Housing Support and Personalisation Providers seminar Housing Support

Housing Support and Personalisation Providers seminar Housing Support Enabling Unit

HOUSING SUPPORT & PERSONALISATION HSEU PROVIDERS SEMINAR December 2012 Dr Ann Rosengard

SDS National Strategy, Progress and process l National Strategy l Implementing the legislation l Who is accessing SDS? l Where does Housing Support fit in? l Housing support and particular needs l Issues and Action points Dr Ann Rosengard December 2012 1

Priorities of Scottish Government & Cosla’s 10 Year SDS Strategy l Widened eligibility - e. g. to DPs l Co-production/ user involvement l Assessment driven by User-defined outcomes l Informed choice/ access to advice l Range of options to maximise choice l Use of Individual Budgets (I. B’s) l User control of support Dr Ann Rosengard December 2012 2

The Social Care (SDS) (Scotland) Bill l Identifies 4 options for service users: 1. 2. 3. 4. l To use a DP to arrange & fund their support To identify the support they want and ask the L. A. to arrange this for them To leave it up to the L. A. to make decisions To combine 1 -3 above in a support package. Access for all ages l l Children and Young People – to involve 16/17’s Older People, including those with dementia Dr Ann Rosengard December 2012 3

Enacting the SDS Bill – 2011/2013 l Placed before Parliament – 29 February 2012 l l Revised Draft – debated by Health & Sport Cttee in June l l Tenth Report - produced 06. 07. 12 Parliamentary debate on Stage 1 on 18. 09. 12 Amendments debated October-November 2012 Vote - Bill passed 28. 11. 12 – with CCPS amendment … l l Consultation – 1 March to 24 April 2012 as far as practical LA’s should make available a wide range of support and a variety of providers Draft Regulations and Consultation and Best Practice Guidance (non-statutory) – to be produced early 2013. Dr Ann Rosengard December 2012 4

Implementation - take up of SDS (DPs) l l Government stats mainly cover use of DPs - though data collection is being revised Across Scottish councils, limited but significant growth in take-up of SDS Increased from 2001 - 2009 from 207 to 3017 l 22% increase to 3, 678 in 2010 l 19% increase to 4, 392 by 31. 03. 11 l 15% increase to 5, 049 at 31. 03. 12. Variations between LA areas and ongoing changes in spend/use patterns. Dr Ann Rosengard December 2012 5

Access to SDS/ DPs – Scottish Government stats – 2011 & 2012 Service users 2011 2012 People with a Physical Disability 40 % 37 % People with a Learning Disability 26 % 24 % Physical & Learning Disability 3% 4% People 65 and over 33 % Frail older people 18 % 19 % People with Mental Health issues 5% 5% Gender 53 % women 53 % - (approx twice no of women as men age 65 +) Minority Ethnic 2 % (approx) 3% Dr Ann Rosengard - December 2012 6

Types of provision via SDS Type of DP provision SDS packages 2011 Percentages 2011 SDS packages 2012 Percentages 2012 Personal Care 2918 52% 2978 53% Social/Educ Recreation 1062 19% 1, 137 20% Domestic tasks 827 15% 700 13% Housing Support 535 10% 601 11% Health Care 181 3% 106 2% Equipment; Temporary Adaptations 31 1% 16 0% Respite 984 18% 1238 22% Meals 147 3% 198 4% Other 334 6% 970 17% Dr Ann Rosengard December 2012 7

Vision of Inputs to SDS Implementation in Bill l Health Involvement l l l NHS Lothian Pilot sought to combine NHS and social care funding in packages of support which the person directs. More extensive Health involvement in England Housing Support (HS) l l l Housing, housing support and allocations are recognised by SG as playing a key role in shifting ‘the balance of care’ to ordinary living and non-institutional options. Given changes in commissioning/ monitoring of H. S. since 200708 we seem to know less about its role. Recognising this, Homeless Link (England) has collected data re 8 housing support. Dr Ann Rosengard December 2012

The locus of Housing Support in the 10 Year Strategy l Section 2. 6 stresses the need for a co-ordinated approach to personal and housing support l Recognises personalisation and choice are core values for housing support services “Some people have direct payments that include funding for housing support, allowing them to take a holistic approach to arranging their personal and housing support”. (p. 25) Dr Ann Rosengard December 2012 9

Value of Housing Support l Wider research has identified benefits of H. S. for l l l Diverse support needs, including multiple/ complex Sustaining ordinary living Limiting Health and Social Care costs Preventing homelessness & institutionalisation National Care Standards for H. S. stress importance of informed choice and person-centred approach But less explicit on control? Dr Ann Rosengard December 2012 10

Value of Housing Support l Wider research has identified benefits of H. S. for l l l Diverse support needs, including multiple/ complex Sustaining ordinary living Limiting Health and Social Care costs Preventing homelessness & institutionalisation National Care Standards for H. S. stress importance of informed choice and person-centred approach But less explicit on control? Dr Ann Rosengard December 2012 10

? l To what extent do Housing/ Housing Support needs play a role in SDS? ’ and l How far is the role of housing support in SDS recognised? Dr Ann Rosengard December 2012

SDS in Practice - Evaluation of Test Sites & Recent Update Ridley et al, 2011 l l Implementation of SDS is uneven Traditional DPs viewed as bureaucratic l l Mainly physical disabilities; slow take up Insufficient independent support Seen as not user-led Test Sites – 3 Themes l l l To reduce red-tape Leadership – culture change Investing to save - bridging finance Dr Ann Rosengard December 2012 12

3 Test Sites l Dumfries & Galloway l l l Glasgow l l Used In Control method to help transform social care Community development approach to promote interest Built on Council’s earlier IB pilot (LD) and In Control model Tested & refined assessment and allocation processes Resolved large-scale programme – moving to mainstream Highland l Focused on increasing DPs initially promoted SDS for young disabled people l By end of T-Sites. Drall 3 resolved to mainstream SDS Ann Rosengard December 2012 13

Outcomes of Test Sites at March 2011 (Ridley et al, 2011) l 132 individuals in total across 3 areas l Mainly people with learning disabilities – 64% l More male (52%) than female (48%) l Age and gender profiles varied across areas l All white British/Scottish SDS packages l 107 DPs (2/3 self managed, 1/3 third party managed) l 24 Individual Service Funds (ISFs) Funding streams mainly SW + client contribution Only one T-Site reported using. December Housing funds (2011) Dr Ann Rosengard 2012 l l l 14

More on SDS T-Site Outcomes l l l l Support – found SDS increased flexibility and choice Outcomes - broadly high satisfaction Leadership – all sites developed special teams, infrastructure (IT), systems and targeted funding for SDS Training – not all staff had received this Bureaucracy – high focus on systems Bridging finance – found useful for infrastructure Development - slow progress, but gathered speed. Dr Ann Rosengard December 2012 15

Limited Findings re role of Housing Support l l SDS evaluation sought information on housing (and health) contributions to individual SDS packages Although housing support was referred to in relation to some packages, overall gained little information on specific housing support funding l l Follow Up study did not clarify this further It may be that H. S. is subsumed under outreach social support Is there a case for more focused monitoring; case profiles to clarify/ highlight housing support? Seminar Participants’ experience? Dr Ann Rosengard December 2012 18

Implications for housing/ HS from case studies l Case studies carried out as part of original Test Site study indicated role for housing/ HS: l l l left long-stay hospital care or children’s services new needs – adaptations, equipment, support moving from shared to independent housing accessed supported accommodation flexible support enabled positive community living Examples of SDS assessment highlighting housing/ H. S. needs and being a catalyst to housing gains. Dr Ann Rosengard December 2012 19

? l What are the lessons and implications for housing support of SDS experience to date? ’ l Is there a case for monitoring and clarification of the role of housing support in SDS? If so, why needed now? Dr Ann Rosengard December 2012

SDS, housing support and Particular Needs l Up-To-Us Initiatives § l SDS for older people, including dementia § l to date use of DPs has been limited, though O. P. have increasingly accessed housing support. SDS for Homeless people is being trialled § § l RSL tenants, advocacy orgs & providers enabled to jointly purchase support – (funded by DOH, Comm’s & Local Gov) 4 Pilots – England – Personalisation for rough sleepers Some providers are personalising services (Hough/Rice, 2010). Mental health – slower development than in England. § Need to monitor and build on experience of outcomes. Dr Ann Rosengard December 2012 20

? l ‘Should SDS go beyond traditional housing support to cover housing issues? ’ Dr Ann Rosengard December 2012

? l ‘Should SDS go beyond traditional housing support to cover housing issues? ’ Dr Ann Rosengard December 2012

Opportunity to Innovate l l Personalisation is ongoing – we are at an early stage but there is a gathering momentum of change SDS requires and encourages innovation - options to explore may include: l l l Shared service models e. g. HACT; social networks; using budgets for joint activities and resources Restructuring and small-scale additions to people’s support to meet individual wants and needs Listening hard to people about what might make a difference and collaborating to target support plan Dr Ann Rosengard December 2012 22

Housing Support and Homelessness l Evaluations and wider research stress the key role of H. S. in tackling homelessness l l Influenced new duty to assess H. S. needs and provide support where there is a duty to secure settled accommodation “To ensure that H. S. services are provided to those assessed as being in need” and assess if “any other person residing with the applicant” needs housing support. (Housing(Scot) Act 2010 s. 158) SG consulted on the Duty, issued a Business Regulatory Impact Assessment (2. 11. 12) and Parliament has approved Regulations Final Reg’s approved 27. 11. 12 - 4 broad types of H. S. – with Finances; Accessing sources of support; Advising/ assisting re Housing Rights/ Responsibilities; Resettlement support Regs will be enforced on 1 st June. December 2013. Dr Ann Rosengard 2012 23

Influences on continuing or increasing demand for H. S. l Perfect storm of benefits changes – Will this increase homelessness & related advice/ support needs, despite recent decline due to impact of H. Options/ Prevention? l New LA duty to assess H. S. needs for homeless applicants. Will this increase demand for H. S? ; change routes of access? Enable access to SDS for some? l Sustainability issues facing providers in context of changing environment may impact on agency level demand for H-S Dr Ann Rosengard December 2012 24

Implications of personalisation / SDS for Housing Support l l l Commissioning strategies and inspections may increasingly check how far existing H-S services are personalised and homes are accessible Providers could usefully look afresh at their systems/ processes. How far do assessment & support planning focus on assets, not deficits? How far do they involve co-production? Guidance - Homeless Link - useful guidance with tools and information. Suggests SDS can address complex needs better because starts from person’s views and situation. Also there is a wider range of general and specific guidance, e. g. Alzheimers Scotland. SDS assessment - Self-assessment/ evaluation systems should identify/ address housing support needs and required resources clearly SDS monitoring – Should clarify the extent to which there is a Housing Support element in support packages and what form this takes. Housing standards and choice: Joint planning is needed to ensure that people have access to a range of accessible housing Dr Ann Rosengard December 2012 25

? l What challenges are faced by providers where H. S. needs are temporary and require a flexible response, e. g resettlement/ move on support? Dr Ann Rosengard December 2012

Some references l l l l l Cabinet Office Strategy Unit (2005) Improving the Life Chances of Disabled People. The Stationery Office, London. Alzheimers Scotland (2010) Let's get personal - personalisation and dementia. Alzheimers Scotland, Edinburgh 2010. Department of Health (2005) Independence, Well-being and Choice: Our vision for the future of adult social care, DOH, London. Department of Health (2010) Person Centred Planning: Advice for Commissioners; Also separate documents cover: PCP-Advice for Providers & PCP - Advice for Professionals. All, DOH 2010. DOH , SCIE et al (2012) Towards excellence in adult social care: Progress with adult social care priorities England 2011/12. DOH October 2012 Glendinning C, Challis D, Fernandez J, Jacobs S, Jones K, Knapp M, Manthorpe J, Moran N, Netten A, Stevens M and Wilberforce M (2008) Evaluation of the Individual Budgets Pilot Programme: Final Report. Social Policy Research Unit, University of York, York. (IBSEN study) Hanover and HACT (2010) Up 2 Us Summary Document : http: //www. hanover. org. uk/publicaffairs/Hanoverandhact. Up 2 Us. Summary. doc. Homeless Link (2011) How to Personalise your Service. http: //homeless. org. uk/sites/default/files/Howtopersonaliseyourservice. Final. pdf Hough J and Rice B (2010) Providing Personalised Support to Rough Sleepers: An Evaluation of the City of London Pilot. Joseph Rowntree Foundation, York. Look Ahead (2010) Choice, control and independence: Personalising block contracts in supported housing. Look Ahead Housing & Care and London Borough of Tower Hamlets. Dr Ann Rosengard December 2012

More references l l l l l NHS (2010) The Healthcare Quality Strategy for NHS Scotland. Scottish Government, May 2010 Ridley J, Spandler H, Rosengard A, Little S, Cornes M, Manthorpe J, Hunter S, Kinder T & Gray B (2011) Evaluation of Self-Directed Support Test Sites in Scotland. Scottish Government, Edinburgh. Full Report and Research Findings No. 109/2011: http: //www. scotland. gov. uk/socialresearch Rosengard A and Jackson AA (2012) Supporting homeless people - Exploring the Implications of the new duty to assess the Housing Support needs of Homeless People and to provide Housing Support. Summary of Report to Shelter Scotland (May 2012) SCIE and NHF (2009) At a Glance 08: Personalisation briefing: implications for housing providers Scottish Government (2006) Changing Lives – Report of 21 st century Review of Social Work, The Scottish Government, Edinburgh 2006 Scottish Government (2009) National Care Standards Housing Support. The Scottish Government, issued 2002, revised in 2005 and 2009. Scottish Government (2009) A Personalised Commissioning Approach to Care & Support Services, Scot Gov, Mar 2009 Scottish Government (2010) Social Housing Allocations: A practice guide. August 2010. http: //www. scotland. gov. uk/Publications/2010/08/05104504/7 Scottish Government (2011) Evaluation of Local Housing Strategies Co-Production Pilots with Disabled People. The Scottish Government, December 2011. http: //www. scottish. parliament. uk/S 4_Bills/Social. Care(Selfdirected. Support)(Scotland)Bill/Bill_as_in troduced. pdf Dr Ann Rosengard December 2012

And more l l l Scottish Government (2011) Social Care (Self Directed Support) (Scotland) Bill: The Scottish Government’s response to the consultation. The Scottish Government, October 2011 Scottish Government and Co. SLA (2012) Age, Home and Community: A Strategy for Housing for Scotland’s Older People: 2012 – 2021. The Scottish Government, November 2011 Scottish Government (2012) Update to a User's Guide to Self-directed Support in Scotland. The Scottish Government, February 2012. Scottish Government (2012) Draft Scottish Statutory Instruments: The housing support services (Homelessness) (Scotland) Regulations 2012. made 2012; coming into force: 1 st January 2013 Scottish Statutory Instruments 2012 No. 331. The Housing Support Services (Homelessness) (Scotland) Regulations 2012 (Made 27. 11. 2012; coming into force 01. 06. 2013) Dr Ann Rosengard December 2012 33

Self Directed Support Housing Support and Personalisation: a providers seminar 11 th December 2012 Louise Dunlop, Sue Johnston and Maureen Grant

Who are Loretto? • • • • National Charitable Housing Association Head Office based in Gorbals in Glasgow 2 Companies in Group Operational 35 years Work across 9 Local Authorities Argyll and Bute Falkirk Glasgow City North Lanarkshire Renfrewshire South Lanarkshire Stirling West and East Dunbartonshire 33 Services 468 Staff

People We Work For • • • Mental Health Learning Disability Addictions Homelessness Young People Complex Households / Families Vulnerable young parents Aging ARBD (3 Care Homes : 1 New Build Specialist Facility

Personalisation is defined as a process that : “… Enables the individual alone, or in groups, to find the right solution for them and to participate in the delivery of a service. From being a recipient of services, citizens can become actively involved in selecting and shaping the services they receive. ” The Scottish Government 2009 (Changing Lives Report)

Self Directed Support (SDS) • SDS enables the people we work for to choose how their support is provided to them by enabling each individual to have as much control as they want over the individual allocated budget and their support arrangements. • SDS is therefore the support each individual purchases or arranges to meet agreed health and social care needs. • SDS can be used in many ways. Individuals can have their support within their home, to go to college or to pursue community leisure activities rather than going to a day centre. • Individuals who receive services can choose whether to purchase support from any Care Provider. They can also choose to employ a personal assistant (PA), using a range of options.

Promoting 4 Choices • Option 1 – Direct Payments. (a cash payment) • Option 2 – Individual Service Fund (the council holds the budget but the person is involved in how the money is spent) • Option 3 – The local authority arranges a service for the supported person • Option 4 – A mixture of the above

Outcomes Focused Planning The impact or effect or consequence of help received on a person’s life • Involving the person in identifying the goals they want to work towards – flexibility, choice and control • Outcomes that can be measured both for the individual and for the service as a whole

Lorettos’ Assessment within Outcome Focused Planning • • Talking Points Approach Individuals are at the Core of their support. Conversations and Co-productions Outcomes, Reviewing the effectiveness Decision making processes. Improvements

Assessment Tools. • Resource Allocation Assessment. (Glasgow) • Guided Self Assessment. (North Lanarkshire) • Better Futures • Loretto’s Matrix Tool

Promoting Informed Choice within Loretto • Involvement in the development of the Outcome Based System • Individuals involved in co-production of outcome based plans • Language used is their own • Preferred way of reporting expenditure to each individual • Building strengths and assets • Making outcomes meaningful • Promotion of Assistive Technology

Managing Individual Service Funds • Clear outcome plans detailing preferred options for short / long term outcomes and contingency funds (where appropriate) • Monthly reconciliations of expenditure • Use of Charge Card for other expenditure, i. e. gym memberships, holidays, etc • Monthly / Quarterly invoices • Invoices and Expenditure in preferred format

Informed Choice Process 5. Monthly/ quarterly reconciliation / billing / invoicing 1. Review / Evaluate Assessment and Planning 2. Individualised Service Funds 4. Expenditure for Short / Long term contingency/ other expenditure 3. Co-production of Outcome Plan

Issues to consider • All funds allocated within individual service funds • No direct / indirect costs from Local Authorities • Providers to provide a breakdown of this to the People we Work for • Staff costs v flexibility of service • Hourly rates v Individual funds

Issues to consider PWWF • Promotion of Rights within SDS • Understanding of 4 Options • Understanding how the individual budgets are spent • Promotion of Co-production • Complex needs • Adult Protection • Regulation

Issues to consider Staff • Understanding the principles of Self Directed support • Managing culture change • Managing full system change • Practice Development • Apply Principles in Practice • Managing Contractual Changes

Issues to consider Organisation • Strategic Plan • Policy Development • Analysis and Research • Shaping Services • Flexible Work Force • Contractual Issues • Recruitment and Retention • Learning and Development • Finance

Issues to consider Purchasers • Quality of Service Delivery • Adult Protection • Non-regulated staff • Future commissioning of services • Models of practice

Continued Purchasers • Analysis of impact of SDS • European procurement legislation (Framework contracts) • Crisis management strategy • Impact of Integrated Health and Social Care Bill (Scotland) 2010 • Impact of Welfare Reform

What’s next? • SDS Bill royal assent 2013 • Timescales for implementation of SDS with Local Authorities • Local Authority stance and timescales for implementation • Information sharing with the people we work for, carers, families and partner agencies • Encourage rights, choices and control within SDS • Continue to support individuals to make informed decisions regarding their preferred SDS options the level of control they wish

For Further Information • enquiries@lorettoha. co. uk • louised@lorettoha. co. uk • maureeng@lorettoha. co. uk • suej@lorettoha. co. uk • www. scotland. gov. uk • www. jitscotland. org. uk

Self Directed Support Linzi Christiansen & Judy Middlemiss

Link. Living Who we are: Link. Living has been providing specialist services to encourage health, wellbeing and independence for over 25 years. l l. Currently provide services in Edinburgh, East and Midlothian, Fife and Falkirk. l. We provide over 2, 500 hours per week of support to around 400 vulnerable adults and young people.

Personalisation l 3000% rise in no of service users who use Direct Payments l 36% of service users in Edinburgh use Direct Payments, smaller no’s in Midlothian and Fife. l Increase in Edinburgh largely associated with the tendering of care at home/housing support services for people with learning disability, mental health problems, physical disability and hearing impairment in 2009.

The positives! l Wider market l Able to be more creative in approach l Service users have more control, less uncertainty l No significant decrease in service users, only 1 has chosen to go to another provider.

The negatives! l Flexibility and control can be limited. l Lack of focus on outcomes. l Difficult for individuals to access Direct Payments, particularly those not already receiving a service. l Management of arrears and debt recovery.

Case Studies l Anne l Simon l James l David

For more information or support: Yvette Burgess Unit Director Yvette. burgess@ccpscotland. org Heather Mc. Cluskey Information Officer Heather. mccluskey@ccpscotland. org Tel 0131 475 2676