Adur, Arun and Worthing

Older People’s Housing and

Support Strategy

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Deborah Priebe 28th

March 2005

Contents

Sections Page Whose Strategy is this? 2 What’s the Purpose of the Strategy? 3 Vision 3 Priority Issues for Action and Recommendations 4 Context National Picture 5 Local Picture 7

2001 Census 7 Social and Caring Services Data 11 Primary Care Trust Data 11 Housing Needs Assessment Data 12

National Strategies 14 Local Strategies 18

Social and Caring Services Strategies 18 Primary Care Trust Strategies 21 Borough and District Strategies 23

Website details 29

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Retiring to the coast, or living by the seaside in old age, has long been a cherished dream for a great number of people over many generations. In recent decades increased mobility, better health, greater affluence and improved standards of living in old age, and longer life expectancy have meant that this dream has become a reality for large numbers of elderly people. But this pattern has had severe implications on the demand for services in areas such as the coastal strip of West Sussex, particularly Adur, Arun and Worthing, resulting in high levels of both need and demand. This strategy focuses on these issues and looks at what can be done to address them.

Whose Strategy is this? This Older People’s Housing and Support Strategy (those aged 60 or over) in Adur, Arun and Worthing, has been developed and agreed jointly by the Adur Arun and Worthing NHS Teaching Primary Care Trust (PCT), the Coastal Area of West Sussex County Council Social and Caring Services (S&CS), and the Housing Services of Adur and Arun District Councils and Worthing Borough Council (HS). The strategy builds on work undertaken by these agencies in the Adur Arun and Worthing (AAW) Interagency Housing Liaison Group and the AAW Older People’s Housing and Support Strategy Workshop to agree a joint agenda to meet the support needs of this client group.

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What’s the Purpose of the Strategy?

The intention of the strategy is to provide a common, shared approach to meet the housing and support needs of older people in Adur, Arun and Worthing in order to achieve a holistic, comprehensive, and coordinated response across the agencies to minimise conflict and avoid duplication of resources. In practice this means that the mutual understanding and appreciation of the different priorities and perspectives of each agency will enable organisations to better work together to provide timely and relevant services which are appropriate to clients needs. The agreement and implementation of a Housing Strategy for Older People is one of the objectives identified as a key priority area for development in 2004/5 in the PCT’s Clinical Governance Annual Report 2003/4 and in the Local Delivery Plans 2003-06.

Vision

Our vision is to improve the quality of life for older people, promoting a healthy way of life, greater independence and choice. The PCT, S&CS and HS each have their own aims and objectives. These can be obtained from the organisations websites, listed at the end of this strategy. The AAW Housing and Support Strategy builds on these and supports the aims of individual organisations, which are to:

promote person-centred provision

promote choice for older people

provide care in a more homely environment closer to home

promote good health and well being

promote independence and reduce reliance on institutional care

prevent hospital admissions and facilitate prompt discharge

enable local communities to have more say in service provision

achieve national standards for services

develop services based on evidence of need

develop flexible services to address changing needs

work in partnership and develop integrated systems across services and agencies

improve the quality of housing across all tenures to meet the decent homes standard

provide equity and fair access to services for all older people

adopt a “can do” approach within the resources available

promote informed risk taking and choice for individuals and services

develop sustainable communities and mixed neighbourhoods Some of these aims are, of necessity, aspirational, but all reflect our agreed values and will underpin the actions we take to implement this strategy.

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Priority Issues for Action and Recommendations

Develop joint protocols for service delivery between agencies

Agree a wide, comprehensive menu of options (home care,

assistive technology, extra care, care and repair, disability

housing register, adaptations etc)

Develop joint assessments of housing and support needs

Consider and investigate flexible funding mechanisms and

shared or pooled resources

Engage and involve other agencies and bodies (voluntary

sector, Home Improvement Agencies, Registered Social

Landlords, private sector, users/carers etc) in realising the

strategy

Involve existing relevant and appropriate forums in

implementing the strategy

Set up a reference group of service providers and users/carers

to develop and deliver the strategy

Assess the value of appointing a jointly-funded Older People’s

Housing and Support Coordinator

Investigate how to meet the housing and support needs of

older people with learning difficulties and mental health

problems

Develop pro-active working links with Supporting People to

establish how funding can most effectively be targeted at

those in need

Consider how services can be provided on a cross-tenure basis

Assess whether better and more appropriate use can be made

of existing facilities and resources to deliver services

Agree a mechanism for implementing reciprocal

arrangements between agencies

Examine how services and provision can be made future-proof

(flexible support, lifetime homes, spend to save initiatives,

specialist solutions etc).

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Context The largest user group of social, health and support services are older people. The sheer numbers of existing elderly people, coupled with the forecast population increase in the number of people, means that housing and support for older people has to be a priority for the PCT, S&CS and HS.

National Picture The following data is taken from the 2001 Census. Numbers

The percentage of people aged 65 and over increased from 13 per cent in mid-1971 to 16 per cent in mid-2003.

There were 19.8 million people aged 50 and over in the United Kingdom in 2002. This was a 24 per cent increase over four decades, from 16.0 million in 1961. The number is projected to increase by a further 37 per cent by 2031, when there will be close to 27 million people aged 50 and over.

Over the last 40 years there has also been a substantial change in the age composition of older people. The proportion of people in the UK population aged 85 and over increased from 0.7 per cent in 1961 to 1.9 per cent in 2002.

Projections for 2031 indicate a more rapid ageing of the population over the next 30 years. People aged 85 and over will then comprise 3.8 per cent of the UK population.

Older women outnumber older men, as proportionately death rates are greater among men than among women.

In 2002 there were 2.6 women for every man aged 85 and over. This compares with 2.3 women per man in 1961, but is projected to fall to 1.5 by 2031.

Household composition

Single-pensioner households make up 14.4 per cent of all households

More than two-thirds of single-pensioner households (68.2 per cent or 2,129,000 pensioners) have no access to a car.

More than half of women aged 75 and over live alone - 52.5 per cent of 75-84 year olds and 54.5 per cent of 85 year olds and over. However, only 25.7 per cent of men aged 75-84 and 36.9 per cent of men aged 85 and over live alone.

In 2001 the majority (70 per cent) of older men aged 65 and over lived as part of a couple, but only 40 per cent of women did so.

For those who are not in a partnership, the norm is to live alone. In 2001, 22 per cent of older men and 44 per cent of older women lived alone, and the proportion increased with age. In addition, with advancing age, increasing proportions of older people lived without a partner but with their children (6.7 per cent of women and 3.7 per cent of men aged 85 and over). Similarly, the proportion living with others (not their children) increased with age, reaching 7.6 per cent of women and 6.1 per cent of men aged 85 and over.

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Housing

The majority of older people are owner-occupiers, although the proportion decreases with age. In 2001, among people aged 50 to 64 living in private households in Great Britain, 80 per cent were owner-occupiers. This reduces to 72 per cent of people aged 65 to 84 and 61 per cent of people aged 85 and over.

People over the age of 65 are much more likely to be outright owners than to be buying with a mortgage. In 2001, 61 per cent of people aged 65 and over owned their homes outright.

The proportion of those living in rented housing increases with age - 28 per cent of people aged 65 to 84, and 40 per cent of people aged 85 and over. This compares with 20 per cent aged 50 to 54.

Few older people live in overcrowded conditions – just 1 per cent of people aged 50 and over.

Just over half of all people aged 50 or over in England lived in a property which was under-occupied in 2002/03, although this fell to 32 per cent for those aged 85 or more, indicating perhaps that people in this age group tend to move to smaller properties.

One in ten older people complained of damp rising in floors and walls, of problems with insects, mice or rats or the house being too dark. About 12 per cent of older people said that their house was too cold in winter.

The percentage of people aged 85 years and over living in housing without central heating (14%) is twice that among people aged 50 to 64 in Great Britain (7%).

A total of 3,000 women and 2,000 men aged 75 and over have neither central heating nor sole use of a bathroom (not including residents of communal establishments).

Health and Care

Nationally there are about 336,000 people aged 90 and over, and of these nearly 4,000 are providing 50 or more hours of unpaid care per week to another family member or friend

The proportion of people who say they are in 'not good health' generally increases with age. Over the age of 85, 26.5 per cent of men and 21.9 per cent of women say they are in 'good health'.

Implications and Key Messages

Life expectancy is increasing and the UK has an ageing population Both the numbers and proportion of older people are forecast to continue to

grow Health problems tend to increase as people age Many older people are on limited fixed incomes Many older people live alone Many older people have problems maintaining their homes Residential and nursing home care places are limited and expensive Many older people cannot be discharged from hospital as there is no where

suitable or them to go

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Local Picture These national statistics are particularly acute in West Sussex, especially in Adur, Arun and Worthing. 2001 Census In particular, the percentage of residents aged 60 or over is significantly higher in Adur, Arun and Worthing than nationally. The table below shows the number of people aged 60 and over in Adur, Arun and Worthing.

Variables All people People aged 60 -

64

People aged 65 -

74

People aged 75 -

84

People aged 85 -

89

People aged 90 &

over Area

Adur 59,627 3,313 6,257 4,770 1,225 645

Arun 140,759 8,284 16,878 13,741 3,857 2,053

Worthing 97,568 4,748 9,478 8,602 2,785 1,739

The situation in Adur, Arun and Worthing becomes even more apparent when shown as percentages in the charts below.

England

South East

West Sussex

Adur

Arun

Worthing

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The following two tables show firstly the number of people, and secondly the number of households, comprising a lone pensioner, a pensioner couple, and other all pensioner households (largely friends or siblings).

Variables ALL PEOPLE One person, - Pensioner

One family and no others, - All pensioner

Other households, - all pensioner

Area

England 48,248,150 2,939,465 3,653,726 182,901

South East

7,809,823 473,161 640,264 31,837

West Sussex

736,880 54,828 76,390 3,943

Adur 58,739 4,950 6,280 383

Arun 136,827 13,140 18,645 998

Worthing 95,053 9,030 9,873 756

The tenure of households where the HRP (Households Reference Person) is a pensioner is shown in the table below.

Variables All households where HRP is of pensionable age

Owned Rented from council

Other social rented

Private rented and living rent free

Area

England 5,776,660 3,939,809 974,654 424,115 438,082

South East

942,573 700,147 94,444 81,090 66,892

West Sussex

107,834 84,127 8,145 7,973 7,589

Adur 9,402 7,602 1,048 207 545

Arun 25,567 21,160 1,748 790 1,869

Worthing 15,899 12,981 386 1,374 1,158

Note: In earlier censuses the HRP was referred to as the Head of Household.

Variables ALL HOUSEHOLDS

One person, Pensioner

One family and no others, All pensioner

Other households, All pensioner

Area

England 20,451,427 2,939,465 1,826,453 82,384

South East

3,287,489 473,161 320,054 14,244

West Sussex

320,915 54,828 38,186 1,810

Adur 25,870 4,950 3,139 177

Arun 62,733 13,140 9,320 460

Worthing 44,128 9,030 4,934 353

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The following table shows the percent of total households in each LA that comprise single adults aged 60 years and over.

Adur Arun Worthing

Single adult households aged 60+

22.4%

9%

22.7%

(Source: AAW HNS)

In both Adur and Worthing, households comprised of a single adult aged 60 years and over account for just over one fifth of the total households. Arun by comparison has a much lower percentage of single person households aged 60 and over. The table below shows the percentage of older people in each age group for each LA, as found from the HNS and compared with Census 2001 data.

Population age groups Adur HNS Census

Arun HNS Census

Worthing HNS Census

Total aged 60 & over 32.5% 27% 35.4% 31% 28.7% 28%

60 to 74 21% 16% 21.8% 17% 17.7% 15%

75 & over 11.5% 11% 13.6% 14% 11% 13% (Source: AAW HNS & Census 2001)

The following table shows the population change of older people aged 60 years and over from 2001 to 2006 displayed as the percentage change of each age group as per percentage of the total population, and the change in actual numbers:

Adur % pop. No.

Arun % pop. No.

Worthing % pop. No.

Total population 0% +1,200 0% +4,200 0% +1,600

Total aged 60 & over +0.1% +400 -0.6% +300 -1.3% -900

60 to 74 +0.1% +300 -0.3% +300 0% +200

75 & over - 0.1% +100 -0.4% 0 -1.3% -1,100 (Source: WSCC)

Older people aged 60 and over are predicted to make up 27.1% of Adur's total population by 2006, this is an estimated increase of 0.1%, from the 2001 figure 27%. In terms of actual numbers of older people in Adur, there is a predicted increase of 400 by 2006. Worthing is the only LA where the number of older people is predicted to decrease by 2006. With an estimated decrease of 1,100 older people aged 75 and over by 2006 and an increase of 200 aged 60 to 74 years, the total number of older people aged over 60 is expected to decrease by 900. The following population projections show how these numbers are forecast to increase by 2006, 2011 and 2016.

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West Sussex Adur District

Arun District Worthing District

(Source: WSCC)

These figures illustrate the very high levels of older people in Adur, Arun and Worthing who need housing and support services. Although the actual numbers of older people in each district decrease as the population ages, it is of course the those who are very elderly, rather than those who are only just above pensionable age, who are most likely to need housing and support services, and to require such services to be provided at an intensive level. The county level population forecasts for older people in West Sussex to 2028 (figures beyond 2019 are not available on a district basis) are shown below. (All figures are in thousands).

Age 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028

60-64 52 53.1 54.3 55.6 57 58.8 60.4 62.3 64.2 65.5 66.2 66.2

65-69 51.6 50.1 49.9 49.9 50.7 51.4 52.5 53.7 55.1 56.6 58.4 60.1

70-74 48.3 50.8 51.9 52.4 52.3 50 48.7 48.4 48.5 49.2 50 51.1

75-79 34.2 35.4 36.8 38.5 40.8 44.9 47.2 48.2 48.7 48.6 46.6 45.4

80-84 27.7 28.2 28.8 29.2 29.1 29.4 30.4 31.7 33.2 35.3 38.8 40.9

85+ 30.9 31.5 32.1 32.8 33.7 34.5 35.5 36.4 37.3 37.8 38.6 40.1

(Source: ONS)

Age 2001 2006 2011 2016

60-64 38,600 45,400 52,200 48,200

65-69 37,600 37,200 43,400 49,900

70-74 36,400 34,800 34,300 40,100

75-79 32,200 31,200 29,900 29,700

80-84 23,600 24,200 23,900 23,400

85-89 15,000 14,800 15,100 15,400

90+ 8,200 9,300 10,100 10,700

All ages 754,300 770,300 787,400 803,300

Age 2001 2006 2011 2016

60-64 3,300 3,800 4,100 3,500

65-69 3,100 3,200 3,600 3,900

70-74 3,100 2,800 2,900 3,300

75-79 2,800 2,600 2,400 2,500

80-84 2,000 2,000 2,000 1,900

85-89 1,200 1,300 1,300 1,300

90+ 600 800 800 900

All ages 59,700 60,900 60,900 60,800

Age 2001 2006 2011 2016

60-64 8,300 9.300 9.900 8,500

65-69 8,400 8,300 8,900 9,500

70-74 8,500 7,900 7,700 8,300

75-79 7,800 7,500 6,900 6,700

80-84 6,000 6,000 5,800 5,400

85-89 3,800 3,800 3,800 3,800

90+ 2,100 2,400 2,700 2,800

All ages 141,000 145,200 146,400 151,800

Age 2001 2006 2011 2016

60-64 4,700 5,400 6,200 5,500

65-69 4,600 4,600 5,200 5,900

70-74 4,800 4,300 4,200 4,800

75-79 4,800 4,200 3,700 3,600

80-84 3,800 3,600 3,200 2,900

85-89 2,800 2,400 2,300 2,000

90+ 1,700 1,800 1,800 1,700

All ages 97,600 99,200 101,000 101,700

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Social and Caring Services Data Approximately 18,000 adults receive help at any one time, of these:

4,000 are cared for in residential or nursing homes;

3,000 older people (over 65 years of age) receive home care services.

In addition, though not exclusively for older people, Social and Caring Services:

provides about 30,000 hours of home care each week; funds 33 short break schemes for carers; funds voluntary organisations with £11.8m to provide preventive and supportive

services; has contracts with 48 providers of housing support for older people and spend

£3.43m a year supporting approximately 6,000 people; funds over 1,000 Intermediate Care places jointly with Health, to rehabilitate

people coming out of hospital; receives about 4,200 calls to our out of office hours service in a year, of which

33% received a personal visit last year; gives 220 people direct payments to buy their own supportive services, which

increases their choice and independence; funds 10 Welfare Benefit Advisers who advise and assist people to claim state

benefits to which they are entitled. Primary Care Trust Data The Adur, Arun and Worthing Primary Care Trust provides care for 227,000 people, living along the coastal strip from Littlehampton to Fishersgate. Again, although not only for older people, the AAW PCT:

makes sure that services are available at 32 GP practices, 49 dental practices, 48 pharmacies and 28 optician outlets across the district;

employs 750 staff, most of whom see patients in health centres, community hospitals, GP practices, schools, at home, or in general hospitals – including health visitors, chiropodists, district and school nurses, occupational and speech and language therapists;

manages services at community hospitals in Littlehampton, Rustington and Salvington Lodge which cares for the elderly and many local health centres.

On a typical day in Adur, Arun and Worthing:

4,300 people see a GP (including home visits);

1,600 see a community nurse or therapist; (including both those visited at home and those seen on NHS premises);

750 visit outpatient departments or undergo planned investigations;

65 have surgery;

133 attend A&E.

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Housing Needs Assessment Data The following data is taken from the housing needs assessments carried out by David Couttie Associates (DCA) for each of the 3 district/boroughs relating to housing demand from older people. The surveys for Adur and Arun were carried out in 2003, and Worthing in 2004. Existing households intending to move within the next five years were asked if they required supported housing and what type of supported housing they would be interested in. The following table shows the number of households in each LA interested in supported housing that is generally accommodated by older people. Table 1: Type of supported accommodation for existing households

Adur No. implied

Arun No. implied

Worthing No. implied

AAW total No. implied

Residential / nursing home 27 / 73 100

Extra Care housing / / 24 24

Private sheltered housing 48 118 159 325

Council / HA sheltered housing 128 592 174 894

Total for existing households 203 710 430 1,343

NB: The figures in the above table may contain a small number of households who do not have a member who is an older person.

We can see from Table 1 above that 1,343 existing households in Adur, Arun and Worthing require supported housing that is generally accommodated by older people over the next five years. The highest demand is for Council or HA sheltered housing. Existing households were asked whether they had elderly relatives who may need to move into their area and what type of housing their relatives would need. From Table 2 below we can see the predicted demand for each type of accommodation in each LA for in-migrated older person households over the next five years. It should be noted however that these predictions are not necessarily borne out and that older people themselves often prefer to continue to live in the area they know and within their own home as long as possible. These may therefore be over-estimates. Table 2: Type of accommodation for older person in-migrant households

Adur No. implied

Arun No. implied

Worthing No. implied

AAW total No. implied

Private sheltered housing 231 690 649 1,570

Private housing 350 748 474 1,572

Residential nursing home 245 486 526 1,257

Live with respondent (need extension / adaptation)

241 693 480 1,414

Live with respondent (existing home adequate)

127 88 177 392

Council / HA sheltered housing 294 486 468 1,248

Council / HA Housing 148 310 206 664

Total for in-migrant households 1,636 3,501 2,980 8,117

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Private housing is expected to be in the highest demand with 1,572 households requiring this type of housing, followed by private sheltered housing (n=1,570 households). Table 3 displays the residential and sheltered housing demand for Adur, Arun and Worthing over the next five years Table 3: Type of accommodation for existing & in-migrant households

Adur No. implied

Arun No. implied

Worthing No. implied

AAW total No. implied

Residential / nursing home 272 486 599 1,357

Sheltered housing : 701 1,886 1,450 4,037

Private market 279 808 808 1,895

Affordable sector 422 1,078 642 2,142

The highest demand is for sheltered housing in all three LA's (n=4,037) of which the majority of households (n=2,142) will need to access this type of accommodation through the affordable sector. However, unlike Adur and Arun, Worthing's highest demand is for sheltered housing accessed via the private market (n=808). However this demand will need to be compared with current levels of supply; for example in Worthing the recommendation is to monitor demand and supply and not to increase supply. There also appears to be evidence of a decreasing demand for affordable sheltered housing, which will need to be further explored with both RSL partners and private sector providers such as McCarthy and Stone. Further statistical and demographic information can be obtained from the Office of National Statistics and South East Public Health Observatory websites. In addition statistical data is also contained in the West Sussex Supporting People Needs Report and the Community Profiles for Adur and Arun District, and Worthing Borough Councils. Specific statistical information for individual agencies is available on the PCT, S&CS and HS websites. These variously give details of caseloads, waiting lists, interventions and throughputs. Additional general housing data is contained in the HS Housing Needs Assessments. Some of this information is presented in a separate supporting document entitled “Additional supplementary and statistical information”.

Implications and Key Messages

The number of older people in Adur, Arun and Worthing is far higher than the national average

Population projections forecast a continuing increase in this age group, particularly among the very elderly

Many Social and Caring Services and Primary Care Trust service are accessed solely or mainly by older people

Due to the number of older people in Adur, Arun and Worthing there are high levels of demand for services

Many older people and their relatives would like a access to both private and social rented sheltered housing

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National Strategies A number of key national strategies have been produced in recent years relating to older people and this strategy is in line with the direction and emphasis of those strategies and reflects their overall aims and objectives.

National Standards Framework (NSF) The NSF is probably the best known of the national strategies. The NSF for older people was published in 2001. It sets new national standards and service models of care across health and social services for all older people, whether they live at home, in residential care or are being looked after in hospital. The NSF leads with plans to:

tackle age discrimination to make it a thing of the past, and ensure older people are treated with respect and dignity

ensure older people are supported by newly integrated services with a well co-ordinated, coherent and cohesive approach to assessing individual's needs and circumstances and for commissioning and providing services for them

specifically address those conditions which are particularly significant for older people - stroke, falls and mental health problems associated with older age

promote the health and well-being of older people through co-ordinated actions of the NHS and councils.

The NHS Plan also sets out a major package of investment to improve services and standards of care for older people. Integrated policy and practice development will be essential in developing and working towards the standards set out in this NSF. The NSF is a ten-year programme of improvement implemented through local health and social care partners, and national underpinning programmes. Progress will be monitored through a series of milestones and performance measures, and will be overseen by the NHS Modernisation Board and the Older People's Services. The older people's services NSF set out eight nationwide standards to aim for.

Rooting out age discrimination

Person-centred care

Intermediate care

General hospital care

Stroke

Falls

Mental health in older people

The promotion of health and active life in older age

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The NSF cannot operate successfully in isolation however, and a number of other strategies also exist to build the interface between services. The most important of these are outlined below.

The Government recognises that health, housing, social care and support are inextricably linked. The Department of Health (DH) and the Office of the Deputy Prime Minister (ODPM - formerly DTLR) are working together on a number of initiatives that reflect this link to overcome many of the barriers to joint working in the past. The appropriate support and care services can help people to remain independent and enjoy living in their own homes for as long as possible. Well-maintained, warm, secure and suitable housing can help prevent unnecessary admissions to hospital or institutional care.

Appropriate and decent housing is the foundation that enables vulnerable people to live successfully as part of the community. The right support can play a vital role in helping people to sustain their tenancies and prevent homelessness. Flexible care can enable older people to remain at home in the community with dignity. Housing, care and support is an important part of Government's wider regeneration and social inclusion agenda, and all those involved in the provision of housing should consider the needs of and support for vulnerable people as part of their planning processes.

Quality and Choice for Older People's Housing - A Strategic Framework This strategic framework has developed as part of the work of the Inter-Ministerial Group (IMG) for Older People. The Group was set up in 1998 to take an overview across Government policy as it affects older people.

Best Value in Housing Care and Support: Guidance and Good Practice The Government's Best Value in Housing (BVH) framework recognises that housing should not be looked at in isolation but should be considered together with other local authority service areas, including services which are provided to enable people with support and care needs to live independently in the community.

Preparing Older People's Strategies: Linking Housing to Health, Social Care and Other Local Strategies This guidance document is designed to complement the 2002/03 guidance on producing effective housing strategies and plans produced by the Chartered Institute of Housing on behalf of the then DTLR in 2002.

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Housing for Older People Development Group An external development group, including older people, and people from local councils, the NHS, housing associations and others is working with both Departments to build on the framework document encouraging joint action and a joint approach. Through the ongoing development and improvement of this strategic framework the group seeks to explore the key housing issues affecting all older people and to ensure that policies and actions are in place to address them.

Supporting People Supporting People is led by ODPM working with the Department of Health and the Home Office. It is a new policy and funding framework, introduced in 2003, for housing related services for vulnerable groups. Older people are by far the largest group affected by Supporting People. Councils (involving housing and social services) administer the new funding framework in partnership with the NHS, the Probation Service and other stakeholders. Supporting People aims to improve the quality of life for vulnerable people helping people to live independently in the community.

Better Care, Higher Standards - the charter for long term care Local Better Care Higher Standards Charters were implemented from 2000, as a joint initiative from the Department of Health (DH) and DETR. Charters are for everyone aged 19 and over in England who has difficulties associated with old age, long term illness or disability and for carers who support people in these circumstances. The charters tell anyone needing care and support in the long term in what areas they can expect health, housing and social services to set standards for the services they provide and what to do if these expectations are not met.

Housing Health and Safety Rating System The Housing Health and Safety Rating System (HHSRS or the Rating System) is the Government’s new approach to the evaluation of the potential risks to health and safety from any deficiencies identified in dwellings. The HHSRS, although not in itself a standard, has been introduced as a replacement for the Housing Fitness Standard. The underlying principle of the HHSRS is that any residential premises should provide a safe and healthy environment for any potential occupier or visitor. The Rating System assessment procedure requires, for each hazard, two judgements from the surveyor. These are an assessment of:

(a) the likelihood, over the next twelve months, of an occurrence that could result in harm to a member of the vulnerable age group; and (b) the range of potential outcomes from such an occurrence.

According to the DETR Fuel Poverty Strategy 2001, if just 5% of older people were saved ten days in-patient care for illness caused by poor heating, the NHS would save £40m each year and release 150,000 bed days.

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Further details of these, and other national strategies, can be obtained from the websites detailed. Supporting People is a national programme administered locally. General details of the Supporting People programme are given on the national website; local contacts can be found on the West Sussex County Council website.

Implications and Key Messages

National strategies relating to older people all make links between health, housing and social care

During recent years there has been a move away from residential/nursing home, and long-stay hospital care in favour of promoting independence

Most older people want to remain in their own homes provided that services can be provided and that their home is, or can be made, suitable for them

The Supporting People framework, with County Council, District/Borough Council, Health and Probation representation is intended to give a mechanism to ensure that agencies can work effectively together housing support services for vulnerable people, including the elderly

The HHSRS specifically highlights the hazards of excess cold, excess heat, carbon monoxide poisoning, falls, fire, and ergonomic hazards, all of which disproportionately affect the older age group.

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Local Strategies This strategy also seeks to support local health and council (both county and district/borough), single and multi-agency, general and specific strategies relating to older people. There are a great many of these and therefore only the most relevant are highlighted here. In future this strategy could form one strand of a larger strategy such as a county-wide Older People’s Housing and Support Strategy or an Adur, Arun and Worthing Older People’s Strategy.

Social and Caring Services Strategies S&CS strategies are among the most focussed of the local strategies.

“Our essential aims are to help people to continue to live independently and to provide security for those who need care or support. To achieve these aims requires a change in spending patterns away from institutional care to supporting people to live in the community. However, in so doing we will not compromise on meeting the needs of individuals.”

West Sussex County Strategy 2001-2005

“Vision for Older People’s Services”

S&CS outlines how the aims in its county strategy should be delivered in relation to older people in its document “Vision for Older People’s Services” (2004). This jointly produced health and S&CS shared vision sets out the ways in which the commissioning organisations are committed to partnerships to improve health, well-being, and promote independence for older people and how more locally sensitive strategies will be developed in more detail with the wider involvement of local partner organisations. When illness, accident or adverse social circumstances threaten health or independence, health and social services should be there to respond to problems and their consequences. These services should be provided promptly and in accordance with accepted standards of best practice, published in the National Service Framework for Older People and other Government guidance. Having provided the specialist treatments or personal and social care required, older people should be helped back to their usual lives and maximum level of independence, as soon and so far as possible. An important objective for health and social services is therefore to minimise people’s long-term dependency through active rehabilitation and support. By integrating and organising health and social services in line with the following principles, older people will benefit more from the funding available to the partner organisations, while organisations remain within financial balance overall.

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As the needs of older people vary over time, so the people, skills and organisations most appropriate to meeting these needs will vary. Sometimes only one person or organisation may need to provide care or treatment. Often there will be overlapping needs requiring the simultaneous involvement of both health and S&CS.

No one individual or organisation can do, or know everything. Assessments of need should share the same processes, with information exchanged to ensure a complete picture is built up. Agreed objectives, older people’s choices, and the contributions that different professionals and organisations can make, should guide what service is provided and by whom. Where needs are complex or deterioration is a risk, it may be appropriate for one person to case-manage the co-ordination of care. In all instances, to ensure services continue to be appropriate, pre-agreed reviews must be undertaken by those involved. It may be that services should then be provided by a different organisation, such as in the transfer of care from an acute hospital trust to community services.

The aims and objectives of services provided by different people and organisations, should be made clear and understood correctly. Referrals between them should be based on these understandings, and the choices and suitability of the person being referred to them to benefit. The right balance of capacity between different services provided, should reflect the choice of most older people to stay as independent as possible, for as long as possible. Access to services on the basis of appropriateness and preference rather than availability at the time, will be essential to having the integrated and individually responsive care arrangements older people need. Providing integrated care will mean having integrated services, with people from different professional backgrounds and organisations working together in teams, with a unified management structure and budget. Authority for the use of resources would be devolved, and the context set for inter-disciplinary working, by partner organisations providing staff with opportunities for joint training and development. Over time the skill-mix of teams and the capacity of services to which they have access, may need to be altered to better reflect the needs of older people. Where budgets are not devolved, commissioning organisations should be responsive to varying the levels of service they secure through Agreements. This could involve pooling budgets under formal agreements to transfer resources across organisational boundaries.

As different services become more integrated and their capacities change, it will still be important that their distinctive aspects are targeted on those most able to benefit from them. This is very difficult to define or predict, but should focus on how much effect they will have on ability to remain independent in the short and long-term. This is because insufficient funding exists to provide every kind of service for every kind of need.

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Commission for Social Care Inspection (CSCI) Report In May 2004, the Commission for Social Care Inspection (CSCI) inspected S&CS for Older People. Its report, published in October 2004, stated the following: “We have concluded that there is clear evidence that progress has been made in older persons services since the inspection in 2001. Clear leadership on behalf of the senior management team combined with a strategy of coterminosity with health is leading to better outcomes for service users. There is a general sense with both users and practitioners that the pace of development has increased in the last two years. Older persons are clearly high on the corporate agenda. Robust discussions with Health, particularly with regard to reimbursement and continuing care have taken place and it is clear that a good working relationship has developed at both a countywide and local level.”

Inspection of Social Care Services for Older People, CSCI, 2004 The CSCI review also saw good evidence that S&CS had clear strategic objectives for meeting national priorities. “We found the council and health co-operating in both planning and service delivery. In recent years the provision of adult care has been provided through five area offices, coterminous with the local primary care trusts. Local planning groups within these areas provided mechanisms for both local planning and monitoring of service delivery. The social services department had clear performance plans relating to older persons services and we found evidence that users and carers were involved both in strategic planning and the planning of service developments at a local level. Older persons services was a priority within the corporate council agenda.”

Inspection of Social Care Services for Older People, CSCI, 2004

West Sussex Housing Strategy for People with Learning Disabilities Although this strategy is not age specific, it does recognise the particular difficulties of older people with learning difficulties. As with the main-stream older population, they experience increased physical disabilities with age, which is a particular issue for people with learning disabilities, coupled with the fact that early onset dementia is particularly prevalent among people with learning disabilities.

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PCT strategies Improving the health and well-being of older people is also a key local priority for the PCT. Intermediate Care

In order to achieve this, the PCT has introduced Intermediate Care which is about helping people to live independent lives, with the help and support of the NHS and Social Services. This health care target is about avoiding people being admitted to hospital unnecessarily, providing support for people in their own homes and supporting those leaving hospital. It is not meant to replace hospital care when this is necessary. The Intermediate Care Programme, headed by a team of nurses and therapists in conjunction with social workers, has been introduced first in Adur and is planned to roll out across the rest of the area in due course.

Examples of intermediate care include providing assessment, rehabilitation, and nursing support at home. A package of care could also be a six-week, two days a week rehabilitation programme at a day centre. Or for someone who is more dependent and frail, it could mean up to six weeks’ intensive care and support in a community hospital. Health Enhancement Programme for Older People (HEPOP) Another way that the PCT aims to support people to remain independent is through the Health Enhancement Programme for Older People (HEPOP). A small team of Health staff visiting older people will use a wide-ranging check list to identify those most at risk and who may need access to health, social care, voluntary, or local authority support. They will be put in contact with the right agencies and services, which could result in a visit from their GP, or some work to install a handrail or a step. The aim at all times is to help the older people to live independently for as long as possible. Local Strategic Partnerships (PCT perspective) Over the past year, the PCT has also strengthened its commitment to working in partnership with others. To ensure that it works effectively with its partners to reduce health inequalities, it has invested in Partnership Managers working in each of its three district/borough boundaries. The main focus of this partnership work is through the Local Strategic Partnerships. The purpose of the Local Strategic Partnerships is to reach out and engage with local people and local communities, as well as with local businesses and other statutory providers to develop a vision for the future. Each locality has worked to produce Community Plans which detail the needs and priorities of local people and how the Local Strategic Partnerships are working to address them. By working in this way and gaining a 'wider picture', the PCT is able to understand the health issues of people in the community and the factors that impact on their health and well-being. By talking to local people and putting their views first, both the PCT and their partners are able to develop and provide better services and support.

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“Better Together – A Toolkit for Tackling Local Health Inequalities Targets” Broadly similar issues in relation to older people are outlined in the PCT’s “Better together - A toolkit for tackling local health inequalities targets”. This document also highlights some of the housing issues linked to health since poor housing and inadequate heating can result in low indoor temperatures and pose a potential health hazard to the elderly. Older people are disproportionately affected by Fuel Poverty. The toolkit seeks to address these by

Promoting energy efficiency grant schemes, focusing especially on older people living in deprived areas.

Ensuring that energy efficiency standards of new developments are maintained.

Identifying and linking older people to existing initiatives and schemes to tackle fuel poverty.

Integrating fuel poverty assessments into routine assessments of the health and well-being of older people.

Managed Care Service for Older People This approach is also followed in the PCT’s outline strategy for development of a Managed Care Service for Older People. The aim is to develop managed care as a local service that provides optimum care and outcomes for people who have complex needs and who have, or are likely to have, experienced avoidable multiple hospital admissions. It aims to provide intensive care management and provision to this vulnerable group in their own homes to avoid admission to hospital wherever appropriate. It emphasises this area of care as a key development needed as part of the whole system of care. It begins to identify the impact on and integration with other areas of care to make better use of capacity and to improve access to services. It also recognises that there are a raft of key underpinning issues that are vital to this service development and to success. Joint Commissioning Framework for meeting needs of Older People with Mental Health Problems in West Sussex This draft multi-agency joint strategy aims to provide a coherent framework for the planned strategic commissioning of services for older people with mental health problems and their carers in West Sussex. Specifically the frame should be used to:

Ensure that services are based around the needs of users, carers and communities in West Sussex

Ensure effective and strategic use of resources to meet needs of this client group

Provide a blue-print for services which will ensure a level of consistency across the county but which will allow for local development of services within PCT areas

Provide a clear long-term direction for commissioning and de-commissioning services in conjunction with major partners

Ensure that the aims of National policies and frameworks in this area (including National Service Framework for Older People Standard 7) are implemented, managed and translated effectively into local objectives, targets and actions in order to meet the needs of older people with mental health problems in West Sussex.

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District and borough strategies In addition to these, district/borough councils and HS also have a number of strategies that relate both generally and specifically to the housing and support needs of older people. Local Strategic Partnerships (District/Borough Council perspective) and Community Strategies Adur The Community Strategy prepared by Adur in Partnership (the Local Strategic Partnership) begins to answer questions about what Adur will, and should, be like in 20 from now based on the views and aspirations of local people. Adur’s Community Strategy, entitled “Your Community, Your Future”, sets out to improve the economic, social and environmental well-being of the area. It has been achieved by coordinating the actions of the public, private, voluntary and community sectors through Adur in Partnership. It has ten key themes including health and social care and housing Key priorities and Challenges

Support for older people to live independently for as long as possible

Ensure that vulnerable people are housed in line with the West Sussex Supporting People Strategy, this includes home adaptations for disabled and elderly people

Action plan

Reviewing Help to Stay at Home type services including care and repair etc

Seek opportunities for funding the expansion of the ‘Floating support’ for people over 75 not in contact with statutory services

Develop additional ‘Extra Care’ housing

Develop intermediate care facilities in the community, by establishing community intermediate care and rehabilitation schemes in Adur

Development briefs for developers to take into account ‘Lifetime Homes Standard’

Seek further funds to address adaptations to existing properties

PSA Target - elderly people to stay in their homes for longer

Establish a register of all properties that have undergone adaptations

Produce an ‘Older Persons Housing Strategy’ - link to Health and Social Action plan

Investigate provision for Extra Care Housing developments Arun The Arun Local Strategic Partnership is made up of agencies and organisations from the public, private and voluntary sectors which have come together to build an action programme – “Our Kind of Place” - to deliver real, measurable changes over a period of years. Service delivery will focus on the needs and aspirations of local people, including those who are traditionally excluded, to help everyone enjoy a full and active life. Local

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Councils, the Police, Primary Care Trusts and other health agencies, and voluntary sector groups are all represented. “Our Kind of Place”, the community strategy for the Arun district, was launched in April 2000. It aims to capture the needs, hopes and aspirations of Arun residents and turn them into on-the-ground action to improve the quality of life for all of them, now and for generations to come.

It concentrates on four areas including an ageing population and housing Key partnership actions

Active engagement of key housing partners, particularly the District Council, Health Authority and Social Services, to identify and match the needs of elderly people

To enable more people over the age of 65 to remain living in their own homes

Action programme

To develop services that promote health and independence and tackle issues around social isolation through improved access, transport and supporting people in their own homes

A reduction in the mortality rate of under 75s in Arun compared with the county average, with particular reference to deaths from cancer, coronary heart disease and circulatory disease

Provision of extra care housing to meet the needs of Arun’s increasingly elderly population as evidenced in Housing Needs Survey 2003

A simpler, better-coordinated and easily accessible framework for information for elderly people

Worthing Local organisations in Worthing are working together in a new partnership to produce and implement a Community Strategy to create a better place for those who live, work and visit here. The partnership is called Worthing Together and was formed in April 2002. Worthing Borough Council and West Sussex County Council are working together with partners in the public, private and voluntary sectors. The partnership has produced a Community Strategy entitled 'The Town We Want'. This takes on board what local people said at community forums held throughout Worthing from July to November 2003. The Strategy centres on seven key areas of the town's life: increased prosperity, greater personal safety, move involvement of local people, fewer inequalities, better leisure and cultural activities, improved lifelong learning opportunities, and enhanced transport. The document sets realistic targets for improvements in joint service delivery, including a commitment by each partner to work with others to resolve local needs.

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The strategy has seven specific goals including a town with fewer inequalities particularly in health, housing and social care Immediate actions

Develop a range of services to support older people, including intensive home care support and extra care housing

Promote a public health kit covering smoking, breast feeding, teenage conception, looked-after children, older people, substance misuse, and major killers such as coronary heart disease and cancer

Tackle fuel poverty in the most deprived areas by providing grants to help older and more vulnerable residents with their insulation costs

Longer term actions

Develop a wide range of independent living options and services for people with care or support needs, including homeless people, older people, young people, people with learning difficulties, mental health service users, people with substance misuse problems, women and families escaping domestic violence, physically disabled people, and all others who may need help to live independently

Housing Strategies Housing Strategy Statement 2002-2007 (Adur) The current housing strategy statement covers the period 2002-2007. A revised version of the strategy to cover the period 2004 – 2009 is the process of being drafted. One of the key priorities in the new strategy, supported housing, is relevant to the housing and support needs of older people. This highlights – The Supporting People Shadow Strategy 2003/04 found an under provision of extra care services for older people with support needs.

An extra care housing scheme between Adur DC and Housing 21 has developed 10 units of extra care provision at Burchell Court. In addition, the other units at the scheme have been redeveloped to create more suitable accommodation for this age group

The Interim Housing Renewal Strategy aims to contribute to the achievement of the overall vision for housing in Adur. Its objectives include:

To assist older people to remain in their home where they wish to do so with as great a degree of independence and security as possible

To increase the average energy efficiency of private sector dwellings and to increase the number of properties achieving ‘Acceptable Affordable Warmth’ standards

To reduce accidents in the home A Private Sector House Condition and Energy Efficiency survey was carried out during 2004.

Poor housing conditions within the District were found to be associated with households in social and economic disadvantage. This affects the ability of households to repair and improve their dwellings, in particular elderly households

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Housing Strategy 2003-2008 (Arun) The existing housing strategy covers the period 2003-2008. A new version of the strategy to cover the period 200X – 200X is currently of being drafted. Arun District Council's draft Housing Strategy proposes six priorities. Its fourth priority is 'To meet the needs of an ageing population'. The Housing Needs Survey 2003 found that ”the population is ageing, with considerable evidence of significant and growing support needs”. The Council is working in partnership to address these needs both in the east, with Adur District Council and Worthing Borough Council, and with West Sussex Social and Caring Services and the Adur, Arun and Worthing Primary Care Trust, and in the West with the Western Primary Care Trust, West Sussex Social and Caring Services, Age Concern West Sussex and the Councils for Voluntary Service. The focus is on providing effective housing, allied to the right care, support and wider services, such as good transport and community safety, as the springboard that enables older people to remain involved and live their lives to the full. Older people are more likely to be homeowners, live in unfit housing and more likely to experience physical and sensory impairment than people of working age. In addition, there are an increasing number of older people with a learning difficulty, a mental health need or with a history of homelessness. Older people need to have a range of appropriate housing solutions and types of accommodation and choices of care both public and independent sector. Specific housing objectives in relation to the needs of the elderly in Arun include the following –

The provision of extra Care housing in the east of Arun. This was identified as a high priority by the Arun Local Planning Group and a feasibility study has been carried out into the conversion of Woking Court, Rustington into an Extra Care facility. In 2003, a bid for Department of Health funding was submitted by the county-wide Supporting People Group; this was unsuccessful but was re-submitted in November 2004.

In response to the identified needs for smaller accommodation in the HNS, future housing developments will seek the appropriate mix of dwellings with smaller units being prioritised for elderly persons wishing to move from unsuitable/under occupied Council dwellings.

The Council's community alarm service for the elderly, Lifeline, has been given additional staff and financial resources to enable more units to be supplied to those in need, and for units to be replaced more regularly. Units are available on a short-term basis to assist with combating bed-blocking and to reduce reliance on institutional care and to allow people to remain in their own homes for as long as possible.

The Arun Locality Planning Group organised a stakeholder seminar. A large number of elderly residents were invited to comment on the current and future needs for services - including extra care housing - but also transport and services to assist people to remain in their own homes. In developing its Corporate Plan priorities the Council has recognised the need for tougher enforcement of living standards in the private rented sector, where many vulnerable elderly people live in unsatisfactory conditions. This will be achieved through proactive inspection of HMOs, working with Landlords and, where non-compliance occurs, taking enforcement action in line with an agreed framework. Arun's Private

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Sector Housing Strategy includes priorities focussing on improving housing conditions, energy efficiency and security, all with a particular emphasis on dwellings occupied by vulnerable people. Housing Strategy 2005-2010 (Worthing) A full Housing Strategy for 2005 to 2010 is in the process of being finalized. Two of the Council’s nine key priorities are particularly relevant to older people. The area in and around Worthing has a higher than average percentage of older people. The key issues identified include fuel poverty; repairs and improvements to housing conditions; care and extra care; the future of sheltered housing; home security; health and safety in the home; access and mobility; adaptations; new 'assistive' (home communications) technologies. One major concern addressed by Worthing's Housing Strategy is the number of older people living in poor quality housing.

In Worthing 172 older people are without sole use of a bath or shower and toilet, 45 of them aged 85 or over. 1,560 older people in Worthing have no form of central heating in their home, 252 of whom are aged 85 or over. A key priority is the renewal of poor quality housing stock. It is estimated that 4,335 vulnerable households are living in non-Decent homes in the private sector in Worthing, 54.84% of all vulnerable households. A significant number of these households are likely to be older single people or couples. The Strategy recognises a need for repairs and improvements to the worst housing, but draws attention to decreasing resources. In particular, demand for Disabled Facilities Grants has increased and this impacts on the level of resources available for housing repairs. Staying Put', a service run by Anchor Trust and supported by Worthing Borough Council and Supporting People, carries out minor repairs and energy efficiency works for older owner-occupiers to help them bring defective properties up to standard. It also carries out minor works and disabled adaptations through 'care and repair' for older and vulnerable residents. In 2004 the scheme was linked with the Home Improvement Agency in Arun in line with the county-wide aspiration of providing a consistent, 'joined up' service across West Sussex, and improving the use of resources. A full review of Home Improvement Agencies in West Sussex is currently underway.

Fuel poverty, particularly amongst older people, is also a concern.

The Council funds fuel poverty grants to older and more vulnerable residents in partnership with the Seeboard, although external funding from the Single Regeneration Budget to support runs out in 2005. Worthing Borough Council will continue to fund the scheme with Seeboard, offering 90 grants each year.

There is a recognised need for Extra Care housing and plans for a scheme of 32 rented and 8 shared ownership units in partnership with Hanover Housing Association. Additional needs will be monitored closely once the new scheme is open. The future of existing sheltered housing schemes is also a concern.

Worthing has significantly less sheltered housing units than most other areas in West Sussex and no units for frail elderly people. The Housing Needs Survey analysed the housing needs of older people over the next 5 years and estimated an annual demand for sheltered housing of 808 places in private sector schemes

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and 642 in affordable schemes. Whilst much of this requirement can be met through existing stock there are concerns about the existing sheltered housing stock, particularly in the social sector, and its long-term viability. Some schemes have inadequate access and insufficient space and may become very hard to let over the next few years. The Council has begun work with sheltered housing providers to ensure that these schemes are remodelled or redeveloped to maximise their potential, and that the supply of affordable sheltered units is maintained to a standard and in locations required by residents. One option which will be considered is more flexible use of housing units previously designated 'sheltered' and other current 'general needs' properties to allow for older people to remain integrated in the local community.

The strategy also highlights a number of problems identified with funding for Community Alarm services across West Sussex and a review, led by Supporting People, is underway to resolve these.

The amount of funding is now fixed but the demand for community alarms is growing. Funding does not currently target those people most in need of the service and is spent exclusively on people who rent rather than across tenures.

Another vital project is the SAFE (Security Action for the Elderly) scheme.

This is assists vulnerable people who have experienced a break-in to their home with additional security measures, and has proved highly successful in reducing repeat incidents.

Other issues recognised as needing attention are health and safety in the home, mobility needs and adaptations, and the use of new 'assistive' technologies.

The need for accessible and suitably adapted housing is of particular concern. There were 372 people on the Council's Housing Register at 1st April 2004 requiring ground floor housing, of whom 82 needed wheelchair accessible housing. Not all of these housing applicants will be older people, but many will. The House Condition Survey conducted in 2004 found that 38.5% of households had one or more residents considered to be disabled or infirm. The Housing Needs Survey, on the other hand, identified only 18% of households as including someone with a special need. The Council will carry out a more detailed analysis of both sets of data to make as accurate an assessment as possible of the level and type of need. According to the Housing Needs Survey 48% of all disabled people in the Borough have a walking difficulty and 913 are wheelchair users. Although over 900 properties have already had wheelchair adaptations, in only 29% of cases does a wheelchair user live in a home that has been suitably adapted, suggesting a mismatch between accessible properties and those where wheelchair users live. The Council is working with other agencies across the County to establish a database of adapted properties and introduce an Adapted Housing Register to help match people to suitable properties.

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Implications and Key Messages

There are a large number of local strategies from Social and Caring Services, the PCT and the District/Borough Council’s relating to the housing and support needs of older people

This strategy seeks to support the existing local strategies The most broad ranging of these is the “Vision for Older People’s Services”

which highlights and promotes the need for a multi-disciplinary approach, continuity of care, the importance of case-management, choice for service users, regular reviews of the care provided, integrated services, multi-disciplinary teams, and devolved or pooled budgets

PCT strategies have been largely based on methods of service delivery e.g. the introduction of intermediate care, HEPOP and managed care services for older people and have focussed primarily on minimising admissions to hospital and facilitating early discharge

District and Borough Council Community Strategies have mainly focussed on social inclusion and methods of integrating older people into the community

Housing strategies examine a range of options including measures to support people in their own homes such as the use of assistive technology, adaptations for older people with disabilities and adapted housing registers, as well as the provision of specialist sheltered and extra-care accommodation

Website Details National websites Office of the Deputy Prime Minister www.odpm.gov.uk Department of Heath www.dh.gov.uk Department of Trade and Industry www.dti.gov.uk Supporting People www.spkweb.org.uk

Regional websites Government Office of the South-East www.sepho.org.uk South East Public Health Observatory www.gose.gov.uk

Local websites West Sussex County Council www.westsussex.gov.uk AAW NHS Teaching PCT www.healthinaaw.nhs.uk Adur District Council www.adur.gov.uk Arun District Council www.arun.gov.uk Worthing Borough Council www.worthing.gov.uk