Memorandum from Age Concern and Help the
Aged (SPP 45)
1. SUMMARY
1.1 Many older people have benefited from
innovative services funded, or part funded, under Supporting People
(SP). These services have a vital role helping to promote independent
living and prevent many older people unnecessarily having to enter
nursing homes, residential care, or hospital. Housing support
for older people, offered via SP, often has a low profile but
is an essential component in the delivery of health and social
care at home. Without an appropriate and adaptable home environment
care strategies are likely to fail, which in the long term will
increase public expenditure.
1.2 The future of SP funding is already
distorting or adversely affecting the delivery of retirement housing,
especially in the social rented sector. "Floating support"
is becoming the norm. Guaranteed on-site support is available
only to those older people who can afford to live in the leasehold
retirement sector—where a variation in the lease by majority
agreement is the only means of removing or changing support services.
The needs of residents should be driving the future of the sector—not
the type of funding regime maintaining it. Sheltered housing remains
a positive housing choice for many older people and has an important
role in offering good quality housing options to older people,
whilst freeing up larger family housing.
1.3 The removal of ring fenced funding (in
the absence of other protection) means that the situation is likely
to deteriorate further. Previously protected SP funding will be
diverted to more acute needs related to maintaining social care
support to the most vulnerable. This already appears to be the
case in Barnet where savings in sheltered housing are to be used
to "protect existing older people's services".
1.4 There is growing evidence that low level
housing support for older people offers considerable social and
economic benefits by allowing more people to live independently
at home—this housing support should be offered greater protection.
CLG-commissioned research demonstrates the long term savings and
social benefits offered by preventative services funded under
SP. This is especially the case in the delivery of basic repairs,
adaptations and security features that allow older people to either
remain mobile in their own home, or prevents falls and accidents
that then may require institutional care. But local authorities
appear to be making decisions that deliver returns in the short
term. This means that support is increasingly being rationed to
only the most vulnerable older people. Yet housing support services
offer significant savings over the long term. There is a real
and understandable danger that these services will be downgraded
in the context of acute need around the delivery of core social
care services. Central Government has a responsibility to maintain
a regulated framework of core housing support services, available
to older people regardless of where they live.
1.5 Older homeless people with multiple
care and support needs are already marginalised. Cuts in long
term resettlement and support packages, at a local level, would
worsen the current position.
2. RECOMMENDATIONS
FOR THE
COMMITTEE
2.1 CLG should initiate a comprehensive
policy review of retirement housing in both the private and social
rented sector to look at the impact of funding changes.
2.2 A clearer definition of sheltered housing
is required—and should be facilitated by the Government.
This could set out clearly and concisely to older people, what
they can expect from different types of retirement housing in
the social sector before taking up residence and would offer protection
for different models in the face of funding pressures. We argue
that a fundamental feature of sheltered housing is the provision
of an onsite manager (ie support that is linked to a specific
building). The British Standards Institute (BSI) is developing
models which combine definitions of both physical and service
standards within sheltered schemes—the Government should
explicitly support this work.
2.3 CLG and the Tenants Services Authority
(TSA) should ensure that there are appropriate mechanisms to deal
with legitimate complaints related to housing support with clear
lines of responsibility. Fundamental to delivering any service
is the right to complain if that service is unsatisfactory. Our
research revealed that housing support services in sheltered housing,
funded by SP, appear to fall into a legal grey area. Residents
who make complaints to their provider are referred to the commissioning
authority that may then refer them back to the provider. It appears
that neither the Local Government Ombudsman Service nor the Housing
Ombudsman Service take responsibility for complaints in this area.
Residents who previously wrote to the Housing Corporation or CLG
have been told that they cannot deal with problems, as they are
the responsibility of the local commissioning authority. This
situation is unacceptable.
2.4 CLG should take a more proactive role
in ensuring that local authorities recognise the preventative
role sheltered housing can play. However, initiatives around good
practice will not in themselves address broad problems related
to funding conditions. We welcome the fact that CLG have given
more emphasis to assisting older people living in mainstream housing.
Around 90% of older people live in general needs housing as opposed
to specialist housing. However, specialist housing still has a
vital role to play in combating social isolation and allowing
older people to maintain their independence with the benefit of
low level support. CLG support could include: guidance to commissioning
authorities on how they can protect services during the transitional
period; promotion of good practice among providers based on, for
example, the Centre for Sheltered Housing Studies code of good
practice and: promotion of good practice by housing associations
who have successfully introduced changes to their support services
through engagement and negotiation with their residents.
2.5 CLG should examine the problem of older
homelessness and explore practical measures to ensure more older
people have access to housing and support options that prevent
them ending up in poor temporary accommodation with little or
no prospect of moving on. We are concerned for the most vulnerable
groups of older people, who could experience a further deterioration
in their situation if longer term housing support services are
withdrawn. Our report with Homeless Link, "Coming of Age",
demonstrates that older homeless people could benefit from the
delivery of more flexible packages of care and housing support.
Preventative services can play a crucial role in breaking the
cycle of homelessness, improving quality of life and offering
opportunities to reengage within the local community. We are worried
that socially excluded groups such as older people, without a
strong voice, will be a low priority for many local authorities
over the coming years.
2.6 CLG should set up a working group to
look at how it can improve national performance indictors for
older people to efficiently identify gaps in services. Current
Government indicators, for example NI 142, fail to pick up the
impact of changes in SP and how they affect vulnerable older people.
CLG and DH are proposing guidance to local authorities allowing
them to assess the cost saving of preventative services and tools
to identify and target those most likely to benefit for intervention
("Predicting who will need costly care Kings Fund",
DCLG, DH—2007). Although this approach is welcome in helping
local authorities and health authorities to target resources,
this will not guarantee the continuation of core preventative
services regardless of where an older person lives. Having good
information about the impact of policy changes to older people
in local communities is obviously key in the delivery of local
services. Our work on sheltered housing demonstrated that indicators
of need did not reveal the problems being experience by significant
numbers of older people across the country. National performance
indicators, such as NI 142, do not reflect the services that older
people receive and in fact only measures those already receiving
SP services. Clearly, these indicators are important in determining
how far local authorities are delivering broad national objective.
However, this becomes problematic if indicators are too blunt
to pick up practical service issues for particularly vulnerable
groups. These indicators must act as a trigger for correcting
the kind of systematic failures we have seen related to the withdrawal
of warden services. It is also important that Comprehensive Area
Assessments (CAA) via commissioning authorities, are able to demonstrate
the impact of changes to housing support service on older residents.
2.7 DH and CLG should develop guidance on
the Joint Strategic Needs Assessment (JSNA) to improve intelligence
around the local housing needs of older people. The home environment
is often critical to the successful provision of social care.
However, the delivery of repairs, adaptations and fuel efficiency
measures are often treated separately from the health and social
care services, all designed to allow older people to live comfortably
and independently at home. More progress needs to be made to help
local authorities recognise the interrelationship between these
issues, to allow a more comprehensive and coordinated response.
Without measures like this we believe that local authorities will
not have the necessary information to make informed decisions
about how to best integrate low level housing support with health
and social care services.
2.8 CLG, the HCA and the TSA should have
an important role in supporting local advice and advocacy agencies
to act independently in helping to resolve disputes over the delivery
of services. It is apparent from our research and discussion with
resident groups that in many cases communication between residents,
providers and commissioners has broken down. This means that residents
no longer trust the authorities and are reluctant to negotiate
changes in services, even if they offer improvements in support
services for particular schemes. We believe that an independent
broker is particularly important in any consultation exercise
over services changes. There are examples where providers and
commissioners have not disclosed the full information behind services
decisions to avoid opposition. We think there should be an obligation
on the authorities to disclose full information behind any proposed
changes to services and that residents should have access to an
independent agency that can advocate on their behalf.
3. BACKGROUND
3.1 Age Concern and Help the Aged would
like to praise CLG and the role of the Minister, Baroness Andrews,
for the tremendous progress made on SP funded services, as part
of the Government's general strategy on older people housing,
described in "Lifetime Homes, Lifetime Neighbourhoods"
(DCLG 2008). This strategy has provided a boost for practical
housing services that allow more older people to live independently
at home. This includes an allocation of £35 million
for handyperson services and advice and information services (designed
to help older people successfully navigate their housing and care
options).
3.2 DCLG has actively promoted the role
of home improvement agencies (HIAs) to help older people remain
in their own homes through assistance with basic repairs, adaptations
and financial advice, as well as developing services to help older
people move on to more suitable housing, if required. SP funding
has contributed greatly to the delivery of cost effective practical
services to many vulnerable and low income groups. At the same
time SP has contributed to an ongoing shift towards the improved
coordination of local services, offering a more comprehensive
and joined up approach to supporting independent living. However,
ACE and HTA argue that more needs to be done to bring together
related services such as, for example, Warm Front, POPPS and Home
Improvement Agencies to further extend services to more low income
households. This was the stated aim in the Government's older
people's strategy "Opportunity Age" (DWP 2005). We are
concerned that changes in funding arrangements enhance these developments
rather than cut them back.
3.3 We are worried that cuts in SP type
services will have a disproportionate impact on older people.
This is because older people make up 80% of the client group but
receive just 20% of spending. This means that a reduction in levels
of spending as a result of changes in SP will inevitably have
a disproportionate effect on older people services without a statutory
framework or guarantee for the delivery of services. In our view
the national SP strategy did not properly address older people
and "Lifetime Homes, Lifetime Neighbourhoods" did not
have sufficient analysis of the vital role played by SP in delivering
the Government's older people's housing strategy. Therefore, we
are grateful to the Committee for allowing these concerns to be
raised for further consideration
3.4 We believe that preventative housing
support and social care needs to be regarded as a complete package
in supporting independent living and that basic housing services
for older people need to form part of any social care settlement.
In previous CLG consultations on the future of SP people, ACE
and HTA took the view that basic SP services for older people
should be set within a statutory framework. However, the Government
have taken the view that local authorities are in the best position
to assess the needs of older people locally and to commission
appropriate services. Although we agree that local authorities
should have a stronger role we also believe that this role needs
to be set within a statutory framework that ensures there is minimum
guarantee that basic housing support services are delivered, regardless
of where an older person lives. This needs to be considered in
the context of proposed reforms to social care and the forthcoming
green paper. There is a view that certain basic service should
be accessible to all older people, regardless of income, accompanied
by further consideration of the level of contribution to be made
by the state or the individual beyond that basic provision.
4. SHELTERED
HOUSING AND
WARDEN SERVICES
4.1 We have particular concerns about the
acceleration of changes in sheltered housing as a result of the
ongoing evolution of SP. There is a growing trend, outlined in
our report "Nobody's Listening" towards the withdrawal
on onsite wardens and their replacement with generic or floating
support teams that are not attached to specific sheltered schemes.
The report reveals that in three years time 38% of sheltered housing
will have floating support (as opposed to warden services) from
a base of 5% five years ago. These changes are partly the result
of pressure on local authorities to offer greater efficiencies
in the delivery of services to more older people in the community
who also require housing support. There is certainly a strong
argument that basic housing support services should be available
to all groups of older people regardless of tenure—which
was the stated objective of SP. On this point we are unconvinced
that SP has achieved this objective. In the leasehold sector many
older people receiving pension credit, supported under the previous
system are denied help through SP. Also in the private rented
sector (prs) vulnerable older tenants have not significantly benefited
from housing support services (yet there are comparable numbers
of older people in the prs compared with sheltered housing).
4.2 The development of SP has been particularly
problematic for older people who moved into sheltered housing
on the understanding that they would receive an onsite warden.
Many older people feel that the removal of wardens, as a result
of SP, is unacceptable and that alternative forms of support are
often inferior compared to the regular personal contact offered
by an onsite warden. Although many older people are not adverse
to assistive technology they also require human contact. Older
people are often rightly suspicious of assistive technology if
it is not linked to responsive and reliable services that they
feel confident using.
4.3 When SP funding was introduced in 2003 there
was a debate about whether sheltered housing should be included
under this funding regime. There was an early recognition that
the inclusion of sheltered housing, under SP, could prove problematic
and assurances were given in guidelines designed to protect sheltered
residents. In the report "Supporting People: Policy into
Practice" (DETR, 2001) it was explained that the programme
intended to ensure a continuation of services to existing tenants
in sheltered housing. Authorities, in preparing their SP strategy,
would be required to take full account of those guarantees and
existing obligations. They would not, consequently, be permitted
to withdraw funding from schemes where such an action would leave
the provider unable to continue to provide the support services.
Prior to 2003 sheltered housing was provided as a complete
package, with the funding of housing support via housing benefit
payment for those unable to pay service charges. (There was an
ongoing debate about the move away from residential warden towards
onsite wardens, which pre-dates the SP programme).
4.4 We believe the changes in sheltered
housing, in 2003, created an artificial divide between the funding
of housing management and housing support. This financial component
is at the core of ongoing problems and complexities for many existing
and prospective residents. Although this division may be logical
for the majority of SP services we would like the Committee to
consider whether it is appropriate to sheltered housing. In our
view the split is likely to lead to ongoing instability in the
sector, not only affecting sheltered housing but also the long
term sustainability of extra care housing for vulnerable older
people with additional care needs. Older people considering moving
into to sheltered housing should be offered a core package of
services that define that scheme and removes artificial distinctions
between housing management and housing support. In terms of the
greater choice offered through personalisation, we believe the
choice, in terms of housing support, should be part of the decision
to move into sheltered housing. Older people, who may consider
retirement housing as, perhaps, as their last move, need a longer
term settlement that it not reliant on variations in local authority
budgets from one year to the next. If there are changes in services
all parties need to have agreed parameters and terms of engagement
for that change.
4.5 On a more positive note, the changes
have meant that all older residents receiving SP funding have
an individual support plan and in some cases this has led to a
more strategic approach in the delivery of support. Some of the
difficulties related to support plans in sheltered schemes relate
to the accuracy of the assessments undertaken in the absence of
regular contact.
4.6 Our research highlighted a lack of clarity
over where older residents (and their relatives) can go if they
are unsatisfied with the delivery of housing support services
funded under SP. There is a great deal of confusion about responsibility
for dealing with complaints which appear to fall into an undefined
area in terms of the role of key agencies.
4.7 The Government stated objective is to
ensure that housing services are more closely rooted in what older
people want through local area agreements (LAAs). There is much
evidence that older people prefer the traditional warden services
as opposed to more detached or irregular forms of support. This
is confirmed by the views of older people living in the private
sector, who consistently require an onsite warden. This is because
and onsite wardens offer a regular point of contact for residents
and psychological reassurance in case of an emergency. Despite
the argument that emergency services can be delivered just as
efficiently via telecare, or other forms of assistive technology,
many older people and their friend and relatives find this unsatisfactory.
Clearly, the option for regular contact with a trusted professional
warden is something that older people value, (despite the "experts"
who tell older people they are mistaken and unrealistic in taking
this view).
5. HOME IMPROVEMENT
AGENCIES AND
PREVENTATIVE SERVICES
5.1 We need to ensure that changes in SP
do not undermine the progress made on the development of preventative
service, such as Home Improvement Agencies and handy person services.
CLG has taken steps to facilitate the further development of these
services, which we applaud. In the long term we would like to
see a more integrated package of services that allows a greater
number of older people to live independently. This means bring
together repairs, adaption and efficient heating and insulation
into a coordinated package alongside social care and health.
5.2 There are studies demonstrating the
cost effectiveness of SP services including, most notably, the
Cap Gemini report "Research into the financial benefits of
the SP programme" (January 2008), commissioned by DCLG. This
concluded that the best estimate of the net financial gains of
the Supporting People Programme was £2.77 billion per
year, set against an overall investment of £1.55 billion.
For older people's services it found that for sheltered accommodation
(and other) a cost of £258.7 million gave a £1,090.9 million
gain, for very sheltered housing a cost of £31.4 million
a gained £138.7 million and floating support for older
people costing £37.8 million a net financial benefit
of £25.9 million. Given this evidence it seems surprising
there has not be more analysis of how cost effective SP services
can be protected after the funding transition. Pilot areas looking
at the impact of changes have not provided sufficient time to
properly consider the longer term implications after contracts
have come to an end. Despite demonstrating savings many local
authorities will be under immense pressure to divert funding to
immediate social care priorities, rather than taking a longer
term strategic "invest to save" approach.
5.3 The Committee may be aware that the
London Borough of Barnet has consulted on funding cuts as a result
of pressure to achieve £12 million in savings, of which
£950,000 will be achieved through cutting services in
sheltered schemes. The local MP, Andrews Dismore, secured an adjournment
debate on this on 8 May 2009. We believe the Barnet case
is a further example of the practical dilemma facing many other
authorities, which will be accelerated by the changes to SP, unless
there are measures to maintain and fund resident services.
5.4 There is evidence that the provision
of housing adaptations and equipment delivered by SP funded services
can provide considerable health and social care savings in a number
of areas. The report "Better outcomes, lower costs"
(Office for Disability Issues and Department of Work and Pensions,
2006) points out that the cost of residential care for a wheelchair
users is £700-800 a week or £400,000 over
10 years. The delivery of home modifications, costing on
average £6,000 can prevent or defer entry into residential
care, resulting in a savings of £26,000 in the first
year. The report also highlights saving in: the cost of a home
care; the avoidance of falls and hip fractures; the avoidance
of a range of physical health problems; preventing health care
costs of injury to carers and savings through timely intervention
(link to reforms in the delivery of Disabled Facilities Grant).
The importance of adaptations is also acknowledged in a number
of Audit Commission reports, contributing to a growing awareness
of the importance of improving the reach and scope of preventative
housing services. They have also highlighted the benefits of integrating
adaptations, offered via housing support services, with those
provided through social care and health services. Given this evidence
we would urge the Committee to consider how far SP has contributed
to these services and the consequences of funds being diverted
elsewhere as a result of the proposed changes.
6. OLDER HOMELESSNESS
AND RESETTLEMENT
SERVICES
6.1 SP has had an important role in regard
to tackling older homelessness. It is estimated by the Coalition
for Older Homeless People, that there are in the region of 42,000 older
homeless people in the UK. Age Concern and Help the Aged support
the view that in the long term there should be a statutory obligation
to accommodate all single homeless people. However, until that
is achieved we believe that all homeless people over the age of
50 should automatically be considered vulnerable and in "priority
need" for re-housing. We have expressed concern that the
majority of SP funded services are geared towards the needs of
younger people, involving short term engagement towards training
and employment opportunities.
6.2 The lack of flexible housing support
and resettlement services for vulnerable older people means that
many find themselves stuck in inappropriate temporary accommodation.
We would not accept this situation for the general older population
and we should not accept it for homeless people. Homeless Link,
the Housing Association Charitable Trust and ACE and HTA have
funded and supported innovative services giving older people access
to meaningful occupation projects to improve long term resettlement.
We have struggled to attract statutory funding for services that
are considered mainstream for the housed population. We are concerned
to protect housing support services for vulnerable groups and
having the flexibility to explore innovative approaches.
REFERENCES
"Better outcomes, lower costs" (ODI, DWP—2006)
King, Nigel, et al., "Nobody's Listening"
(Help the Aged—2009)
Lewis, Geraint, "Predicting who will need costly
care—how best to target preventative health, housing and
social programmes" (Kings Fund, DCLG, DH—2007)
"Lifetime Homes, Lifetime Neighbourhoods"
(DCLG—2008)
"Opportunity Age" (DWP—2005)
"Research into the financial benefits of the
SP programme" (DCLG—2008)
Pannell, Jenny, "Coming of age" (Homeless
Link, Help the Aged)
"Supporting People: Policy into Practice"
(DETR, 2001)
May 2009
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