HOUSING SUPPORT & PERSONALISATION

HOUSING SUPPORT & PERSONALISATION

HSEU PROVIDERS SEMINAR

December 2012

Dr Ann Rosengard

SDS National Strategy, Progress and process

National Strategy Implementing the legislationWho is accessing SDS?Where does Housing Support fit in?Housing support and particular needsIssues and Action points

Dr Ann Rosengard December 2012 1

Priorities of Scottish Government & Cosla’s 10 Year SDS Strategy

Widened eligibility - e.g. to DPs

Co-production/ user involvement

Assessment driven by User-defined outcomes

Informed choice/ access to advice

Range of options to maximise choice

Use of Individual Budgets (I.B’s)

User control of support Dr Ann Rosengard December 2012 2

The Social Care (SDS) (Scotland) Bill

Identifies 4 options for service users:1. To use a DP to arrange & fund their support

2. To identify the support they want and ask the L.A. to arrange this for them

3. To leave it up to the L.A. to make decisions

4. To combine 1-3 above in a support package. Access for all ages Children and Young People – to involve 16/17’s Older People, including those with dementia


Enacting the SDS Bill – 2011/2013

Placed before Parliament – 29 February 2012 Consultation – 1 March to 24 April 2012

Revised Draft – debated by Health & Sport Cttee in June Tenth Report - produced 06.07.12 Parliamentary debate on Stage 1 on 18.09.12 Amendments debated October-November 2012

Vote - Bill passed 28.11.12 – with CCPS amendment … as far as practical LA’s should make available a wide range of

support and a variety of providers Draft Regulations and Consultation and Best Practice

Guidance (non-statutory) – to be produced early 2013.


Implementation - take up of SDS (DPs)

Government stats mainly cover use of DPs - though data collection is being revised

Across Scottish councils, limited but significant growth in take-up of SDS

Increased from 2001- 2009 from 207 to 3017 22% increase to 3,678 in 2010 19% increase to 4,392 by 31.03.11 15% increase to 5,049 at 31.03.12. Variations between LA areas and ongoing

changes in spend/use patterns.Dr Ann Rosengard December 2012 5

Access to SDS/ DPs – Scottish Government stats – 2011 & 2012

Dr Ann Rosengard - December 2012 6

Service users 2011 2012

People with a Physical Disability

40 % 37 %

People with a Learning Disability

26 % 24 %

Physical & Learning Disability

3 % 4 %

People 65 and over 33 % 33 %

Frail older people 18 % 19 %

People with Mental Health issues

5 % 5 %

Gender 53 % women 53 % - (approx twice no of women as men age 65 +)

Minority Ethnic 2 % (approx) 3 %

Types of provision via SDSType of DP provision

SDS packages2011

Percentages2011

SDS packages2012

Percentages2012

Personal Care

2918 52% 2978 53%

Social/EducRecreation

1062 19% 1,137 20%

Domestic tasks

827 15% 700 13%

Housing Support

535 10% 601 11%

Health Care 181 3% 106 2%

Equipment; TemporaryAdaptations

31 1% 16 0%

Respite 984 18% 1238 22%

Meals 147 3% 198 4%

Other 334 6% 970 17%Dr Ann Rosengard December 2012 7

Vision of Inputs to SDS Implementation in Bill

Health Involvement NHS Lothian Pilot sought to combine NHS and social care

funding in packages of support which the person directs. More extensive Health involvement in England

Housing and Housing Support (HS) Housing, housing support and allocations are recognised

by SG as playing a key role in shifting ‘the balance of care’ to ordinary living and non-institutional options.

Given changes in commissioning/ monitoring of H.S. since 2007-08 we seem to know less about its role.

Recognising this, Homeless Link (England) has collected data re housing support.


The locus of Housing Support in the 10 Year Strategy

Section 2.6 stresses the need for a co-ordinated approach to personal and housing support Recognises personalisation and choice are

core values for housing support services

“Some people have direct payments that include funding for housing support, allowing them to take a holistic approach to arranging their personal and housing support”. (p.25)


Value of Housing Support

Wider research has identified benefits of H.S. for Diverse support needs, including multiple/ complex Sustaining ordinary living Limiting Health and Social Care costs Preventing homelessness & institutionalisation

National Care Standards for H.S. stress importance of informed choice and person-centred approach - But less explicit on control?


Links between Allocations, Housing Support & SDS

Sc.Gov. Practice Guide on Allocations (2010) Recognises people with health issues or

disabilities may need priority in allocations as well as suitable support i.e. to improve or stabilise their condition and enable

independence with the same choice, control and freedom as any citizen

Stresses that practical assistance should be based on the person’s own choices and aspirations. (Section 6.4.1. para 202)


?To what extent do Housing/ Housing

Support needs play a role in SDS?’

and

How far is the role of housing support in SDS recognised?

Dr Ann Rosengard December 2012

Implementation of SDS is uneven Traditional DPs viewed as bureaucratic

Mainly physical disabilities; slow take up Insufficient independent support Seen as not user-led

Test Sites – 3 Themes To reduce red-tape Leadership – culture change Investing to save - bridging finance


SDS in Practice - Evaluation of Test Sites & Recent Update

Ridley et al, 2011

3 Test Sites Dumfries & Galloway

Used In Control method to help transform social care Community development approach to promote interest

Glasgow Built on Council’s earlier IB pilot (LD) and In Control model Tested & refined assessment and allocation processes Resolved large-scale programme – moving to mainstream Highland Focused on increasing DPs initially promoted SDS for

young disabled people By end of T-Sites all 3 resolved to mainstream SDS


Outcomes of Test Sites at March 2011 (Ridley et al, 2011)

132 individuals in total across 3 areas Mainly people with learning disabilities – 64% More male (52%) than female (48%) Age and gender profiles varied across areas All white British/Scottish

SDS packages 107 DPs (2/3 self managed, 1/3 third party managed) 24 Individual Service Funds (ISFs)

Funding streams mainly SW + client contribution Only one T-Site reported using Housing funds (2011)


More on SDS T-Site Outcomes

Support – found SDS increased flexibility and choice Outcomes - broadly high satisfaction Leadership – all sites developed special teams, infra-

structure (IT), systems and targeted funding for SDS Training – not all staff had received this Bureaucracy – high focus on systems Bridging finance – found useful for infrastructure Development - slow progress, but gathered speed.


Changes highlighted by Test-Site Update to 31.03. 12(Ridley et al, 2013 forthcoming) Strategic vision & programmes - differed e.g.

community development; trialling approaches/ pathways; speed/ scale; individual contributions

SDS systems - ongoing change – e.g. SEQ/ RAS Outputs - > 1000 packages - almost 90% Glasgow

High use of ISF’s and individual contributions in Glasgow

Mainstreaming SDS – fastest in Glasgow Learning disability - major client group overall Mental Health – slow progress to date, but changing Equalities - Increased take up by minority ethnic groups


More Follow Up Study Findings to March 2012

Challenges re Training & Support; Information & reach Specialist SDS teams valued, but capacity issues No progress evident re reducing bureaucracy Tensions between top-down strategies, speed,

resources, choice/ control in process, morale issues Financial / welfare benefits context caused uncertainties/

high concern for service users, providers and staff At times concerns re risk appeared to shape process Limited Housing and Health engagement to date Data did not allow exploring individual outcomes


Limited Findings re role of Housing Support

SDS evaluation sought information on housing (and health) contributions to individual SDS packages

Although housing support was referred to in relation to some packages, overall gained little information on specific housing support funding Follow Up study did not clarify this further It may be that H.S. is subsumed under outreach social support

Is there a case for more focused monitoring; case profiles to clarify/ highlight housing support?

Seminar Participants’ experience?


Implications for housing/ HS from case studies

Case studies carried out as part of original Test Site study indicated role for housing/ HS: left long-stay hospital care or children’s services new needs – adaptations, equipment, support moving from shared to independent housing accessed supported accommodation flexible support enabled positive community living

Examples of SDS assessment highlighting housing/ H.S. needs and being a catalyst to housing gains.


? What are the lessons and implications for

housing support of SDS experience to date?’

Is there a case for monitoring and clarification of the role of housing support in SDS? If so, why needed now?


SDS, housing support and Particular Needs

Up-To-Us Initiatives RSL tenants, advocacy orgs & providers enabled to jointly

purchase support – (funded by DOH, Comm’s & Local Gov) SDS for older people, including dementia

to date use of DPs has been limited, though O.P. have increasingly accessed housing support.

SDS for Homeless people is being trialled 4 Pilots – England – Personalisation for rough sleepers Some providers are personalising services (Hough/Rice, 2010).

Mental health – slower development than in England. Need to monitor and build on experience of outcomes.


?

‘Should SDS go beyond traditional housing support to cover housing issues?’


Example - City of London pilot – Personal budgets (P.B’s) for homeless people

Tested how personalisation might benefit Rough Sleepers given policy to end rough sleeping by 2012. Appointed a P.B. Coordinator (former outreach worker) Didn’t use a formal SAQ or RAS - set budgets up to £3,000 Asked participants what they need to access/ set up home Had to use a broker to help negotiate & access support Could only spend PBs on resettlement/ sustainability 15 were offered a PB; 13 used this and 11 were housed Participants engaged with support Most had sustained their accommodation using agreed help/

support by end of evaluation.


Opportunity to Innovate

Personalisation is ongoing – we are at an early stage but there is a gathering momentum of change

SDS requires and encourages innovation - options to explore may include: Shared service models e.g. HACT; social networks;

using budgets for joint activities and resources Restructuring and small-scale additions to people’s

support to meet individual wants and needs Listening hard to people about what might make a

difference and collaborating to target support plan


Housing Support and Homelessness

Evaluations and wider research stress the key role of H.S. in tackling homelessness Influenced new duty to assess H.S. needs and provide support

where there is a duty to secure settled accommodation

“To ensure that H.S. services are provided to those assessed as being in need” and assess if “any other person residing with the applicant” needs housing support . (Housing(Scot) Act 2010 s.158)

SG consulted on the Duty, issued a Business Regulatory Impact Assessment (2.11.12) and Parliament has approved Regulations

Final Reg’s approved 27.11.12 - 4 broad types of H.S. – with Finances; Accessing sources of support; Advising/ assisting re Housing Rights/ Responsibilities; Resettlement support

Regs will be enforced on 1st June 2013.


Influences on continuing or increasing demand for H.S.

Perfect storm of benefits changes – Will this increase homelessness & related advice/ support needs, despite recent decline due to impact of H.Options/ Prevention?

New LA duty to assess H.S. needs for homeless applicants. Will this increase demand for H.S?; change routes of access? Enable access to SDS for some?

Sustainability issues facing providers in context of changing environment may impact on agency level demand for H-S


Implications of personalisation / SDS for Housing Support

Commissioning strategies and inspections may increasingly check how far existing H-S services are personalised and homes are accessible

Providers could usefully look afresh at their systems/ processes. How far do assessment & support planning focus on assets, not deficits? How far do they involve co-production?

Guidance - Homeless Link - useful guidance with tools and information. Suggests SDS can address complex needs better because starts from person’s views and situation. Also there is a wider range of general and specific guidance, e.g. Alzheimers Scotland.

SDS assessment - Self-assessment/ evaluation systems should identify/ address housing support needs and required resources clearly

SDS monitoring – Should clarify the extent to which there is a Housing Support element in support packages and what form this takes.

Housing standards and choice: Joint planning is needed to ensure that people have access to a range of accessible housing


?

What challenges are faced by providers where H.S. needs are temporary and require a flexible response, e.g resettlement/ move on support?


Some references Cabinet Office Strategy Unit (2005) Improving the Life Chances of Disabled People. The

Stationery Office, London. Alzheimers Scotland (2010) Let's get personal - personalisation and dementia. Alzheimers

Scotland, Edinburgh 2010. Department of Health (2005) Independence, Well-being and Choice: Our vision for the future of

adult social care, DOH, London. Department of Health (2010) Person Centred Planning: Advice for Commissioners; Also separate

documents cover: PCP-Advice for Providers & PCP - Advice for Professionals. All, DOH 2010. DOH , SCIE et al (2012) Towards excellence in adult social care: Progress with adult social care

priorities England 2011/12. DOH October 2012 Glendinning C, Challis D, Fernandez J, Jacobs S, Jones K, Knapp M, Manthorpe J, Moran N,

Netten A, Stevens M and Wilberforce M (2008) Evaluation of the Individual Budgets Pilot Programme: Final Report. Social Policy Research Unit, University of York, York. (IBSEN study)

Hanover and HACT (2010) Up2Us Summary Document : http://www.hanover.org.uk/public-affairs/HanoverandhactUp2UsSummary.doc.

Homeless Link (2011) How to Personalise your Service. http://homeless.org.uk/sites/default/files/HowtopersonaliseyourserviceFinal.pdf

Hough J and Rice B (2010) Providing Personalised Support to Rough Sleepers: An Evaluation of the City of London Pilot. Joseph Rowntree Foundation, York.

Look Ahead (2010) Choice, control and independence: Personalising block contracts in supported housing. Look Ahead Housing & Care and London Borough of Tower Hamlets.


More references

NHS (2010) The Healthcare Quality Strategy for NHS Scotland. Scottish Government, May 2010 Ridley J, Spandler H, Rosengard A, Little S, Cornes M, Manthorpe J, Hunter S, Kinder T & Gray

B (2011) Evaluation of Self-Directed Support Test Sites in Scotland. Scottish Government, Edinburgh. Full Report and Research Findings No.109/2011: http://www.scotland.gov.uk/socialresearch

Rosengard A and Jackson AA (2012) Supporting homeless people - Exploring the Implications of the new duty to assess the Housing Support needs of Homeless People and to provide Housing Support. Summary of Report to Shelter Scotland (May 2012)

SCIE and NHF (2009) At a Glance 08: Personalisation briefing: implications for housing providers Scottish Government (2006) Changing Lives – Report of 21st century Review of Social Work,

The Scottish Government, Edinburgh 2006 Scottish Government (2009) National Care Standards Housing Support. The Scottish

Government, issued 2002, revised in 2005 and 2009. Scottish Government (2009) A Personalised Commissioning Approach to Care & Support

Services, Scot Gov, Mar 2009 Scottish Government (2010) Social Housing Allocations: A practice guide. August 2010.

http://www.scotland.gov.uk/Publications/2010/08/05104504/7 Scottish Government (2011) Evaluation of Local Housing Strategies Co-Production Pilots with

Disabled People. The Scottish Government, December 2011.http://www.scottish.parliament.uk/S4_Bills/SocialCare(SelfdirectedSupport)(Scotland)Bill/Bill_as_introduced.pdf


And more Scottish Government (2011) Social Care (Self Directed Support) (Scotland) Bill: The Scottish

Government’s response to the consultation. The Scottish Government, October 2011 Scottish Government and CoSLA (2012) Age, Home and Community: A Strategy for Housing for

Scotland’s Older People: 2012 – 2021. The Scottish Government, November 2011 Scottish Government (2012) Update to a User's Guide to Self-directed Support in Scotland. The

Scottish Government, February 2012. Scottish Government (2012) Draft Scottish Statutory Instruments: The housing support services

(Homelessness) (Scotland) Regulations 2012. made 2012; coming into force: 1st January 2013

Scottish Statutory Instruments 2012 No. 331. The Housing Support Services (Homelessness) (Scotland) Regulations 2012 (Made 27.11.2012; coming into force 01.06.2013)


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