageing are well known and documented.

    Given the right support and funding, and day services are cost
    effective, we should be seeking to reinvent day services to meet
    the challenges of the twenty first century.”

    David Jones
    Chief Executive
    Bristol Charities

    “In Suffolk, there is a new model of day care being delivered
    – the Keeping Well Centre.

    This is based on an eight-week programme and for one day a week,
    customers are actively involved in health promotion with the aim of
    signposting them to support when needed.

    The overall philosophy is for promoting independence in order to
    remain safely within their own homes, having made informed

    For more information visit:-
    (on the intermediate care webpage).”

    Kate Miles

    “I think day centres are still an important integral part of
    enabling people to remain within the community.  They provide a
    good resource for socialising and ensuring people have an enjoyable
    day through stimulating activities. Staff need to be aware of their
    users needs and choices and provide variety to enable them to have
    a fulfilling day.”

    Kathryn Uren, Assistant Unit Manager, Copper Beeches Day

    “Day centres largely exist because mainstream activities in
    the community and public transport are not anywhere near
    sufficiently accessible. 

    Where day centres are arguably a necessary part of service
    provision until we have a more accessible community, only limited
    progress can be achieved through a wider range of activities.  So
    many service users are still patronised and institutionalised –
    better staff training in empowerment and the social model of
    disability is a must.”
    Ruth Chamberlain,  City of York Council

    “While I agree that day services can be institutionalised and
    lacking in imagination, they do seem to fill in some essential gaps
    that care packages just don’t fill.

    I do feel that organisations offering specialised day services
    should be very clear about exactly what is on offer, and exactly
    who is able to gain access to such services.

    I am shocked to discover that in my area, there are
    privately-run organisations which advertise day opportunities to
    adults with physical disabilities, or adults with acquired brain
    injuries (which are often accompanied by physical disabilities),
    but which do not provide any kind of personal care.

    Should service users need assistance in using the toilet, for
    example, then they are unable to access these services, unless they
    can fund their own care staff (recently priced at £60 per
    day). It would appear that these organisations, being private and
    therefore not under the jurisdiction of the local authority, are
    able to pick and choose who they are prepared to work with; so some
    services are only accessible to able-bodied disabled people. I
    think advertising should explain this clearly, to avoid
    disappointment. I also think that any information which accompanies
    funding applications should be clear about what criteria is being

    With local authorities moving increasingly to private services,
    who knows how many services users will be left with no services,
    purely because their need for personal care cannot be met?

    What will happen to service-users whose only wish is to spend a
    couple of days a week in a room with a few other people, chatting,
    drinking tea, reading the paper, getting helped to the toilet,
    having a friendly ear when needed, taking an interest in
    activities, but not particularly wishing to join in? What if some
    people don’t want to do anything ‘productive’ or ‘meaningful’? Who
    defines ‘productive’ and ‘meaningful’?

    Sometimes, all people may want, is not to be the only person in
    the room for a few hours a day, but to know that the other people
    in the room can be trusted, and can provide help and friendly
    conversation as and when required. Although this is something most
    people are quite capable of doing alone, what if they’d like to do
    that, and just not be alone for two or three days a week?

    Surely person-centred services, while providing imaginative,
    meaningful activities, must also take into account the choices of
    people who simply want to perhaps do very little – but in the same
    room as others who have made the same choice? This kind of service
    is only wrong if people are given no choice. In a person-centred
    service, if it is the informed choice of the person, then how can
    it be wrong?”

    Helen Hall,  Worcestershire

    “When I started work in a local authority day centre for
    older people 25 years ago I was horrified that the three craft
    instructors spent so little time with the service users and so much
    time talking to each other, eating, cashing up etc. I was just as
    horrified that even on the fairest of days the drivers were always
    wanting to leave before 3 pm and if it looked as if there was a
    spot of rain or a slight mist they wanted to leave after lunch.

    I fervently hoped that by now things would have changed and
    service managers and staff would see how day care could enrich the
    lives of service users by offering varied activity which was
    enjoyable and stimulating. This is certainly not my experience at
    the same local day centre that I worked in all those years ago.
    Managers come and go and still there is no evidence of service
    users gaining positive experiences. It appears to be a luncheon
    club only. Every now and again a game of bingo may take place.
    Someone I knew went after suffering a stroke and was promised that
    she would be able to bake the following week. Five years later she
    is still waiting to bake those sausage rolls.

    I really wished that someone would have the vision to see that
    if day-care was responsive and flexible it may help to keep people
    at home longer or help carers to carry on the caring role for
    longer.  Day centres could really be so lively and exciting if the
    manager and staff believed in their importance to service users. I
    am sure there are some day centres somewhere that are exciting
    places but not in my experience.”

    Joy Johnson

    “Day centres are only ‘an inadequate way of meeting people’s
    needs’ if they fail to take proper account of what those needs
    are.  WRVS realises the importance of focal points within local
    communities, where people can come together to take part in a range
    of social activities and also access advice, assessment and

    The way to ensure that any ‘day centre’ aspect of these focal
    points meets local need is to involve the people who will actually
    be using services in their development.  People attending a day
    centre should feel a sense of belonging and ownership. They must
    know that service providers will listen to their voice, respond to
    their requests and promote their requirements.

    Making day centres and community centres more vibrant, more
    accessible and more service user driven is the way forward, not
    abandoning them as a concept altogether.”

    Carolyn Dodson, executive director WRVS

    “Suffolk Social Care is undergoing a programme of day care
    modernisation and our countywide forum for day services debated
    your headline query “Can a new Day Centre Dawn?” in
    Community Care 20-26 January. Our response is an emphatic

    In Suffolk we are consulting with older people and carers about
    how we can provide services that meet their needs. We are reminded
    through this process that the crucial element to remember in
    relation to any service is that they should be individual to the
    person and should be outcome focussed.  We prefer to refer to
    “day services” rather than “day centres”
    since the outcome may not be focussed on a particular building. Day
    services coordinators in Suffolk are brokers as well as providers
    of services. It is also likely that increased use of direct
    payments in relation to services will increase diversity in this
    respect and promote participation in the social inclusion

    We have a varied approach to provision, working closely with a
    variety of partners in health, education and the voluntary sector.
    An example of is a new Keeping Well Centre that addresses health
    promotion for older people. This seeks to enable people to make
    informed choices about their lifestyle and care and offers an
    eight-week programme of health promotion and falls prevention
    activities, including Tai Chi.

    Day services are part of our community and you will often find
    teenagers joining older people in activities. We work with local
    schools to provide IT training within our Day Services. Once we
    have broadband this will enable those grandparents who want to
    email grandchildren in far off (also not so far off) places to do
    so. With the addition of a web cam we hope to improve this method
    of communication. There has been much excitement from older people
    – who are now demonstrating to their younger generations that
    they are not excluded from any forms of communication.”

    Marie Adams.
    Day Services Modernisation Manager, Suffolk Social

    “Without a doubt more effort should be made by staff to make
    day centres stimulating.
    Day care can be and should be an exciting option for older people. 
    All it takes is the motivation and will to make it so. We at The
    Grange Day Centre in Throckley Newcastle upon Tyne enjoy shattering
    stereotypes of aging and images of day care provision. Yes we do
    have bingo, quizzes, dominoes, entertainers, trips out, craft
    sessions and people who just come each week to meet and socialise
    with old and new friends but we also have workshops led by
    professional artists which allow people to develop new skills and
    participate in activities that they would not normally have the
    opportunity to take part in.

    During the past six years (with the support of Kellett Fund at
    Community Foundation, Northern Rock Foundation, Scottish and
    Newcastle Breweries and Newcastle City Council) our service users
    have worked with various artists to produce seven stained glass
    windows, a stained glass door and ceiling, several woodcarvings and
    four solid oak carved doors, mosaics to the entrance of the centre
    and a sign for the club, which is also part of the centre.

    Service users have worked with creative writers and produced a
    book, worked with silk and oil painters, a ceramicist, digital
    artists, musicians, story tellers, reminiscence and life theatre
    artist and created a web site which
    shows images of their achievements. Some of this work has been
    intergenerational, as we have worked with several schools sharing
    skills and life experiences. The art works are of a high standard
    and are a great source of pride for centre users and staff.
    At the moment service users are working with a digital artist, a
    ceramicist and a glass artist and are designing a steel fabricated
    fence (with glass and ceramic insets), which will be installed at
    the entrance.

    During the next three years they will be working with a stained
    glass artist to produce two more windows, an artist who will run
    workshops exploring self portrait work by making moulds in clay or
    wax and a film maker and writer to produce a play about their
    lives. We are all looking forward to the challenge.

    The arts have successfully brought people together and have
    provided an opportunity for individuals to work together towards
    shared goals and end product. They have acted as a catalyst for
    confidence building through the realisation of new skills or
    improved past and present skills; which ultimately has created a
    more improved and active quality of life for participants. So much
    so that service users were more receptive to physically challenging
    activities and have undertaken several days abseiling, canoeing,
    archery, curling and bike riding which we will be continuing this
    year. One participant (who also went down a slip wire) abseiled two
    days before his 90th birthday and said it was one of the most
    exciting days of his life.

    Their courage and motivation has also shattered an illusion of
    aging I had. I thought you were never too old to learn but possibly
    had to take a lot longer before the new knowledge or skill was
    internalised. How wrong I was. A group came back from abseiling
    saying they had a new challenge they wanted to conquer a fear of
    water. One woman of 83 had never been in a swimming pool in her
    life was afraid of water but had always wanted to learn how to
    swim. We arranged a tutor and a group started to go to a swimming
    pool every week. To our surprise she learned to swim after 4
    sessions. I would like to add that our oldest abseiler was
    93-years-old and several people who have to use wheelchairs also
    took part. These are not groups of really fit third agers. They are
    people who thought they were too old or frail to undertake such
    activities. It is a wonderful feeling when a 93-year-old man who
    has never had the opportunity to paint picks up a paint brush for
    the first time and discovers with his first painting that he is an
    artist. The reflected pleasure that staff receive is

    I agree with Sheila Bell, day services co-ordinator for Suffolk
    Council when she states ‘that services should be needs led.
    Whatever you do has to reflect those users.’
     If not it will only serve to contain or warehouse people who have
    so much more to offer. Day care should be reciprocal. People do not
    want to be passive receivers of services. Their lives culture and
    history are important resources that should always be

    Michele Wright
    Day Centre Manager


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