Memorandum from Housing 21 (SPP 29)
1. SUMMARY
— Housing 21 is a specialist provider of
older people's services—a leading national charity which
promotes choice and independence for older people through a range
of care, health and housing solutions. We have nearly 400 retirement/sheltered
housing schemes which means 14,000 sheltered homes for older people.
We have 1000 extra care homes in management and another 1,000
homes in development. We are also one of the largest domiciliary
care providers in the UK providing 38,000 weekly care hours into
people's own homes.
— For a very long time (even since its
development as a new funding structure) we have been concerned
about the impact of the Supporting People programme on older people's
housing. We have chosen to focus our submission on the impact
of the Supporting People strategy on sheltered housing which is
our primary concern though we also make some comment on the impact
on extra care housing. We have responded to the questions raised
by the Committee though, in general, we want to make the point
that Supporting People has not delivered everywhere in the country
for those living in or wishing to choose sheltered housing as
an option in later life.
— This issue of changes to the services
in sheltered housing is our concern. We are concerned at the number
of older people who have lost out on Supporting People funds over
the last few years. We set out the important role of sheltered
housing in maintaining the independence and well being of older
people and in prevention, its role in community cohesion, in supporting
older people who could be isolated and that it remains a popular
choice for older people.
— Yet we have seen, and will see more of,
the loss of bespoke scheme manager services. We are concerned
about the lack of a strategic view of the role and place of sheltered
housing in many areas of the country. We urge a more coherent
strategy from Government on sheltered housing of which Supporting
People is one part. We believe that the loss of the ring fence
will mean a loss of more services in sheltered housing and argue
for a universal approach like that being considered in the debate
about social care. This, we consider, will protect this much valued
provision.
— We also ask the Committee to consider
how the debate about the impact of and future of Supporting People
will link to the debate about social care and personalisation
especially looking more closely at developments such as ensuring
that housing related support would be part of the common assessment
framework promised in the 2007 strategy. We also argue that there
needs to be better consultation about change and this should be
in a more strategic context. We also ask that a mechanism is established
to share good practice and set a national, universal framework
for support in sheltered and extra care housing as is likely to
be the case in the funding of social care.
2. BACKGROUND
AND CONTEXT—ABOUT
HOUSING 21
2.1 Who we are
Housing 21 is a specialist provider of older
people's services—a leading national charity which promotes
choice and independence for older people through a range of care,
health and housing solutions. Our vision is a life of choice for
older people. With nearly 50 years of experience we provide a
complete service to meet the needs of older people supporting
older people to have a good later life.
2.2 What we do
We are a major provider of housing, care and
specialist dementia services and the only housing association
with a dementia centre of excellence, Housing 21 Dementia Voice.
We have nearly 400 retirement/sheltered housing schemes in 150
local authority areas in England. This is over 14,000 sheltered
homes for older people. As the leading association building extra
care housing we currently have 1,000 extra care homes in management
and another 1,000 homes in development for rent and home ownership.
We are also one of the largest domiciliary care
providers in the UK providing 38,000 weekly care hours into people's
own homes. Our specialist services respond to the diverse needs
of older people and include dementia care, end of life care and
day care. Our welfare benefits managers support our customers
in all our services to help them access the benefits they are
entitled to.
We partner commissioners across England to offer
holistic services for older people and have significant PFI and
PPP partnerships in Kent, Oldham and Walsall. We research what
we do to ensure that services work for older people be they housing
options or end of life support.
With funding from the Housing Corporation (now
the Tenant Services Authority) and the Care Services Improvement
Partnership (now the Putting People First Programme) we have concluded
a project that has looked at the impact of the personalisation
agenda on specialist housing settings and a final report is due
to be published in June 2009 (available on our website at www.housing21.co.uk).
We are also producing a fact sheet for commissioners on extra
care in the new personalisation agenda in late spring.
We have supported the development of the strategy
for housing in an ageing society, Lifetime Homes, Lifetime Neighbourhoods,
through our membership of the CLG/DH Housing and Older People
Development Group and have supported research on the impact of
floating support on older people living in sheltered housing undertaken
by Help the Aged which culminated in the report Nobody's Listening
published early this year.
2.3 Our interest and concern about Supporting
People
For a very long time (even since its development
as a new funding structure) we have been concerned about the impact
of the Supporting People programme on older people's housing and
have written to Communities and Local Government on many occasions
either on our own or together with our specialist older people's
housing association peer organisations to raise issues of concern
and suggest a way forward.
In particular, in a joint response to the consultation
of the development of the 2007 Supporting People strategy (from
Housing 21, Anchor Trust and Hanover Housing Association) we expressed
some specific concerns about the impact on sheltered housing.
The key points made, outlined below, still remain:
— A lack of understanding of or recognition
of the value of sheltered housing which is a popular choice for
older people and contributes significantly to the choice, control
and prevention agendas
— Concern over the impact of the loss of
the ring fence on the continuation of services
— Variations in commissioning practice
— The lack of corporate/strategic ownership
of the programme in some localities
— The move towards "floating support"
which has in many areas been confused and has undermined sheltered
housing
— The fact that councils can withdraw funding
for support service with little notice.
In this response we set out our current concerns
in these and other areas.
3. OUR COMMENTS
ON THE
CURRENT ISSUES
IN SUPPORTING
PEOPLE
3.1 Introduction
We have focused our submission on the impact
of the Supporting People strategy on sheltered housing which is
our primary concern though we also make some comment on the impact
on extra care housing.
To clarify by sheltered housing we mean a group
of flats and/or bungalows with an emergency alarm and some communal
facilities. On site support is provided by a scheme/court manager.
This can include rented and leasehold housing. Increasingly older
people living in sheltered housing have sensory impairments, mobility
problems and mental health issues. Sheltered housing is also used
as a community resource with the facilities and activities provided
used by older people in the local area.
Extra care housing offers self contained housing
with a diverse range of communal and community facilities and
with access to 24 hour on site care delivered flexibly to respond
to people's changing needs. It can be to rent or buy and caters
for people who have care and support needs with most (but not
all) having a care package of at least four hours per week.
We have responded to the questions raised by
the Committee though, in general, we want to make the point that
Supporting People has not delivered everywhere in the country
for those living in or wishing to choose sheltered housing as
an option in later life.
We are aware that the Dept of Communities and
Local Government is currently looking at a strategy for sheltered
housing which we understand is considering a range of issues including
design and standards, sustainability, models of service delivery
and paying for services including Supporting People funding. We
have offered our initial comments to this review but believe that
the uncertainty about the future funding of support for people
in sheltered housing is undermining the value and role of sheltered
housing.
We hope that the Committee will recommend
measures to clarify the Government's long term strategy for sheltered
housing in relation to Supporting People and stress the importance
of achieving both clarity and security in revenue funding for
this provision for older people and providers alike. After all,
choices to move in retirement are never taken lightly and research
shows that security is one of the key reasons why older people
have chosen this specific provision. (Personal Budgets, Personalisation
and Older People's Housing, Older People's Programme, available
June 2008—see www.housing21.co.uk)
3.2 Has the Supporting People strategy delivered?
3.2.1 Meeting the aims—the importance of
sheltered housing
The strategy had a number of aims which focused
on keeping the needs of services users at the heart of the programme,
enhancing partnerships with the third sector, delivering in the
new landscape of LAAs and CAAs and increasing efficiency and reducing
bureaucracy.
In our view issues of local council practice
and some changes to the national programme itself have meant that
these aims have not been achieved in all areas of the country.
For example over the period from 2003-04 to
2007-08 we have seen a significant fall in the number of older
people receiving Supporting People funding. Over this period,
numbers of older people in receipt of Supporting People have decreased
by over 100,000, from 919201 in 2003-04 to 808,487 in 2007-08
(Inside Housing 9 January 2009) and whilst there was no "official
explanation", this occurred at a time when resident wardens
in sheltered housing have been dropped in many localities. It
also coincides with a profound period of demographic change where
numbers of older people are growing.
The impact of changes to service in sheltered
housing is the issue we focus on in particular.
3.2.1.1 Promoting independence
Sheltered housing plays a crucial role in maintaining
the independence and well being of older people and thus has an
important role in prevention—preventing more costly health
and care requirements. It is self contained, independent living.
Indeed work commissioned by Communities and Local Government in
2008 (Cap Gemini Research into the Financial Benefits of the Supporting
People programme, 16 January 2008) showed that investing in Supporting
People including in sheltered housing can reduce costs to other
departments and services. In summary it is a high impact, low
cost, preventative service that is much needed especially as the
older population grows.
The average age of people moving into sheltered
housing is 71 (77 for extra care) and many older people chose
sheltered housing because of the supportive environment it offers.
Good quality sheltered housing with a dedicated and resident support
service is popular and is providing older people with security,
safety and a sense of community promoting mutuality, fun and friendship.
About 25% of people moving into sheltered housing are self funders
and many come directly to us (60%) rather than through local council
nomination.
3.2.1.2 Community cohesion
A further and crucial role of sheltered housing
is that good quality schemes provide the "glue" for
a local community with the court manager (Housing 21 term for
scheme manager) playing a crucial role not only in offering support
to residents but in creating a community supporting the local
community of older people surrounding the scheme. Many schemes
provide a range of services and activities for older people in
the locality often through partnerships with other agencies. Mutual
support is created both in the scheme and in the community and
losing this service at a time when we are all concerned about
promoting community cohesion and strong communities seems a retrograde
step. Retaining the community spirit, the activities and the engagement
of people in the schemes will suffer with the lack of a bespoke,
and in preference, resident court manager service.
3.2.1.3 A popular choice
Lastly it has been argued that sheltered housing
releases family housing (where older people were previously occupying
a "family" home and wanted to move to more appropriate
housing for them) and offers a choice for older people to live
in a community and to not feel isolated at home. There is increasing
concern about depression in later life and the isolation of older
people yet Supporting People changes are helping to destroy the
assets that can help to support lonely and isolated older people.
Our annual care and wellbeing survey show that the activities
arranged at our courts—many of which are also used by older
people in the surrounding community—are well used and liked.
For example in our rented schemes at least 40% of tenants take
part on social activities on the sheltered court (with 60% also
open to local people), 30% take part in outings and trips (with
60% open to local people) and 30% take part in informal gatherings
such as coffee mornings. (Housing 21 Care and Well Being report
2008-09)
Whilst there are some concerns about the viability
and sustainability of some schemes there is no doubt that it remains
a popular choice for many older people. Yet we have seen a move
away from funding support services in sheltered housing to a floating
support type model and this is having serious consequences on
the aim of the Supporting People strategy to keep the service
users needs at it heart.
3.2.2 Loss of Supporting People funding for sheltered
housing and its implications
3.2.2.1 Help the Aged research
A report from Help the Aged (Nobody's listening,
2009) based on research into the move to floating support has
raised some concerns that we support as a major provider. Some
of the issues identified in the research are impacting on our
schemes and residents. The research suggests that in three years
only 61% of sheltered schemes will have a warden type service
with floating support covering 38% of schemes. This is from a
base of 5% five years ago. It also sites many examples of changes
that have happened now leading to the loss of dedicated services
in sheltered housing. This includes cancelling existing contracts
for resident wardens with a number of providers and using a larger
generic contract for support services across whole local authority
areas into both sheltered schemes and ordinary housing. We are
concerned about this shift. Coupled with other factors impacting
on sheltered housing including a lack of capital funds for modernisation
and a lack of older people's housing strategies in some areas
this well used and popular asset is in danger of being destroyed.
The Help the Aged research also sites some of
the challenges that older people have had in relation to this
change. This includes worries about the loss of resident warden
services on the security and atmosphere of the schemes, about
cost issues and about lack of consultation. These are well set
out in the Help the Aged report and not therefore repeated here
since we understand Age Concern/Help the Aged will make its own
submission.
A more favourable change highlighted by the
research is the development of floating support services from
existing sheltered housing—often referred to as the hub
and spoke model—where the onsite service is used as
the basis for services to the wider community and to the scheme—something
that we welcome since it protects the service for existing residents
and develops new services for people in the surrounding community.
3.2.2.2 Housing 21 experience
We do want to offer one or two examples of the
impact of the withdrawal of funding for our bespoke and resident
warden service to you which lead to our recommendations.
— In one area where the local council stopped
paying the Supporting People funds (of £3.75 pw) for the
resident manager service and developed a mobile or floating service
of £5 per week our residents chose to continue our service
losing the Supporting People funding support. Given the move toward
personalisation and personal budgets—impacting on SP as
well as care funding we were surprised that developing a personal
SP/support budget was not offered so older people would have been
more in control of the funds available. This was hardly responding
to choice. The Committee really needs to consider the impact of
this agenda in its deliberations. If older people have the choice
to retain a much valued service it seems clear what many would
choose.
— In another area there are plans to withdraw
Supporting People funds for any person living in a bedsit. Presumably
on the grounds that the council considers bedsits unsuitable despite
the fact that older people have chosen to live there. Ironically
evidence from Housing 21's Tenant Satisfaction Survey in 08 shows
that older people in bedsits value the service offered in sheltered
housing more. This leads to another key point. Sheltered housing
does vary across the country. Some schemes are older and in need
of modernisation. Others are incredibly popular. Many offer services
and support to people in the local community as well as in the
schemes. There is not one model and it is the market that will
or should dictate the future of schemes not the arbitrary withdrawal
of funds.
This also points to the lack of a strategic
view of the role and place of sheltered housing in a locality
and the importance of the links with revenue and capital. We
would like to see a more coherent strategy from Government about
the future of sheltered housing—echoing points made by Help
the Aged in their report. This needs to look at capital and revenue
funding issues and its viability as well as how sheltered housing
fits in local housing and older people's strategies. This will
require some funds for reshaping and modernising some schemes
that are still seen to be popular and viable in the longer term.
Housing 21 undertakes its own court viability review—a regular
review of the popularity of schemes taking into account a range
of factors. This leads to much more rounded and strategic decision
making and can challenge some of the assumptions made about the
so called lack of popularity of bedsit accommodation.
By contrast we have some evidence of good practice
in relation to the need to develop new service whilst continuing
to support those in sheltered housing. In one area the council
are offering a lump sum per court facilitating some flexibility
in the support services on offer reflecting different needs but
retaining the essential features. This does not prevent the development
of other floating support services for older people in the community.
We believe this offers a model for a universal approach whilst
offering flexibility for the development of new services including
floating support.
3.2.2.3 Personalisation, social care, sheltered
housing and Supporting People
One key issue that the committee needs to focus
on is that Supporting People is for the person and not the building
which is a concern we have in the approach taken in some areas.
Older people must be consulted about any change and must have
a say in the future of their schemes particularly since when
the Supporting People programme was developed there was a promise
that older people would not lose this support. Wholesale change
based on a building type flies in the face of personalisation.
There is a real need to consider how Supporting
People funding links to the debate about the future funding of
social care and the personalisation agenda. This links to
how sheltered housing offers a preventative service discussed
earlier. Although Supporting People funding has been a part of
the pilots for individual budgets there has been some disparity
between the focus of personal budgets for social care funding
which is at the higher end of the Fair Access to Care criteria
(FACS) and the focus of Supporting People at the preventative/promoting
independence end. There is some concern that Supporting People
could be subsumed in to the care budget with the consequent loss
of funding for prevention and this seems all the more likely given
the impact of the recession on local council budgets.
It seems that initiatives that link housing
with care and health for individual people in an integrated way
are still at first base—one example being the common assessment
framework. The Supporting People strategy talked about both this
framework and individual budgets as a way to join up services
for individuals and though we have some good joined up commissioning
in many councils particularly where we have extra care housing
there is still a way to go to ensure people are at the heart of
service development. We are not convinced that "service users"
do know what to expect from the services on offer to them nor
feel they have real choice or control.
3.2.3 Extra care housing and Supporting People
Generally we have no specific difficulties with
the funds made available under Supporting People for extra care
housing. One issue in extra care has been to ensure that the housing
management, care and support services older people receive are
"seamless" even though there are from different funding
sources. We have found that where care funding and Supporting
People funding is integrated in a local area this has been helpful
and this points to the need for clarity and clear strategies in
specialist housing for older people in localities. We have also
had some positive support though Supporting People funds for activity
coordinators in some areas and this, we hope, will continue.
Like in sheltered housing some consistency would
also help so that there are some clear parameters across the country.
We are also keen that the Committee, in looking at the future
of Supporting People, also considers what issues might arise
from the Green paper on the future funding of social care and
the personalisation agenda for residents of extra care receiving
housing related support. The current system of funding extra care
via social care funding and Supporting People provides a viable,
quality alternative to residential care for many older people.
We want to see this housing continue to be sustained and to flourish
in the new personalisation regime and would make the point that
the Supporting People funded support plays an important role in
this.
A key concern, as for sheltered housing, is
to retain the community spirit, activities and engagement, which
are the hallmark of good quality extra care as the system moves
towards personalisation in care.
3.3 What are the implications of withdrawal
of the ring fence on existing services and on opportunities for
innovation?
Our concern about the loss of the ring fence
is that this will accelerate the loss of preventative services
such as sheltered housing. We welcome the shift to LAAs with the
opportunity for a more integrated and strategic approach. We accept
that the ring fence is unlikely to return and so in its place
needs to be a more robust monitoring and performance framework
that tests how far local councils are supporting older people
to live independently in specialist housing. We are aware
that a proposal in Lifetime Homes, Lifetime Neighbourhoods is
the setting up of an Innovations Panel on the role of specialist
housing and we would like the Committee to recommend that this
looks at support and care services as well as design issues for
the future.
Supporting People in the hands of innovative
councils has led to innovation in service provision and this will
continue. The issue is to ensure that this becomes universal and
based on the outcomes frameworks already established. Our worry
is that in a cash strapped environment and, particularly given
the economic downturn, we don't lose all preventative housing
and support services given that there will no longer be a ring
fence or any clear expectations at national level.
Given the debate about a framework for long
term care where there is now a debate about a providing a universal
offer (progressive universalism) why not consider a similar
universal offer in relation to support in sheltered housing? This
might echo the approach taken by some forward thinking councils
for example.
4. OUR RECOMMENDATIONS
— We would like to see a more coherent
strategy from Government about the future of sheltered housing—echoing
points made by Help the Aged in their report about vision and
leadership on sheltered housing. This needs to look at capital
and revenue funding issues and its viability as well as how sheltered
housing fits in local housing, care, health and older people's
strategies. How Supporting People fits to this strategy will be
important and we urge the Committee to push for a more coherent
national approach which recognises too the role that the market
plays in sheltered housing's future.
— With the loss of the ring fence there
is a need for a robust performance monitoring framework that assesses
how far councils are supporting older people to live independently
in specialist housing. This needs to consider clearly what the
universal offer is in relation to funding support services in
sheltered housing and extra care housing.
— However it is funded there needs to clarity
in the funding of these bespoke support services in sheltered
housing which recognises its key role in the independence and
well being agenda. As stated above this requires a national framework
to offer national consistency. We consider that the current changes
to the programme will not provide the clarity needed and may well
lead to further loss of funds for older people.
— The Committee needs to consider the impact
of the personalisation agenda in its deliberations and the future
of social care and its impact. Although Supporting People funding
has been a part of the pilots for individual budgets there has
been some disparity between the focus of personal budgets for
social care funding which is at the higher end of the Fair Access
to Care criteria (FACS) and the focus of Supporting People at
the preventative/promoting independence end. There is some concern
that Supporting People could be subsumed in to the care budget
with the consequent loss of funding for prevention and this seems
all the more likely given the impact of the recession on local
council budgets. The Committee need to be assured that this does
not happen given the loss of the ring fence. There is also a need
to promote greater joining up at a local level so for example
the Committee might like to pursue the current state of play in
the common assessment framework for example.
— Residents in sheltered housing should
not have their support funding withdrawn without proper consultation—they
moved in on the basis that there would be a resident warden so
there must be a clear process for consultation to take place.
Too often the decision to withdraw is taken on the basis of the
building yet the support is for the person.
— We welcome the development of the "hub
and spoke" model since this retains the service and facilitates
for those in sheltered housing and enables the development of
outreach service for older people in the surrounding community.
There are some examples of this working favourably which can be
drawn on.
— There is a plan for an Innovations Panel
to look at the future of specialist housing as a result of Lifetime
Homes, Lifetime Neighbourhoods. We would like the Committee to
recommend that this looks at support and care services as well
as design issues for the future.
— Lastly the Committee needs to consider
how good practice and innovation can be shared and promoted in
an environment where bespoke funding is being taken away. What
role can the Government take in promoting new solutions whilst
not throwing the old ones away?
May 2009
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