Mackintosh O’Connor Associates Research and consultancy

LOCAL PARTNERSHIP AGREEMENTS Making homes work for disabled tenants

Sept 2012

SOUTH WEST IMPROVEMENT & EFFICIENCY PARTNERSHIP Sheila Mackintosh Lynn Collingbourne

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Page Summary 3 1. Introduction 5

2. Concentration of need in the housing association sector 6

3. The funding problem 7

• Loss of direct subsidy 7 • The Disabled Facilities Grant (DFG) 8 • Housing association use of the DFG 9 • The impact of transfer and national associations 9

4. Housing association spending on adaptations 11

• Spending on minor works 12 • Spend per property 12

5. Should housing associations pay for adaptations? 14

• Equality issues 15 • It’s not ‘just a maintenance thing’ 16 • Complexity of the customer journey 17 • The need for consistency in minor works 19 • The impact of Ombudsman judgements 19 • Changes in regulation 20 • What might be an appropriate budget? 21 • Developing adaptations as a core service – an example 23

6. It’s not just about funding 23

• Use of data and intelligence sharing 24 • Website information 24 • Communication 24 • Use of independent OTs 25 • Training 26 • Procurement 26 • Improving asset management 26 • Housing options advice and allocations 27

7. Setting up an agreement 28

• The needs of partners 28 • Models of agreement 29 • The Bristol Home Adaptations Local Standard 30 • The Devon ‘Homes without Barriers’ protocol 33 • The Cornwall Common Operating Agreement 35

8. Conclusion 36

9. Toolkit for setting up an effective agreement 39

CONTENTS

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Home adaptations are vitally important to enable people with disabilities to remain independent in their own homes. This paper looks at the results of recent home adaptation partnership agreements developed in the South West of England between local authorities and housing associations. The key issue addressed is resources. After direct funding was withdrawn housing associations increasingly made use of the Disabled Facilities Grant (DFG). The influx of applications placed a strain on local authority budgets with some associations using a disproportionate share.

Most associations put considerable resources into minor works, such as grab rails and ramps, and some associations also have excellent policies for funding major adaptations including: bathroom conversions, adapted kitchens, stairlifts and extensions. Although there is a lot of good practice the funding picture is very variable. Some associations have generous budgets while others have low ratios of funding to stock levels and place much greater demands on the DFG. Work by the Building Research Establishment suggests that adaptation budgets in the council stock should be in the region of £60 per property, but half the housing associations with the majority of the stock in Devon and Bristol spent less than £30 per property.

As a high proportion of social housing tenants have disabilities it might be expected that home adaptations would be a core function of housing associations and that they would be leading the way, not just in the design and delivery of new accessible housing, but in how to adapt the existing stock. Instead, because many associations have become divorced from funding responsibilities, some are not dealing with effectively with critical asset management and value for money issues. More coherent policies also need to be developed to provide alternatives to adaptations to give tenants more choice including: practical help with rehousing and downsizing, better ways of advertising adapted properties and more effective allocation of new accessible homes.

Local authorities are keen to develop partnership agreements to get a more consistent approach from associations and to ensure that other users of the DFG get a fair share of the budget. Most housing associations also see the benefit of joint working and sharing expertise. Partnership agreements are now in place in Bristol and Devon; Cornwall is well on the way to developing an agreement. Agreements have helped to raise awareness of the problems facing tenants with disabilities and have delivered an increase in association funding levels, clearer service pathways, and better procurement. Protocols take time to set up and to embed in practice and

SUMMARY

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at the end of this report is a toolkit which outlines an effective approach to setting up a sustainable agreement.

Local agreements can improve services for tenants considerably, but they can only go so far, particularly when many housing associations are part of much bigger regional and national organisations. It is unclear how some of the concerns about funding raised in this report can be addressed. External scrutiny through Audit Commission short-notice inspections has ended. The Homes and Communities Agency has taken over responsibility for the regulation of associations from the Tenant Services authority, but a lighter touch co-regulation approach is unlikely to encourage fundamental changes in the way adaptations are delivered. Furthermore, the emphasis is on new development and the role of housing in economic recovery. The needs of disabled tenants in the existing housing stock are unlikely to be high on the agenda.

There is a role for the Department of Health to put more money into adaptations and a reallocation of resources by The Department of Communities and Local Government might help to ease the burden on those local authorities whose budgets are currently over-stretched because of high demand from housing association tenants. In the meantime local agreements are the best way forward to deliver improved outcomes and more choice for people with disabilities and mobility problems.

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Local Partnerships Agreements:

Making homes work for disabled tenants

Home adaptations help people with disabilities and their carers manage more effectively in their homes. They include minor works such as grab rails through to stairlifts and shower rooms. Done well they improve mobility and safety and help people remain independent in their homes. As housing associations provide accommodation for an increasing proportion of disabled people they play an important role in providing adaptations. This case study looks at Home Adaptation Agreements developed in Devon and Bristol and one that is being set up in Cornwall. These have enabled closer working between housing associations and local authorities and helped to improve the delivery of home adaptations to tenants.

The work in Devon and Cornwall was funded by the South West Improvement and Efficiency Partnership (RIEP)1. The agreement in Bristol was financed by the Tenant Services Authority (TSA) as part of their Local Offers Programme2. The report also draws on a previous study looking at good practice in the delivery of protocols at a national level: ‘Housing Associations and Home Adaptations: Making it work smoothly’,3 other adaptation projects in the South West of England and work in the City of Westminster looking at the possibility setting up a protocol.

Partnership agreements are required for a number of reasons:

• To clarify who is responsible for funding minor and major works • To improve communication with tenants and between partners • To provide clear signposting and service pathways for tenants • To develop a standard approach so that all tenants get a similar service • To improve value for money by developing joint procurement contracts • To ensure that the right type of properties are adapted • To make sure that tenants are offered alternative options, including

rehousing, at an early stage • To ensure that choice based letting systems have useable information on

adaptations and accessibility

1 The REIP funded work in Cornwall was analysed by the Audit Commission in 2011 – we would like to thank Trish Nixon, Housing Advisor, for her input.

2 Tenant Services Authority (2010) Going local: Landlords and tenants working together to raise standards, London: TSA.

3 Heywood, F. and Mackintosh, S. (2008) Housing Associations and Home Adaptations: Making it work smoothly. A study of adaptation agreements between local authorities and housing associations, Habinteg: London.

1. INTRODUCTION

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• To have consistent allocation policies with sufficient flexibility to take account of the needs of disabled people

• To ensure that the development of new housing and the redevelopment of sheltered housing is based on better information about levels of demand from disabled people

Agreements can be complex to set up; in both Bristol and Devon there were more than 40 different housing associations and in Devon there was the added complexity of having eight district authorities, two unitary authorities and the county council within the partnership. Protocols tend to focus on associations with the most stock or which make most use of the DFG. It is not easy to get an agreement that suits everyone and compromise is inevitable. This report aims to look at the issues from all sides: from the local authority perspective, from the housing association side and most importantly from the perspective of service users – disabled people themselves, their families and carers.

Housing associations provide homes for a high proportion of people with disabilities. The sector has grown over the last 20 years and now accommodates over one in ten households - more than those in the Council sector4. It is estimated that 42% of social housing tenants are either disabled or have a long term illness compared to a rate of 17% across all tenures5.

People with disabilities are concentrated in social housing because disability and low income tend to go hand in hand. More children with disabilities are surviving infancy6 and they and their families are more likely to be in social housing; this is even more likely if a child is severely disabled7. Working age adults who are disabled have significantly lower incomes than those who are not, especially when the added costs of disability are taken into account8. The need for adaptations rises with age; 32% of household heads in social housing are aged over 75 compared to

4 Pawson, H. and Wilcox, S (2011) UK Housing Review 2010/2011, London: CIH. 5MORI/Housing Corporation (2001) cited in Habinteg (2007) Housing association guide to disability

equality schemes and actions plans. 6 National Statistics (2001-2011) Special Educational Needs in England, London: Department for

Education and Skills/Department for Children, Schools and Families. 7 Beresford, B. and Rhodes, D. (2008) Housing and disabled children, York: Joseph Rowntree

Foundation 8 Smith, et. al. University of Loughborough (2004) Disabled people’s costs of living:

More than you would think, York: Joseph Rowntree Foundation

2. CONCENTRATION OF NEED IN THE HOUSING ASSOCATION SECTOR

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only 25% in the population as a whole9. Numbers over 85 will double in the next twenty years and more than half of those households are likely to contain someone with a serious illness or disability10. Overall, 21% of people in social housing with a long term illness or disability in 2007/08 felt that their home did not meet their needs11. Children are the group least likely to be in suitable accommodation.

These trends have a significant impact on the need for adaptations and accessible housing. As a result, the provision of adaptations can no longer be seen as a peripheral activity for housing associations. It is becoming core function, a key customer service and an investment for the future.

There are many reasons why agreements are needed; often both the catalyst and the main sticking point is funding. To explain why this is such a problem it is necessary to step back and look briefly at the recent history of funding in the housing association sector and the effect this has had on local authorities.

Loss of direct subsidy

In 1991 housing associations managed only 3% of the housing stock and they received a direct subsidy for adaptations from the Housing Corporation as part of the Social Housing Grant (SHG). Tenants had a clear and simple pathway for getting assistance; it was their landlord’s responsibility not the local authority.

Through the 1990s the sector grew, there were mergers into bigger housing groups and a large number of properties were transferred from Council ownership. The earliest transfer associations had no funding for adaptations as this was provided through the SHG, however, later transfer associations had earmarked resources for adaptations as part of budgets for major refurbishment work. As a result many associations were felt to have sufficient resources to pay for adaptations themselves. The Housing Corporation was under pressure to make savings12 and the adaptations subsidy was cut from a peak of £29m in 1996 to less than a fifth of that a year later,

9 Dept of Communities and Local Government (2007) The Demand for Social Rented Housing, Housing Research Summary No. 236. 10 Hughes, N (2012) A Better Fit? Creating housing choices for an ageing population, London: Shelter 11 Dept of Communities and Local Government (2009) Housing in England 2007-08 12 Request under the Freedom of Information Act by Frances Heywood.

3. THE FUNDING PROBLEM

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declining further until 2007 when direct funding was finally withdrawn13. The assumption was that housing associations would fund work themselves, but instead associations and their tenants began to take up the mandatory right to Disabled Facilities Grant (DFG) administered by local authorities. This has had a considerable effect on how local authority adaptation budgets are allocated between the tenures.

The Disabled Facilities Grant (DFG)

The DFG was first introduced in legislation in 1989 to support low income owners and private sector tenants. As associations only managed a small portion of the stock and had their own direct funding it was unlikely that they, or their tenants, would ever use this grant. It could not have been predicted that they would grow to be such important players in the housing market or that their own direct funding would be withdrawn.

By 2007 the situation had changed and in recognition of the use of the DFG by housing associations the Housing Corporation transferred a one-off sum of £1.5m to the DFG. However, this was far short of the £29 million in subsidy per year in 1996 for significantly fewer tenants. Although central government funding for the DFG gradually rose over the period 1997-2007 the average increase was only £8,800 per year. This kept pace with inflation and rising demand, but not the major increase in housing association applications. In 2011 The Building Research Establishment estimated that the DFG pot only contained about 10% of the money required if all unmet need identified in the English House Condition Survey were to be addressed14.

Central government subsidy only accounts for a proportion of the resources local authorities put into the DFG; most provide a budget based on the need assessed by the Government and many add much more. However, increasing their contributions has become more difficult as authorities commonly supported the DFG by using another subsidy: Private Sector Housing Renewal funding (PSR) but this was cut from £300 million in 2010/11 to zero in 2011/12. Although there was an injection of £20 million from the Department of Health into the DFG in January 2012 there is no guarantee that this will be repeated and it did not replace the loss of the PSR. At the same time demographic changes and the increase in numbers of older people in all tenures needing help with adaptations are placing even more demands on DFG budgets in most parts of the country.

13 Heywood, F. and Mackintosh, S. (2008) Housing Associations and Home Adaptations: Making it work smoothly, London: Habinteg, p2. 14 CLG (2011), Disabled Facilities Grant allocation methodology and means test: Final report. DCLG

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Housing association use of the Disabled Facilities Grant

Figure 1 demonstrates the way in which housing associations have begun to use more of the DFG budget. In Bristol over the last nine years the proportion of completed DFGs provided to housing association tenants more than doubled from 9% to 22%. This diminished after the local agreement was set up. At the peak housing associations were using about a fifth of the DFG budget. However, this is less than in other areas because Bristol has retained its housing stock where adaptations are funded from the Housing Revenue Account (HRA) not the DFG.

Figure 1 Increased use of DFG by housing association tenants in Bristol

*Launch of local agreement April 2010

The impact of transfer and national associations

In other areas local authorities have had to cope with much higher proportions of DFG expenditure going to associations – particularly the early transfer associations. In Cornwall two of the three transfer associations had no budget for adaptations at the time of handover. In 2010/11 over 40% of the DFG budget was going to housing associations - in the west of Cornwall this reached 63%. Only one provider in Cornwall contributes to the cost of the DFG. Cornwall has set up a Common Operating Agreement in order to streamline internal processes and to try to reduce this imbalance.

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HA cases as %of all DFGcases

HA cases as %of DFG budget

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In Devon, housing association use of the DFG by district was much more variable ranging from 8% - 69% of cases, and 8% - 57% of the budget (shown in Figure 2). Three authorities had more than a third of their budgets going to housing associations. North Devon was the highest at 57% which mostly went to the association set up in 1998 to take on responsibility for the Council stock. Unsurprisingly, this district also had long DFG waiting lists with cases taking almost two years end to end. These findings demonstrate clearly why local authorities are keen to get agreement on the crucial issue of funding. If associations take a large proportion of the DFG budget authorities find it difficult to offer the speed of service they would like to people from any tenure.

Figure 2 Percentage of Devon authorities’ budgets going to housing associations 2010/11

*Additionally in Plymouth there were 36 HA tenants awaiting DFG at an estimated cost of £234,000 representing 25% of the budget alone

The pressure placed on DFG budgets by housing associations are repeated in other local authority areas in the South West, mainly as a result of demand from transfer association tenants. For example in Dorset 12% of the stock is managed by housing associations yet in two districts they use between 50% and 60% of the budget. In Bath & NE Somerset and in North Somerset the proportion of DFGs going to associations tenants is also over 50%. In other areas, such as Bristol and Plymouth, it is not the transfer associations, but some of the big national associations which are the principal users of the DFG.

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Although there are problems with DFG funding across the South West, not all areas of the country are affected in the same way. A few authorities, including some London Boroughs, reported that in 2012/13 applications for DFGs were down and that they can therefore afford to fund housing association cases. It is not clear why this is happening, but may be the result of a combination of circumstances: social care call centres being stricter about who they deem eligible for services or homeowners assuming that cut-backs mean that it is no use applying for a grant. As most authorities never actively advertise the DFG it is hard to say that they are really meeting all unmet need. Home owners and private tenants find it very difficult to find out about grants unless referred by a hospital, GP or their own OT. It would be useful to have a more comprehensive study to show the true picture nationally as there are clearly severe pressures in some areas.

It is also difficult to know exactly what associations spend on adaptations themselves as they are not obliged to submit any national returns. However, it would be a mistake to assume that they are not putting in any resources – quite the reverse. Most associations do a great deal of minor work themselves which is vital to improve tenant’s safety and independence in the home. They also include adaptations in major refurbishment work. One of the better resourced transfer associations, Plymouth Community Homes, had a budget of £3m to spend over five years on adaptations as part of the Decent Homes programme.

There are other examples of good practice in the delivery of adaptations, such as the Westward Housing Group in Devon which employs its own occupational therapist (OT) and includes a transfer association, Tarka HA, which has one of the largest budgets for adaptations per property in the South West and carries out most work without recourse to the DFG. One association in Bristol providing housing for older people also makes very little use of the DFG, instead operating a policy of upgrading properties when they become vacant to ensure the majority of its stock is suitable for people with disabilities. The National Housing Federation has produced a briefing paper outlining numerous other examples of good practice around the country15.

15 National Housing Federation (2012) Briefing Paper: Home Adaptations www.housing.org.uk/publications/find_a_publication/care_and_support/adaptations_briefing.aspx

4. HOUSING ASSOCIATION SPENDING ON ADAPTATIONS

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Spending on minor works

However, there are considerable variations in funding levels, even with minor works. In Cornwall two associations did no minor works at all, one funded up to £500, six funded up to £1,000 (although one of these needed an OT recommendation first) and only one did more than the £1,000 threshold. Before protocols were developed there were similarly large variations in the thresholds used by associations working in Devon and Bristol. The levels set for these thresholds are arbitrary and are not based on the needs of the tenant for a fast and effective service or even on the cost of the most common types of work. It also has a knock-on effect on local authority occupational therapy workloads as is discussed further below (see p 19).

Table 1 Housing associations and minor works in Cornwall

TYPE OF ASSOCIATION FUNDING CRITERIA - MINOR ADAPTATIONS

1 x Local 1 x National (specialising in older people)

No policy for minor works - encourage residents to approach Council for all adaptations

1 x Transfer association Up to £500

1 x Local

Up to £500 and between £500-£1000 where OT recommendation is provided

1 x Regional

2 x Transfer associations

2 x Nationals

Up to £1000

1 x Regional Up to £1500

Spend per property

Budgets for all types of adaptations (both minor and major works) vary considerably, as can be seen in Figure 3. There seems to be no consistency relative to the size or type of the association. A few have really high levels of expenditure. A recent transfer organisation had the highest budget of all: £143 per property. This organisation was approaching the end of the initial agreement period, but was planning to maintain the budget going forward because of levels of need. However, an early transfer association was at the other end of the scale with only £24 per

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property, despite equally high levels of need. Of all the associations which were major stock holders in Bristol and Devon half had budgets of under £30 per property and only three had funding comparable to or exceeding the budget for the Bristol or Exeter Council stock at £90k and £89k per property respectively. Of the 16 associations shown in Figure 3 ten had less than half the level of council funding. Two national associations fell into this group of lower spenders.

It might be expected that budgets would be higher in London, but the opposite was the case. In Westminster five of the nine associations with the greatest stock had budgets of under £11 per property in 2010/11, three had around £30 and only one had just over £60. In comparison the transfer association, City West Homes, had a budget of £1m equating to £83 per tenancy.

Figure 3 Spend per property 2011/12 - Bristol and Devon

Note: In Bristol budget levels shown are after the agreement came into place – levels were lower previously (see Fig 5 below).

Spend per property is a relatively crude measure and may under-estimate some associations commitment to adaptations. A few find it hard to determine what they actually spend as budgets are not identified separately; it is often just part of repairs and maintenance expenditure. Other associations upgrade properties during major improvements or when certain types of property suitable for disabled people, such as sheltered housing, become vacant and they do not necessarily record this separately. Figure 3 tried to take account of all types of adaptation expenditure.

0 20 40 60 80 100 120 140 160

Local

Regional

Transfer

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Council stock

Spend per property £

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Prior to the setting up of adaptation agreements few local or regional associations contributed to DFG costs. However, some national associations have standard agreements that they have applied across the country. From the perspective of the nationals themselves it is clear that it is very hard to comply with different funding models in different areas. As a result some simply offer a standard percentage of funding which varies from 20% to 50% of the costs of major works. This usually works well and most local authorities are happy to accept this level of funding. However, others nationals have proved difficult to bring into protocols as they are reluctant to contribute to costs. One specialist association has refused to contribute to DFG costs in any local authority area; however, it already has high levels of adaptation expenditure. However, others clearly have low budgets in relation to stock levels and even when they sign up to protocols, some are unable to comply. Other national organisations are inconsistent, having funding agreements in certain areas, but refusing to join them in other parts of the country which results in a post code lottery for their tenants. A worrying trend is that local associations with very good adaptation policies and high levels of funding often find their budgets and policies are watered down when they join national or regional groups.

It is clear that some associations make far more use of the DFG than others and, of those that use the DFG, some pay towards the costs and others do not. From interviews with numerous associations and local authorities it is clear that there were differing views about whether associations should fund more themselves or contribute to DFG costs (Table 2).

Table 2 Should housing associations pay for adaptations themselves and/or contribute to DFG costs?

YES NO HAs have high proportion of disabled tenants - adaptations are a core function and should be funded accordingly

Responsibility rests with social services and there is a legal entitlement to use the mandatory DFG

Other legislation also affects HAs including: Health and Safety, Equalities Act, Human Rights Act, Age Discrimination Act and Corporate Responsibility legislation.

Ombudsman cases support the view that local authorities are responsible for major adaptations

There is not enough in the DFG pot in most areas and it is hard to increase resource levels. Some HAs are taking more than their

Authorities should make sure there is enough funding to meet demand

5. SHOULD HOUSING ASSOCATIONS PAY FOR ADAPTATIONS?

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fair share, others are using it in a way that is difficult for LAs to manage e.g. no consistent minor works threshold Issues of fairness/equality – between different HAs, between HA tenants and other DFG users, between council tenants and HAs

Insufficient reserves/recycled capital grant, funding pressures/uncertainty, difficulties raising finance, static rental income, loss of SP funding, impact of welfare reforms etc.

By providing funding HAs will be more involved in what is done to their stock, have better asset management and ensure VFM

The poorest in society should not have to support the most vulnerable through rents

Need for one stop shop and quick service. Tenants prefer to deal with their landlord not negotiate complex LA service pathways

Tenants pay for adaptations twice – through council tax and rent

Involvement in funding would lead to more joined up thinking on alternatives to adaptations e.g. rehousing, downsizing, use of sheltered housing, development of new accessible homes, matching people to properties etc.

National and regional associations cannot manage different policies in different areas

It is clear that housing associations have considerable funding pressures and that uncertainties about the economy, difficulties in raising finance, cuts in Supporting People funding and the potential impact of the Welfare Reform Act on levels of arrears prevent some committing themselves to improving adaptation budgets. However, most have now come to the end of their decent homes programme and lack of development investment over recent years means that some have significant surpluses.

Although the ultimate legal responsibility rests with the local authority, the argument in favour of more adaptation funding coming from housing associations seems very strong. Given the high and growing proportion of disabled tenants in the sector adaptations are becoming a core function and should be funded accordingly. There is simply not enough in the DFG pot to provide for current levels of demand from association tenants in most areas as they were never expected to use this funding route. It is very difficult for local authorities to increase funding levels given the recent cutbacks in expenditure. Failure of associations to contribute to the DFG means lengthening queues for all users. It also leads to a number of other problems.

Equality issues

There are key issues about equality:

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• Housing associations have numerous legal obligations to provide equal levels of service delivery and to ensure the safety of all their tenants, including those who are older and disabled. Tenants of national or regional associations are subject to a post code lottery if their landlord neither has an adequate adaptation budget nor contributes to DFG costs. If they are lucky tenants will be in a local authority area where waiting times are short, but in other areas they may be subject to long delays.

• There are also equality issues between different associations within each local authority area. At present neighbouring tenants with different landlords can get very variable levels of service according to how the adaptations process is funded and delivered.

• There are also equality issues with Council tenants who do not use the DFG. • Finally, there are conflicts with the needs of low income owner occupiers and

private tenants. The added demand from housing associations results in long queues so local authorities never advertise the DFG. Many people who might have benefitted never find out about them and those that do apply end up waiting much longer than they should. In some areas this is particularly acute where one or two associations are taking far more than their fair share of the DFG budget.

It’s not ‘just a maintenance thing’

The debate is not just about funding per se. It is also about how the divorce from responsibility for funding alters the mind-set of organisations. If the duty for funding and managing adaptation work is seen to rest with the local authority the subject will simply disappear from housing association agendas. It may be discussed in terms of new development and wheelchair accessible homes, but the needs of disabled tenants in the existing stock will not be fully considered. Adaptations become ‘just a maintenance thing’. There is no analysis of unmet demand, no separate budget and no understanding of the long waits some tenant’s experience. This has knock-on effects within organisations as adaptations become in effect a hidden service. All the following issues were found in the research for this report:

• Reception staff do not know where to direct disabled people • Websites have no mention of adaptations or the topic is hidden many clicks

away from the home page under repairs • Housing officers and maintenance staff often receive little training about

disability and adaptation issues • Disabled people and their carers are under-represented on boards and

tenants advisory panels

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• Asset management issues are not always addressed – is the right stock being adapted, could better designs be used, could maintenance costs be reduced, do voids inspections record adaptations correctly, could there be better matching of tenants to new properties being developed?

• Adaptations are not adequately recorded on property databases making it hard for disabled tenants to find suitable homes

• Procurement and value for money is not considered when an organisation does not foot the bill.

Tenants themselves seldom complain. They simply struggle on as they do not have sufficient knowledge of the system to be able to question their association about levels of service delivery.

Complexity of the customer journey

For associations that fund all adaptation work themselves the customer journey is simple and the tenant has one point of contact. This is how it was for all tenants when associations had direct subsidy. When tenants have to apply for a DFG the route to get an adaptation can be complex and slow. Local authorities have to accept the blame for some of these problems. Many have disjointed systems split between several departments. Most of the authorities in the South West studied as part of this work have started to make changes to make services quicker and simpler for all users. However, disabled tenants still find it very confusing to have to turn to the council for help rather than their own landlord and may find themselves unwittingly caught in arguments about who should fund the work.

TENANTS CAUGHT IN THE MIDDLE • “The housing association said they can’t do the work as it’s not in their budget,

so it’s been passed to the council”. • “The OT wrote to the housing association, but they said they had no money.

We’ve been waiting 9 months since then.” • “I’ve seen so many people - I don’t know where they were all from. First it was

the housing association – now it’s the council that’s involved”. • “I got in touch with the housing association and they told me to go to the council

– it’s got me confused”. • “I don’t know who to call. I’m just trying to struggle on”. Bristol resident’s survey 2010 prior to introduction of the local standard

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Without a partnership agreement the first a housing association may know about an adaptation case is when they receive a request for landlord’s consent for work – often many months after the tenant first applied for help (see Fig 4). Getting that consent can result in more delays, especially if there is no named contact in the association, or if approval can only be given by a head office in the case of national or regional associations.

Agreements have to provide effective pathways for tenants needing adaptations and make sure housing associations are involved at an earlier point. The Bristol and Devon agreements ensured that there were named individuals and one contact number for adaptation enquiries in each organisation. Devon has produced a professional leaflet that all associations can badge and use as their own. This is not just useful for tenants; it also makes sure that staff understand the process. However, this would all be unnecessary if housing associations took full responsibility for funding.

Figure 4 The complexity of the route for tenants

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The need for consistency in minor works

Inconsistencies with minor works are particularly hard for local authorities to deal with. OTs are often approached directly by tenants and they do not know which cases to refer to the landlord. They would prefer all associations to fund up to the same level: at least £1,000, ideally £2,500. Most agreements therefore include clauses about minor works thresholds and encourage associations to fast-track these cases in the same way as a straightforward repair. It is safe to assume that people do not ask for minor adaptations, such as lever taps or grab rails, unless they really need them.

There are numerous examples of maintenance and repair staff referring relatively small jobs to OTs for assessment because of concerns about specifying work incorrectly. This adds to OT waiting lists and creates unnecessary delays in getting work done. A report by the College of Occupational Therapists ‘Minor Adaptations without Delay’16 identifies the types of work that can be readily carried out without OT involvement. It includes a technical appendix which provides detailed guidance for fitting handrails and other minor adaptations.

Referral to the OT service for assessment and specification of minor adaptations not only represents a waste of OT resources it also means tenants have a much longer wait and have an increased risk of a fall or other accident. Targets for standard repairs and maintenance tasks, usually around 28 days, should also apply to minor adaptations to protect vulnerable tenants. If housing associations do not already have these standards they should be included in agreements.

The agreements in Devon and Bristol included ‘Trusted Technician’ training for association staff based on ’Minor Adaptations without Delay’. The training was well received, helped staff feel more confident and reduced the demand on OTs. An alternative approach if housing association staff do not have the skills or capacity to do minor adaptation work in-house is to contract the work out to a Home Improvement Agency or suitable contractors skilled in dealing with disabled people.

The impact of Ombudsman judgements

A further argument from associations about funding is that they have no legal responsibility; this rests with the local authority, and has been reinforced by Local Government Ombudsman decisions. The most frequently quoted ombudsman judgement is a 2011 case from Liverpool where a housing association had made a tenant wait for an adaptation as his property was in a major improvement scheme.

16 Heywood, F. et. al. (2006) Minor adaptations without delay: A practical guide and technical

specifications for housing associations, London: College of Occupational Therapists.

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Although the housing association was a signatory to a local protocol the judgement given was that the local authority should have ensured that the work was carried out within a reasonable time as it has the ultimate legal responsibility under the Chronically Sick and Disabled Persons Act 1970 which requires social service authorities to arrange assistance17.

However the judgement ends by saying “Where the local authority believes that RSLs should make a contribution to the costs of adaptations in their own properties this should be negotiated and established through formal agreement. Whilst there is no specific obligation on the RSL to fund such work … it may be considered good practice for a responsible social landlord to respond to the needs of their disabled tenants.” (Author’s italics)

Changes in regulation

Until relatively recently there was an important player over-seeing adaptations policies and processes at a national level. This was the Audit Commission. The quality of housing association adaptation services began to improve considerably from the mid-2000s onwards as a result of their short-notice inspections. These put a clear emphasis on associations consulting and communicating with their older and disabled tenants, having sufficient data on their needs, setting a realistic budget, having a fast-track minor works service, and developing agreements with the local authority. The loss of this external scrutiny after the Comprehensive Spending Review in the autumn of 2010 has been detrimental to further improvements in service delivery.

Until 2010 regulation of associations was the responsibility of the Tenant Services Authority and tenants were to have a say in shaping national policy through the National Tenant Voice. Responsibility now rests solely with the Homes and Communities Agency. A co-regulation approach has been introduced which is supposed to involve more tenant scrutiny. However, as has already been discussed, if adaptations are not seen as a core service, if issues about budget levels and service delivery are not on agendas and if there are insufficient disabled people on boards or involved in scrutiny panels it is unlikely that any significant changes will occur. The focus of the HCA has always been on development which has increased in importance as new housing is now seen as a key factor in economic recovery. In these circumstances it is hard for the voices of disabled tenants in the existing housing stock to be heard.

17 Local Government Ombudsman (4th April 2011) Report on an investigation into complaint no 10 008 979 about Liverpool City Council

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The emphasis on ‘Localism’ means that central government departments such as the Department of Communities and Local Government have drawn back from issuing national guidance. The only way forward is to set up more local agreements. However, there has to be a role for central government in talking to national and transfer associations that have low budgets and that are currently not contributing to DFG expenditure to see if a way can be found to sort out some of these funding anomalies. An increase in funding from health would also boost the amount of resources available to local authorities, but this needs to be allocated more systematically. An ad hoc injection of resources at the end of a financial year is not easy for local authorities to spend as building work has to be planned too far in advance.

What might be an appropriate budget?

Assuming that many housing associations should either be doing more adaptation work themselves or contributing to DFG expenditure; what is an appropriate budget? It is useful to look at the ratio in the Council stock where adaptations are funded from the Housing Revenue Account. In both the examples of Council stock budgets in Figure 3 above they are around £90 per property - more than three times the level of half of the associations shown in the same diagram. A Building Research Establishment study commissioned by Department of Communities and Local Government to inform the level of Major Repairs Allowance for Council landlords recommended an average of £60 per property for adaptations and showed that transfer associations required an average of £75 per property in order to deal with current need and any backlog18. This is significantly higher than the budgets for a large proportion of the associations operating in the South West.

However, many associations will baulk at the thought of increasing expenditure to these levels, especially at a time of economic austerity. Budget levels will also depend on the nature of the stock and the characteristics of tenants. An association with mostly newer stock may need much less than one with a lot of difficult to adapt, older or acquired properties and many older and disabled residents. Effective procurement can also lower costs. At the moment budget setting is often rather ad hoc; either last year’s budget with an increase for inflation, or a small proportion of the repair and maintenance budget. Budgets could instead be based on better data about tenants and stock; information that is collected but not always analysed.

From interviews as part of this work it is clear that most maintenance staff responsible for adaptations play little part in the budget setting process and it is not

18 BRE (2009) Review of the Major Repairs Allowance, Appendix B. www.communities.gov.uk/documents/housing/pdf/1290222.pdf

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until the attention of senior staff is drawn to the problems facing disabled tenants that budgets rise. In Bristol the CEOs of the associations with the most stock in the city were on the steering group. They saw first-hand the results of a telephone survey of their tenants who were on waiting lists for DFGs. A recent article in Inside Housing quotes one of those CEOs “we had tenants living in properties where they hadn’t been able to wash [properly] for a year.”19 This CEO also said very clearly that “small associations have the same duty to their tenants as larger ones and they should have budgets in line with their stock and the needs of their tenants”.

As a result of this increased awareness of the problems their tenants were facing the budgets of many of the local and regional associations increased significantly in 2010/11 as is shown in Figure 5. It caused a considerable fall in housing association use of the DFG budget (see Figure 1, Section 3 above). The budgets for two associations have dipped slightly since, but they have remained substantially higher than before the protocol was introduced.

However, despite signing the agreement, there has been little change in the budget of the national association making most use of the DFG in Bristol and early in 2012/13 another national association said it had run out of funding showing how difficult it is for local agreements to influence the policies of national organisations. Budgets also increased in Devon, but the protocol is at an earlier stage and longer term trends are not yet evident.

Figure 5 Changes in budget levels per property Bristol 2009-12

Note: Launch of local agreement - April 2010

19 Inside Housing (Jan 2012) Trapped in their own homes, Repairs and Maintenance Supplement, pp4-8.

0

50

100

150

200

250

LA National Reg 1 Reg 2 Local 1 Local 2 Local 3 Local 4

Bud

get

£000

s

2009/10

2010/11

2011/12

Budget per property

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Developing adaptations as a core service

The case study of Knightstone Housing Association below shows that budgets do not have to be excessive to deliver an enhanced service to tenants and that not all housing associations need to reach the budget to stock ratios of local authorities. The important factors are:

• Involve tenants in planning services • Develop a detailed knowledge of resident’s needs • Work with the relevant local authorities • Promote the new adaptation service • Have resources in place to cope with an initial surge in demand • Have a continuing policy of monitoring and review

DEVELOPING ADAPTATIONS AS A CORE SERVICE

Knightstone Housing Association operates over a number of local authority areas in the South West of England. As a result of survey work about four years ago they realised that a large number of residents had disabilities. A Disability and Equality Group was established which has since driven service changes. As a consequence the adaptation budget increased from £60,000 for 8,400 eligible properties (a ratio of £5 per property) to £330,000 (a ratio of £39 per property). They now fund and deliver works up to £3,500 which includes installing showers. They have trained their staff to be able to react speedily to requests for assistance. Above this level they ask residents to apply for a DFG, but they have several local agreements where they contribute up to 50% of DFG costs and they work closely with local authorities to ensure residents get a good service.

Improved publicity and awareness following the launch of the new service led to a 300% increase in demand. Demand has since stabilised at 470 jobs per annum. Interestingly the demand is not mainly from older people as might be expected. Fully 40% of users are under 55 years of age. Knightstone is quite a typical regional housing association – their profile is probably replicated in many others across the country.

Knightstone continues to monitor the progress of their policy. A recent survey has shown that getting advice is now felt to be easy. Satisfaction with the service is consistently high and over 80% felt that the work had improved their health and well- being. Over three quarters of respondents think they are now more likely to stay in their own home.

What are the advantages to the housing association?

The Knightstone business plan states that their purpose ‘is to give customers a great service’. The new adaptations policy was based on a thorough knowledge of their resident group and it is now seen as a core service and an investment for the future. They continue to monitor progress and can demonstrate clear benefits to their tenants.

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Although funding is a vital part of any agreement there are also a range of other issues that protocols need to address:

Use of data and intelligence sharing

Housing associations collect a large amount of information through Status/Star surveys and tenant profiling exercises, including information on disability, age of tenants and the need for adaptations. Information on adaptations and accessibility is also collected by survey and inspection teams. As already discussed this could be better analysed and used for budget setting. It would also enable better planning for adaptations in the existing stock, in major refurbishment projects, new build developments, and sheltered housing schemes. Sharing this information between organisations in partnerships would enable better planning for accessible homes in the local area. If improved information were put into choice based lettings adverts it would also help people wanting to move and the OTs or HIA staff assisting them bid for suitable properties.

Website information

Surveys of housing association websites in Bristol and Devon showed that prominence is often given to equalities policies, but any information about practical housing help for disabled people is either non-existent or hidden. Even typing ‘adaptations’, ‘grab rails’ or ‘showers’ (typical search terms) into the search box often gives no useful material on some sites. When information is found the only telephone number is often the local authority OT service. More housing associations should hold workshops to see how disabled people use their IT systems to make sure the right information is not only recorded, but is used in a way that is helpful.

Communication

Good communication with tenants is essential. These are people who are struggling with daily tasks and are often ill or depressed. In the first instance they need to know who to turn to. They then need to be kept informed. People will accept reasonable delays, but the feeling that no-one is ultimately accountable for their case causes a great deal of distress. It is important that housing associations take responsibility for on-going communication with their tenants.

6. IT’S NOT JUST ABOUT FUNDING

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LACK OF COMMUNICATION • “We need approximate times, reassurance that things will get done.” • “You get very despairing when nothing happens and you don’t know when it is going

to happen.” • “If someone could just drop me a line, or ring me to show they haven’t forgotten me

- I haven’t heard anything for 12 months, probably more.” • “If they could say ‘we’ll get it done by next November’ then you have something to

aim at. But this way I just don’t know.” • “Unless I ring them no-one keeps in touch with me. There is not enough

communication.” Bristol residents survey 2010 prior to introduction of the local standard

Agreements also focus on improving communication between partner organisations through having named contacts and regular management meetings. In several authorities associations are encouraged to make the DFG application on behalf of their tenant to ensure the association has close involvement in the case right from the start.

Use of independent OTs

Most minor works can be done without an OT (see Section 5 above) but sometimes a second opinion is important, for example if someone has a degenerating condition. Usually local authority OTs will be happy to help, but in some area there is a long wait. Housing associations need to be aware of waiting times and have access to an independent OT who can be called on to provide a quicker response. A few of the larger associations have their own in-house OT and there is potential for others to buy into these services on an ad-hoc basis.

Local authority OTs should be involved in major works, but again if there are long delays outside help could be brought in, provided they use the same criteria as local authority OTs if it is a DFG case. There were clauses in both the Bristol and Devon agreements about the use of independent OTs if tenants were waiting too long.

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Training

Mention has already been made of ‘Trusted Technician’ training for maintenance staff and contractors (see Section 5 above). However, reception staff and housing officers also need to be aware of disability issues, know what the adaptations policy is and where in the organisation to refer people. Mystery shopping in Bristol revealed that even when a protocol is in place some reception staff still direct people with queries about minor works to the local authority OTs instead of to their own maintenance service.

Procurement

Procurement is a key issue and is becoming more important as local authority and housing association funding becomes tighter. Many housing associations are already part of procurement consortia for repairs and maintenance. These can be extended to procure commonly required adaptations to ensure that everyone gets good value for money. Sharing of intelligence could enable much better services to be delivered to tenants.

Many housing associations and local authorities still seek several quotes for each job. It is rare that such a requirement does not create delays in getting work done and some organisations and procurement consortia have framework contracts which have improved speed, quality and price - these could be shared more widely with partner organisations. There is also the possibility of negotiating extended warranties for equipment in procurement contracts. Partners in Devon and Dorset have already achieved economic efficiencies through procurement of stairlifts and further work is in progress to improve value for money from shower adaptations.

Recycling of equipment, such as stairlifts has also been successful in many areas. This is an important issue to include in agreements to reduce waste and cost.

Improving asset management

Numerous examples of inappropriate dwellings being adapted have been identified through the protocol projects, many of which have to be removed when a tenancy ends. Dwellings that may not be suitable for adaptation, such as upper floor flats with no lifts, need to be identified to prevent this happening in future. Similarly, properties that would be good to adapt need to be earmarked. Wherever possible sheltered schemes needing refurbishment need to made be fully accessible before a disabled person moves in, not afterwards.

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Housing associations also have a key role to play in improving the design of adaptations – deciding not just what works well for their stock, but sharing expertise with other organisations for the benefit of all disabled people. This also feeds into procurement decisions and could improve value for money. It may also reduce on-going maintenance expenditure.

Housing options advice and allocations

Providing housing options advice for tenants and helping them move to already adapted or more accessible properties was seldom mentioned in early adaptation agreements, but it is becomingly more important. There is now a large amount of accessible property which could be used more effectively. Many older and disabled residents want to stay put, but a proportion are quite prepared to move – they just need more help than other tenants.

A recent survey of customers of adaptation services in Dorset identified that 22% would have been prepared to consider moving. A Rowntree study estimated that, of families with disabled children, half would rather move than have their current home adapted20. In Dorset, where a ‘Housing Options for Older People Service’ is operated by the home improvement agency to provide support throughout a move and for six months afterwards, around 25% of people introduced to the service opted to move.

The recent establishment of a new OT post within the Accessible Homes team in Bristol to facilitate move-on of disabled residents requiring adaptations has had immediate success. Prior to the initiative during 2010/11 only two people needing major adaptations were helped to move. In the first six months of the new service 20 households had been supported to move.

Downsizing incentives and more imaginative use of the DFG could enable some resources to be directed to helping people with the costs of moving home. Where the alternative would be a very expensive adaptation moving can be considerably cheaper and provide a much better long term solution for the disabled person and their carers.

Consideration also needs to be given to the accessibility of the local environment and the proximity of shops, surgeries, hospitals and other amenities a disabled person might need. This joined up thinking about accessibility in its broadest sense is now being incorporated in agreements, such as the one in Devon.

20 Beresford, B. and Rhodes, D. (2008) Housing and disabled children, York: Joseph Rowntree Foundation.

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Engagement of residents in the Devon protocol provided helpful feedback about the Devon Home Choice system and how it could be improved to assist disabled people in identifying and bidding for suitable properties. Choice based lettings systems often do not give enough information for disabled residents to make decisions and the limited time allowed in bid cycles may prevent them from viewing and bidding for properties. Partnership agreements need to include clauses about whether practical and financial support will be provided to help people move and allocation systems adjusted to take account of the needs of disabled residents. There may be a need for more training for inspection and allocation teams and the improvement of information on property databases.

The needs of partners

Each of the partners in any protocol has a different agenda. The key thing is to focus on the needs of the tenants and write the protocol from their point of view. They want a clear route with one point of contact so they can be kept informed of progress. They also need a quick service – many people do not ask for help until they reach crisis point when they need help fast. Most requests relate to bathing issues so this should be a key target for action in partnership agreements.

Table 3 The needs of partners

RESIDENTS

HOUSING ASSOCIATIONS

LOCAL AUTHORITIES

One point of contact See a benefit from the agreement Control expenditure

Quick decisions Increase tenant satisfaction Bring in resources

Rapid service Reduce risk Speed up delivery

Be kept informed Value for money Better communication

Results: Able to wash, be safe, be independent, have dignity

Control work done/make better use of stock

Equitable service

7. SETTING UP AN AGREEMENT

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Models of agreement

Agreements usually focus on associations which have the largest amount of stock in an area and/or which make greatest use of the DFG. However, there are often tensions between different objectives. The aim should be to:

• Help organisations whose adaptation services are less well developed to rise to the standard of the top performers

• Develop processes that are right for that particular area and its local associations but not exclude those that are regional or national

• Give tenants an improved service while at the same time trying to achieve better value for money for local authorities and housing associations.

• Ensure that when work is entrusted to a housing association that the local authority receives information about the progress of the case as they have responsibility to ensure a tenant gets help within a reasonable time frame.

Not all of these issues are easy to resolve and protocols in different areas tend to vary as a result. There are five different models of agreement operating across the country as is shown in Table 4.

Table 4 Different funding models

MODEL DETAIL

1. HA pays up to a threshold

e.g. Up to £1,000 or £2,500 Anything above referred for DFG

2. Two tier approach HA pays 100% up to a threshold and shares costs above the threshold e.g. 50% over £1,000

3. Type of work e.g. HA does all level access showers without recourse to DFG

4. HA pays 100% No limit - or cap on budget and once budget committed referred for DFG

5. Variable rates Each housing association negotiates its own rate

The most common type of agreement is the first model where an association simply does minor works and all other cases are passed to the local authority for a DFG. However, as was discussed Section 5 above, a protocol is essential to make sure that everyone is working to the same minor works threshold.

For tenants the optimal model is No. 4 where the housing association does all adaptation work themselves, particularly where they use their own OT, as this is straightforward, likely to result in a faster service and can enable them to relocate to

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another property in the same area if this is a better solution. At present this is most likely to be the model used by the later transfer associations, although there are other associations with excellent policies which are also using this approach. However, it is recognised that smaller associations and some regional and national associations with a limited local workforce may prefer to use local authorities to carry out the adaptations even if the association pays for the work.

In other areas local authorities have approached each association in turn and asked what they will be willing to contribute (Model No. 5). This enables them to get additional resources put into adaptations locally, but it does not always resolve other aspects of service delivery such as improving communication, reviewing procurement or having a better housing options service.

In Bristol and Devon the local situation resulted in different models of agreement that gave the best fit with local circumstances. Bristol has a two tier system (No. 2) and Devon an approach based on the type of work (No. 3). Cornwall is still in the process of setting up an agreement and the issues to be addressed are outlined below. The agreements that are in place have not only increased the level of resources going into adaptations but have also improved service delivery for tenants and resulted in much better on-going communication between the partner organisations. The benefits of each protocol are discussed in more detail below.

THE BRISTOL HOME ADAPTATIONS LOCAL STANDARD

Bristol is a unitary authority with over 40 housing associations. The agreement covers 12 of the associations with the most stock and was launched in April 2010. It was kept short and simple and was written from a resident viewpoint. It was divided into two sections – one for the housing associations and one for the local authority which covered the following areas:

Housing associations • Improving communication with tenants – single point of contact, leaflet/website, housing

officers to be ‘adaptation advocates’ • Improving communication with partners – one named person in HA to be contact point • Improving the speed and quality of the service – fast tracking minor works • Target standard for minor and less complex work (up to £2,500 done by HA) • Using the Disabled Facilities Grant (50% contribution for work costing £2,500- £10,000) • Use of OTs, use of independent OTs and Trusted Technician training • Landlords consent for work – simpler system • Maintenance of equipment / recycling – HAs to take this over • Decent homes / major improvements – make sure adaptation needs taken into account • Contractors – share intelligence, HAs able to use framework agreement • Moving options – record information more consistently on property databases and HCB • Measuring results – regular monitoring returns

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Local authorities • Improving communication with partners – one named point of contact • Improving speed of service – fast tracking HA DFG cases to clear waiting list • Measuring results - reporting back progress of DFG cases, annual report There was an emphasis on communication to enable tenants to be kept informed throughout the process. There is now one point of contact in each housing association and one OT and one surveyor in the local authority dealing with all housing association cases. Cases can be discussed and issues resolved at an early stage and all parties have an understanding of any financial or other pressures each might be experiencing.

The threshold for minor works done by the associations themselves had historically been either £500 or £1,000. The protocol raised this to £2,500. This was based on analysis of previous housing association DFG cases which showed that there were very few cases each year between £1,000 and 2,500 and that most were straightforward and could be handled relatively easily by the housing associations themselves.

Cases over £2,500 are passed to the Council for a DFG, but the costs are shared 50:50 up to a further threshold of £10,000. Over this amount the cost is funded by the local authority - housing associations are only required to pay a maximum of £5,000. In practice the funding for more expensive cases is negotiated and housing association contributions may be higher in some cases if it helps the case to proceed faster. The agreement has resulted in far fewer minor works cases being referred to OTs and a fall in the number of DFG cases.

The local authority also made changes. Its service was slow and fragmented and the housing associations wanted to see an improvement in the speed of service. A decision was made to clear waiting lists of all association cases. Some schemes were progressed by the housing associations themselves, but the majority received a grant. This meant that in the first year after the launch of the protocol DFGs for housing associations did not fall as much as expected, but going forward there should be reduced demand. This first ‘pilot’ year also gave time for associations to take the agreement to their boards and get an increase in adaptation budgets.

The Council subsequently remodelled its service to ensure rapid delivery of adaptations for people in all tenures. It has set up an integrated adaptations service called ‘Accessible Homes’ with OTs, caseworkers, surveyors and rehousing staff located in the same team with a single manager. Housing association adaptations requiring a DFG now take 6 months end to end compared to 17 months prior to the review. It is also easier to help someone move home as there is a designated Housing OT.

A total of 12 of the 15 associations making greatest use of the DFG are signed up to the agreement and one further association is partly signed up. The latter is a national association which is contributing a small amount of funding per case. Their written policy on adaptations is good but their budget is insufficient to support it: £20 per tenancy, only enough to cover minor works. Unfortunately they are one the biggest users of the DFG in Bristol, but local staff have little influence to alter policy at national level and no further resources are as yet forthcoming. A further national association has only partly complied

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with the protocol in 2012/13 citing lack of resources to make their contribution. Another specialist national association is not part of the protocol having refused to fund adaptations in any local authority area.

In Bristol there was concern that housing associations with well-developed policies and generous funding regimes would lower their standards. So far this has not happened. Those with good adaptation policies usually have a thorough knowledge of their tenants and stock and have disabled people on their boards – they are therefore unlikely to lower their standards as a result of an agreement. However, having them as partners on steering groups and management boards helps raise the standards of the others.

Obtaining landlords consent for work used to cause delays – in practice this has mainly affected tenants of national associations where local staff are unable to make decisions without head office approval. There is only one association where this is a lengthy process.

It was intended that the Bristol agreement would involve some joint procurement – instead many associations opted to use the existing local authority framework contract as this already included experienced contractors able to deliver a high quality service at a reasonable price. The agreement also covered arrangements for housing associations to take on the maintenance of stairlifts, for equipment to be recycled if possible and for adaptations to be included in major refurbishment works provided that this would not cause unreasonable delay.

An Operational Management Team was set up to ensure the agreement was fully implemented. This group originally met monthly, but this reduced to quarterly after the second year. One of the housing associations has taken the lead in running this group and collecting the quarterly performance monitoring data. The local authority provides data about current DFG cases on a monthly basis to all individual housing associations and completes an annual summary report. In practice it has proved very difficult to get monitoring data from housing associations on performance indicators such as time taken to complete work. Maintenance staff dealing with adaptations do not have the time to do data analysis, and their IT systems do not always identify adaption work separately from repair and maintenance activity.

It is testament to the strength of the partnership that the management group is still well attended and valued by the various organisations involved. After an initial reluctance to share information with competitors a considerable amount of trust has developed and people are willing to discuss their experience and intelligence.

A resident’s scrutiny group has been established which is reviewing monitoring data and looking at the home choice system. They have also carried out mystery shopping. This revealed that some associations have excellent front-line services but also showed that other reception staff are still referring minor works cases to the local authority OTs. It demonstrates the need for on-going training to ensure that all staff know about the protocol.

The benefits of the local standard to housing associations

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• Early knowledge of tenants needing help • Improved decision making about the best solution for tenants • Up to date information about the pipeline of cases and expenditure • Quicker turnaround of DFG funded adaptations • Improved tenant satisfaction • Ability to use the local authority framework contract • Increased staff expertise through Trusted Technician training • Staff able to share ideas and gain support through the Management Group This was summed up by a member of the Operations Management Team who said, “Everyone thought it had been a really good project; good outcomes for tenants as well as staff due to better communication with Bristol City Council and OTs.”

The benefits to the local authority

• Increased housing association budgets • Association contributions reducing waiting lists for people in all tenures • Reduced demands on Council staff • Better communication and closer working relationships • An effective management group able to tackle new issues • Access to feedback from the Resident Scrutiny Group • Raised awareness in the region that housing associations will be expected to contribute

to funding

THE DEVON ‘HOMES WITHOUT BARRIERS’ PROTOCOL

The protocol was launched in March 2011. Signatories included 13 housing associations, 9 of the 10 local housing authorities, Devon County Council, and the social care services within Torbay Care Trust and Plymouth City Council. To keep the protocol simple it was based on type of work rather than a financial contribution. It was agreed that associations would complete straightforward work themselves – showers, straight stairlifts and small ramps. It makes the process much easier for tenants if they can go to their association for all but the most complex work. Trusted Technician training for housing association staff was provided to give them the confidence they needed to take direct responsibility for minor and straightforward adaptations. Assistance with assessments is still available from County Council OTs, although two associations already share an in-house OT. All schemes of a more complex nature are funded through the DFG as before. The Homes without Barriers protocol lays out what a tenant can expect from both their landlord and the local authority. Headings reflect what tenants told partners they wanted from a protocol: • That the help available and who to contact is well advertised • Minor adaptations (e.g. grab and stair rails, lever taps and other small works) are carried

out quickly • Information and help is available to move home if this is the best solution

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• Good information about purpose built, adapted and adaptable homes is available • That there is enough time to view and consider homes available • To have a say in occupational therapy assessments which are carried out quickly where

needed • Major adaptations to be planned well and completed quickly • Adaptations to be maintained by the landlord after the work is complete • Tenants to have regular contact with a named contact person to hear about progress • More tenants to be able to benefit from the service (through recycling of

equipment/already adapted properties and better design of new homes) • Tenants to be involved in monitoring how the agreement is working As in Bristol the housing associations which have signed own most of the stock and make most demands on the DFG, but again it was not possible to bring on board all the associations. There were two noticeable omissions. One is a national association with a large amount of property in Plymouth. This association signed and complies with the Bristol agreement and has several other 50% funding agreements elsewhere. It seems inconsistent to make no contribution in Plymouth. The other exception is a transfer association which although signed up is not yet able to fully comply. For the majority who have signed there was a need to develop a cost effective way for them commission the work themselves. A Procurement Working Group was established to look at developing contracts for showers and stairlifts. The process has been co-ordinated by the procurement section within one local authority. A new contract for stairlifts was in place by April 2012 and one for level access showers will be operational by April 2013. In Devon the customer pathway for DFG cases is more complex because of the county/district split. A working group looked at Customer Access in conjunction with the OTs at County level. They mapped out the best way to get OT assessments and the track for tenants who need a DFG. It is also important to make sure the district councils can track the progress of work so they can step in if an association does not complete within a reasonable timeframe. This monitoring system is still being developed. A professional leaflet has been produced which all associations and authorities can brand with their own logos and make available to tenants in paper form or on websites. This identifies that their housing association is the first point of contact, sets out what help is available and the stages in the process. The leaflet is designed for tenants but is equally helpful for staff to ensure they know how to advise people. Making better use of the accessible housing stock and help with rehousing was a key part of the Devon protocol. Devon Home Choice staff were involved in the process of setting up the agreement and have already begun to make changes as a result of feedback from the Resident Scrutiny Group. The benefits of ‘Homes without Barriers’ Positive outcomes were already being demonstrated a year into the implementation of the protocol. Minor adaptations were being handled directly by many associations thus freeing up OT time to deal with more complex assessments. Partners are becoming more successful in helping people to move instead of carrying out costly adaptations. As a result demand for DFG from tenants has already reduced in most areas.

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A Management Group is taking the implementation of the Homes without Barriers protocol forward. There is also a strong Resident’s Scrutiny Group monitoring progress and reviewing the arrangements for service delivery. The recent appointment of a housing options partnership co-ordinator for Devon has been helpful in providing support to this group. In Devon, because of the geography and the larger number of partners, it will probably take longer to fully embed the protocol than in Bristol. In reviewing the progress with the project in January 2012 members of the Management Group said the successes included: • Enthusiasm for the project • Commitment to joint working • Improved priority for adaptations within housing associations and budget increases • A decline in use of DFG by housing associations • Progress with joint procurement • Leaflet that all partners can use • Raised expectation that housing associations should participate • Allowed progress with related issues e.g. maximising reuse of existing accessible stock • An effective Resident Scrutiny Group

THE CORNWALL COMMON OPERATING AGREEMENT

Cornwall became a unitary authority in April 2009 and the focus has been on restructuring to integrate services. A Common Operating Agreement has been set up to 'Achieve the timely delivery of adaptations to tenants' homes and make the most effective use of respective capital funds and available resources'. Partners will eventually be asked to sign up to deliver an effective and consistent aids and adaptations service to social housing tenants. The Common Operating Agreement covers the following key areas: • Providing strong leadership for the service • Effectively involving customers in improving and monitoring the service • Identifying the need for adaptations now and in the future • Meeting the need for adaptations through a funding strategy • Standardised customer information and satisfaction surveys • The process for delivering the service and target waiting times • Minor adaptations • Design standards and eligible works • Consistent recording systems • Adapted property register and rehousing policies. There was considerable variation in the housing association funding thresholds for minor works and OTs were often asked to do assessments for small jobs. A pilot scheme basing OTs with associations has resulted in initial enquiries being dealt with more effectively and a better shared understanding of the process. The focus at present is on developing an integrated end-to-end local authority adaptations service. As in Devon there is a need to achieve better value for money through smarter procurement. In Cornwall there is a £500-600 difference in the cost of showers procured by different partners and considerable variation in the way that quotes are obtained for work.

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Procurement agreements and framework contracts are being developed to reduce costs and generate efficiencies. They are also looking at making better use of the stock and weighing up the benefits of having a disabled housing register. As more than 40% of the DFG budget is spent on housing association cases there is clearly a need to create a shared approach to funding, particularly with the transfer associations. One of the national associations in Cornwall is already contributing 40% of costs. A partnership agreement will be developed in 2013.

Housing associations will be at the forefront in dealing with the effects of the ageing

society and the increase in disability in younger age groups. Adaptations and

accessible homes are no longer peripheral issues that can be subsumed as part of

maintenance and repairs. They are core services, a key part of asset management

and an investment in the future.

Local agreements and protocols are essential to enable delivery of adaptations on an

equitable basis in each area. They bring benefits to all partners and result in a much

better service for disabled tenants. However, they take some time to become

established. It requires strong leadership, on-going management and effective

scrutiny for these voluntary agreements to remain in place.

It is not always possible to bring all the potential partners on board. However, the

impact of a small association refusing to comply with a protocol is not nearly as

important as the effect of a larger association which makes considerable demands

on the DFG budget not meeting the terms of the agreement. Some older transfer

associations and national associations are using a high proportion of local authority

budgets. This is leading to long delays and a poorer service for people from all

tenures and results in a post code lottery for tenants.

There has been no national guidance about adaptations instead ‘localism’ means

that each authority has to find its own way of dealing with minor works and DFG

applications from housing association tenants. In this context local agreements are

8. CONCLUSION

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extremely important, but they can only go so far. If some of the biggest housing

associations in the country refuse to contribute resources there is very little

authorities can do.

However, persuading housing associations to take more responsibility for funding

major works is vital. It would enable more joined-up and effective decision-making

about procurement and about what properties should be adapted, what type of

adaptations should be installed, what new accessible properties should be

developed, and how tenants with disabilities can be helped to move if this is

provides a better long-term solution. All of which would lead to better value for

money. It would also mean better direct communication between landlords and

their most vulnerable tenants and a clearer route though what are otherwise

complex and confusing service pathways.

It is hard to see who will take up the challenge of ensuring that these matters are

addressed. The loss of the Audit Commission short-notice inspections means that

there is no longer regular external scrutiny of adaptations policies and procedures.

The Tenant Services Authority and Tenants Voice are no longer in existence and

responsibility now rests with the Homes and Communities Agency. A new co-

regulation approach has been introduced which involves more tenant scrutiny.

However, if adaptations are not seen as a core service and if insufficient disabled

people are on boards or scrutiny panels there is unlikely to be fundamental change.

Furthermore, the emphasis is now on new development and the role of housing in

economic recovery. The needs of disabled tenants in the existing housing stock are

unlikely to be high on the agenda.

It can only be hoped that the Department of Communities and Local Government

will play a more active role, particularly to encourage some of the bigger

associations to set realistic budgets and to resolve the problem of some of the

transfer associations taking an unfair share of the DFG. At the very least all

associations ought to have the same threshold for funding minor works to prevent

unnecessary delays for tenants and reduce the demands on occupational therapy

services. Setting this at £2,500, as has been done in Bristol, would encompass all

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the jobs identified in the report on minor works by the College of Occupational

Therapists.

At present the burden falls on local authorities which, although they have the legal

responsibility to provide adaptations, do not have sufficient resources to cope with

all the financial or operational demands placed upon them. Either sufficient funding

will need to be put into the DFG pot to replace that lost when the Housing

Corporation withdrew direct funding in the late 1990s, or housing associations will

have to set reasonable budgets according to the level of need amongst their tenants

and the number and type of dwellings, as happens in the Council stock. The only

people that suffer when this is not resolved are disabled tenants themselves.

There is also clearly a role for the Department of Health to put more money into

adaptations, particularly as more medical care is likely to take place in home settings

as the population ages. This may help to ease the burden on those local authorities

whose budgets are currently over-stretched.

At present, without clear national guidance for housing associations, the only way to

achieve better outcomes for tenants is to develop stronger and more sustainable

local adaptation agreements. The ‘Toolkit’ below draws out the lessons from this

work to enable more partners to come together to develop effective protocols.

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Through this work Mackintosh O’Connor Associates and THCP have developed a process to ensure agreements are set up in an effective and sustainable way. The steps are:

• Nominate a project co-ordinator – someone who will drive the project, preferably without a direct interest in any of the partner agencies

• Data collection - the associations in the area, stock levels, use of the DFG

• Involve tenants from the start – to be on steering group and to take part of surveys, focus groups and consultation. Participants may already be on HA boards or in equality or consultation groups. Use tenant liaison officers and housing officers to find other people willing to be actively involved – they may be disabled themselves, be carers or simply interested in the issues. Recognise that some disabled tenants may find it difficult to participate in ‘traditional’ methods of involvement such as meetings and focus groups – some work will have to be done via telephone, email and video links.

• Formation of a steering group - Housing associations need to be represented by people able to make decisions and influence budget setting. It is also important to include senior people at district level including OT and DFG managers. In non-unitary authorities include people at county level from adult and children services with responsibility for equipment and adaptations. Also include at least one tenant.

• Inception meeting - bring all parties together, including tenants, to share experiences, understand the constraints facing all potential partners and focus on the needs of the customers of the services – the disabled people themselves. Once managers stop focusing on operational and demand issues and start thinking about the process from the point of view of a disabled person progress can be made. Agree an agenda to implement change.

• Talk to key partners – find out about policy and procedures, resident and property characteristics, adaptation budgets/expenditure, the path customers take, sticking points or bottlenecks in the process and views on issues to be covered in any agreement, and tenant’s views on current service and changes they would like to see.

• Draft agreement – to be circulated to all partners for comment

• Final version of agreement

9. TOOLKIT FOR SETTING UP AN EFFECTIVE AGREEMENT

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• Launch event – remember this is the effective start not the end of the process. Not everyone will sign up on the day - the agreement often has to go to housing association boards. Budget setting cycles mean that partners may not be able to fully engage for some time. Those unable to meet the funding requirements are often willing to engage in further dialogue. Include them in training sessions and meetings to encourage them to do more.

• Involve OT locality teams – once the protocol is launched ensure both adult and children’s service OTs know how to route cases coming into the central call centre or after an assessment has been completed. When a major adaptation case is referred back to a housing association OTs should ensure DFG teams are notified so that progress can be monitored.

• Set up ‘Trusted Technician’ training – housing association maintenance staff need training to be confident in the delivery of adaptations. They do not always need the full Trusted Assessor training, but prefer training in practical skills. OTs, technical officers or handypersons from the local authority or HIA may be able to provide the right level of training. Include disabled people themselves as part of the training team.

• Implementation group – form a management group to take it forward –this should include people with decision-making and budgetary responsibilities to ensure the protocol is properly embedded, but also include maintenance staff with responsibility for adaptations. This group can look at issues such as procurement, design of adaptations, recycling of equipment etc. It should also ensure monitoring data is collected. Strong links with the local development partnership group could also help to ensure compliance with the adaptation agreement.

• Scrutiny Group - form a resident scrutiny group to monitor progress – and take action on their findings. In Devon the Scrutiny Group has already led to changes in the information on accessible homes on Devon Home Choice and in Bristol mystery shopping has shown associations that reception staff need more training.

• Organise and support the groups - make provision for someone to organise and support the implementation and scrutiny groups and to keep contact details updated. Also have a fund to pay expenses for tenants – HAs are usually willing to pay for travel but some additional funds may be required e.g. to provide lunch or shopping vouchers to give recompense for people’s time.

• Delivery of effective protocols requires leadership and drive - it is important to identify someone to act as a protocol champion who has the

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necessary authority and influence, particularly where an agreement straddles district boundaries.

• It takes time – protocols are not a quick fix and it can take more than a year for funding to be agreed and for new ways of working to become embedded. Even then work needs to continue to bring other organisations into the partnership and to develop aspects of the protocol, such as improved rehousing and development policies.

Contact details:

Sheila Mackintosh - Mackintosh O’Connor Associates

Email: sheila@mackintoshoconnor.co.uk

Website: www.mackintoshoconnor.co.uk

Lynn Collingbourne - The Housing Consultancy Partnership

E-mail: lynn.collingbourne@thcp.org

Website: www.thcp.org