Memorandum from the National Housing Federation
(SPP 98)
EXECUTIVE SUMMARY
Housing related support provides essential preventative
services to vulnerable groups that should be valued and protected.
Supporting People has been shown to provide considerable value
for money to the public purse and cashable savings from, for example,
health and adult social service budgets. The removal of the Supporting
People ring fence creates a significant risk that vital services
for vulnerable people will suffer as funding is diverted away
to other priorities. For the flexibility of the new funding environment
to deliver improved services important safeguards need to be put
in place.
— Public investment and oversight of Supporting
People needs to be maintained. Supporting People funding should,
as a minimum, be maintained at its current level. It should also
be retained as a named expenditure within the area based grant
available to local authorities.
— The CLG should provide a stronger, longer-term,
package of measures to smooth the transition of funding for housing
related support to the area based grant with the lifting of the
ring fence.
— The CLG should remain a national champion
for housing-related support and carry out an annual self-assessment
of its performance on delivering on social exclusion.
— The potential benefits of removing the
ring fence will not be realised without better commissioning practice
across all local authorities. Commissioning practices in some
areas do not recognise the wider value for money of preventative
services. In some areas contract prices are at risk of being so
squeezed as to threaten the quality and viability of services
to the detriment of vulnerable people.
— Local authorities need to take a more
consultative and strategic approach to considering the future
funding of services, such as sheltered housing for older people.
— In the next Spending Review round, government
should commit to a rejuvenated target on social exclusion which
covers a broad range of socially excluded groups and recognises
people with multiple needs.
— The role of housing related support needs
to be recognised by government as a critical part of the future
care and support system.
1. INTRODUCTION
1.1 The National Housing Federation represents
1,200 not-for-profit housing associations. Collectively,
our members provide two million homes and community services for
five million people. Approximately 700 Federation members
provide care and support services for some of the most vulnerable
people in society, including many people who have no contact with
statutory services. They help vulnerable people to maintain their
independence and exercise greater choice and control over their
own lives.
1.2 This submission emphasises the successes
of the Supporting People programme in supporting vulnerable people
and meeting a number of local and national priorities. It highlights
some of the challenges of the programme and the potential risks
to service users of removing the ring fence and makes recommendations
in the light of these.
2. THE VALUE
AND IMPORTANCE
OF HOUSING
RELATED SUPPORT
2.1 Housing related support is vital in
helping vulnerable people to live independently, develop life-skills,
participate in their community and fulfil their potential, as
evidenced by the Supporting People Outcomes Framework.[24]
2.2 Housing related support has been shown
to be cost effective and good value for money. The CapGemini study
of the benefits of Supporting People estimated that £1.55 billion
in housing-related support services generated savings of £2.77 billion
to the public purse.[25]
2.3 More recently, the Federation has been
working with the Department of Health's Care Services Efficiency
Delivery team to demonstrate the cashable savings that housing
related support can deliver to health and adult social service
budgets, through, for example, the avoidance of hospital admissions
and reduced numbers of "looked-after" children.[26]
The services analysed often cost less and delivered better outcomes
than the most likely alternative if housing related support was
not available. They also enabled people to exercise greater independence,
choice and control over their lives.
CASE STUDY
1: ONE HOUSING
GROUP—PONDERS
BRIDGE HOUSE
One Support developed this service in London
to address the needs of residents with severe mental health problems.
It was commissioned jointly by the local authority and Primary
Care Trust to bridge the gap between institutional care and independent
living. It provides a mixture of specialist individual support
and group living skills. The care costs for residents are £19,000 less
per person per annum than hospital or residential care.
CASE STUDY
2: ENDEAVOUR HOUSING
ASSOCIATION—HESTIA
Endeavour Housing Association developed the Hestia
project to provide settled accommodation and support for women
with multiple and complex needs, including drug and alcohol addictions,
mental health problems and repeat offending. Together, Endeavour,
the health trust, police and probation services identified this
group as falling between the cracks of statutory services and
re-presenting at acute services with increasingly complex needs.
The project consists of 10 properties with a linked support
package to help the residents live as independently as possible
and engage with education, training and work. A co-ordinator links
all the statutory agencies involved to help deliver tailored support
to each resident. The project has reported reduced admissions
to hospital, a reduction in offending behaviour and has prevented
children being taken into care. Annual savings to social services,
health and local authority housing services are estimated at £12,000 per
client.
3. PRESERVING
THE SUCCESSES
OF SUPPORTING
PEOPLE
3.1 The Supporting People programme has
helped drive improvements in housing related support. Since 2003 there
have been a number of successes in commissioning, delivering and
monitoring services. Of course, not every administering authority
can boast best practice and significant challenges and obstacles
remain. Nevertheless, a number of Supporting People's successes
are significant steps forward that need to be protected as the
ring fence is withdrawn and the identity of the programme is threatened.
The successes of the programme to date include:
— User involvement—service users
are now much more involved in making decisions about the services
they receive.
— Demonstrable value for money, as shown
above.
— Personalised services—individual,
tailored support plans have become a core part of Supporting People
services.
— Quality services—All Supporting
People services are assessed and reviewed and the Quality Assessment
Framework continues to drive up standards.
— Focus on outcomes—Supporting People
services can clearly demonstrate how they help people to achieve
or maintain independence.
— Better ways of working—providers
forums help share good practice to improve and join-up services
for users.
3.2 As the Audit Commission inspections
of local authorities have demonstrated, good practice is not standard
across the country and there remain major concerns about the implementation
of programme in some local areas. Where it occurs, good practice
is often a result of Supporting People teams in the local authority
working with support providers to understand local needs and agree
contracts that focus on the outcomes that a service should achieve.
4. COMMISSIONING,
FUNDING AND
CONTRACTING
4.1 Reducing bureaucracy and increasing
efficiency was a key theme of the 2007 Supporting People
Strategy.[27]
The programme's record on this has been mixed. Housing associations
have worked with commissioners to review services, develop new
models of delivery and identify cost savings. However, the tendering
process and the various contract monitoring and managing commitments
has increased bureaucracy and added administrative costs in some
areas.
4.2 Since the launch of Supporting People,
services have faced year-on-year pressure on contract pricing.
While costs for service providers have risen, there has tended
to be little or no inflationary uplift offered by administering
authorities. Some local authorities have cut costs by blanket
cuts rather than making strategic decisions about what services
are needed and what can be provided for the money available. An
Audit Commission report[28]
in 2005 found that many local authorities were not making
efficiency savings in a strategic way by allocating funding according
to need. It also found that there was little scope for further
efficiency gains.
4.3 In the summer of 2008, the Federation
conducted a survey of its members on funding and contracting.
This found that:
— In 2007-08 for the contracts surveyed
the average increase was 1.4%. In 35% of contracts covered by
the survey, no uplift was received by the respondents.
— Few contracts went beyond April 2009 making
it difficult to plan to meet the needs of vulnerable people.
— Providers were subsidising services from
organisational reserves or other funding streams.
— Providers have had to respond to a real-terms
reduction in contract prices by increasing caseloads for support
workers and shortening the length of time spent with each client
to maximise the number of clients.
4.4 Our members are increasingly concerned
that services will deteriorate in quality or cease to be viable
and about the negative impact this will have on the lives of vulnerable
people.
4.5 Achieving value for money in any service
requires a careful trade-off between price and quality. However,
continually expecting providers to reach more clients on the same
or, in real terms, lower levels of investment is unsustainable.
Investment in housing related support needs to be maintained in
order to ensure high quality services.
4.6 Supporting People commissioning has
developed useful data on comparative costs and prices which have
helped improve efficiency. However, commissioners need a more
sophisticated understanding of value for money than seeking the
lowest costs available or maximising throughput. A broader concept
of value for money should take into account outcomes across the
whole lifecycle of a service, including savings to other services,
such as health.
4.7 Effective contract negotiations should
include an honest discussion about pricing and outcome targets
in relation to the type of service and client group involved.
Commissioners should actively tailor monitoring requirements to
focus on what is needed to judge the effectiveness of a service.
4.8 The commissioning, tendering and monitoring
process can create massive bureaucratic burdens for housing associations.
Our survey in 2008 revealed many providers were still on
short-term contracts. The demands of tendering for services every
two or three years requires our members to engage in a constant
cycle of evidence gathering, form-filling and box-ticking. Some
commissioners have used framework agreements and steady-state
contracts to reduce the administrative burden and improve value
for money. Of course, public spending decisions need to be transparent,
accountable and evidence based, but real concerns remain that
contracting and monitoring processes are disproportionately and
unnecessarily bureaucratic. This is not in the interests of service
users, particularly given providers' ability to demonstrate the
quality of their services and the outcomes achieved.
CASE STUDY
3: HAMPSHIRE COUNTY
COUNCIL
In 2006, Hampshire County Council conducted a
value for money evaluation of the costs of tendering some of their
Supporting People services. They compared costs of competitively
tendered services against those which had been subject to a detailed
value for money assessment, but had been purchased following individual
negotiations with providers rather than a tendering exercise.
The Supporting People team compared outcomes and hourly rates
of the services, as well as looking at the costs to the authority
in staff time spent managing the process, including advertising
tender opportunities, evaluating bids and contract negotiations.
They found that competitive tendering added considerable costs
for little or no discernable benefits in quality or outcomes of
services purchased.
4.9 In some areas, hourly rates for Supporting
People services have been compared to the relatively lower rates
of domiciliary care by local authorities. Such a comparison ignores
the specific skills of providing support to vulnerable people
that staff can bring to services, including giving advice and
making subtle judgements as part of assessing the needs of individual
clients for personal support plans. These skills distinct from
domiciliary care and should be valued in their own right.
4.10 Despite the raft of guidance for better
commissioning from housing related care and support, health services
and commissioning from the third sector, good commissioning practice
remains patchy.
5. FUTURE THREATS
AND OPPORTUNITIES
(a) End of the ring fence
5.1 The removal of the ring fence creates
opportunities for local authorities to respond to local needs
in more flexible and creative ways. Commissioners can work together
to link up housing related support with other services to deliver
better outcomes without being constrained by the specific eligibility
criteria of Supporting People. High-performing local authorities
with engaged Supporting People teams have already used these freedoms
to develop new services to better meet local needs.
5.2 However, in areas where Supporting People
has struggled to gain recognition by other departments and services,
housing related support may lose out. This point is explored in
more detail below.
(b) The risk to services for the most vulnerable
people in our society
5.3 The Supporting People programme has
given an impetus and identity to housing related support. Without
the protection of a distinct grant there is a significant risk
that funding for housing related support services will be diverted
to meet other priorities and, as a result, vulnerable people will
suffer. There are several reasons why, despite its effectiveness
and track record, housing related support is vulnerable to cuts.
These include the failure of some local authorities to recognise
the value of the preventative services as a high a priority. This
is not helped by the absence of a specific statutory duty to support
Supporting People client groups. In some areas, there is also
a pressure to divert funding towards more politically popular
local issues than services for socially excluded people.
5.4 The fear that money will be diverted
away from Supporting People is heightened by the additional pressures
on local authority spending in an economic downturn.
5.5 If funding is diverted away from Supporting
People, services will close. Losing these services would undo
many of the successes achieved in recent years and would deepen
the challenges faced by vulnerable and socially excluded people.
Socially excluded groups with complex and multiple needs often
struggle to access the services they need as it is. If services
close, a vital safety net of support will be removed. This could
exacerbate social problems like rough sleeping, poor mental health,
drug and alcohol addictions. In the longer term this would increase
costs for statutory services, placing much greater demands on
acute health services, accident and emergency departments, the
mental health system, children's services, probation services
and residential care.
5.6 There is less of a risk of money being
diverted away from Supporting People in high performing local
authorities, where there are active Supporting People teams and
a strong track record in engaging providers and reviewing services.
In such areas the importance of housing related support is recognised
and prioritised across local authority strategies. However, there
are many areas where Supporting People has struggled for recognition.
In these areas, opportunities of greater freedom and flexibility
may be used to close services. There is already considerable regional
variation in the availability of housing related support. This
means there are big differences in life chances for vulnerable
people depending on where they live. Removing the ring fence has
the potential to increase this inequality between local authorities.
5.7 While greater local freedom and flexibility
creates opportunities for better, more outcomes focused commissioning,
it does not guarantee it. Losing the focus, structures and "brand"
of Supporting People may frustrate better commissioning of services
by reducing the profile of housing related support. Without a
ring fenced programme to provide a focus and rallying point, extra
effort is required from government to ensure there are the structures
and opportunities for providers to work with commissioners in
a co-ordinated way to tackle major long-term issues.
5.8 The removal of the ring fence will also
make it harder to track and evaluate how funds are being spent.
It will be more difficult to understand what is happening with
expenditure on housing related support if it can not be inspected
or audited separately. The Audit Commission's comprehensive area
assessment, the new inspection framework for local public services,
has a broad commitment to assess the impact of local services
on vulnerable people. However, it remains to be seen to what extent
it is possible and realistic for the assessment to review an area's
performance against indicators that it has not prioritised.
5.9 There are also a number of "vulnerable"
and socially excluded people who fall outside the national indicator
set. The groups covered by the targets in PSA 16 are limited
to people who are already in contact with statutory services.
Many people in contact with Supporting People services fall out
of these categories: homeless people, people with moderate learning
disabilities or people with mental health problems who do not
access medical care. To understand the picture of local provision
and protect services there needs to be a way to understand and
monitor expenditure on housing related support at the national
level.
(c) Getting the case heard by local partners
5.10 Housing associations are seeking to
engage with a broader range of local partners and local authority
departments to convince Local Strategic Partnerships (LSPs) to
make housing related support a priority for the local area. Many
of our members are already working hard to get the case for vulnerable
people heard locally. This has included discussions with adult
social care teams, health and drug and alcohol commissioners to
show how housing related support can meet local needs and underpin
a wide range of local authority priorities.
5.11 However, LSPs are not all equally accessible
or ready to receive these messages. Housing associations have
faced the following problems in getting their case heard by local
partners:
— Basic accessibility and transparency
of the LSP—getting clarity over decision-making processes.
— Lack of understanding of housing related
support.
— Lack of support provider representation
on the LSP—housing associations providing care and support
services are usually assumed to be represented through the voice
of the voluntary sector representative, if at all.
5.12 If housing associations are to continue
to deliver a high level of services to vulnerable people they
need a more supportive environment in which they can make links
across services. The ways of doing this will vary locally, but
central government needs to give a range of incentives to ensure
local partnerships and statutory authorities focus and prioritise
support services for socially excluded groups.
(d) Older people's services
5.13 Supporting People has allowed a greater
number of older people to access the kind of low level support
they need for maintaining their independence. However, concerns
have been expressed by some tenants and providers about the impact
of Supporting People cuts on sheltered housing.
5.14 Floating support is increasingly used
as the model for services, where support is not limited to a specific
site or type of accommodation but delivered to the wider community.
In the right circumstances, this can help providers deliver flexible
support to meet the needs of service users regardless of the tenure
they have. However, some providers and residents have raised concerns
where money has not remained available to continue to employ scheme-based
wardens. Wardens are popular with older people and many moved
into sheltered housing with the expectation that these services
would continue. The withdrawal of wardens has also had meant in
some areas that there are fewer opportunities to provide neighbourhood
social activities which are important in tackling the isolation
and loneliness that too many older people face.
5.15 Concerns are often the result of the
absence of a clear local strategy for sheltered housing based
on an understanding of what would best meet older people's needs
in the area. This can lead to an inflexible approach where new
models of service are imposed on residents and providers, without
asking older people what they want and without allowing an adequate
time for providers and residents to discuss the options available.
(e) The link between accommodation and support
5.16 Capital investment in housing is a
vital component of effective housing related support. People with
higher-level or multiple needs, for instance, will often need
specifically designed housing that can bring together care services
as well as housing related support. This might include extra care
or sheltered housing for older people, or accommodation for people
with mental health problems or purpose-built foyers for younger
people. These projects address housing and other needs at the
same time.
5.17 Supporting People has removed the link
between developing new specialist accommodation and funding for
housing related care and support, making it harder for housing
associations to deliver new supported housing. Associations face
risks in develop new accommodation where there is no guarantee
that they will be able to deliver support services connected with
it once built.
5.18 There are a number of other significant
issues that hinder the development of the broad range of supported
housing options needed. These include the lack of good data on
needs in local and regional development plans, NIMBY-ism and the
difficulty in getting planning consent and the failure of capital
investment programmes to accommodate the additional costs or challenges
associated with the delivery of some types of specialist housing.
5.19 Local authorities need to work with
housing associations and service providers to gain a better understanding
of the need for supported housing and feed this into plans for
upgrading, remodelling or redeveloping existing provision of supported
housing.
(f) Uncertainty of the impact of the removal
of the ring fence
5.20 The risks of removing the ring fence
are high and the precise impact of the changes to Supporting People
is still uncertain.
5.21 It is still far too early to gauge
the likely impact of removing the ring fence. The timescales for
the pathfinder authorities that piloted greater freedoms in Supporting
People were too short to allow authorities to explore the full
range of options available or to see significant changes in commissioning
practices emerge. Given the varying length of existing Supporting
People contracts it will be a considerable time before it is possible
to get a broader sense of what is happening to housing related
care and support.
5.22 This significant and potentially disruptive
change to funding threatens to destabilise services to vulnerable
people.
5.23 These significant uncertainties reinforce
the need to retain Supporting People as a named grant within the
area based grant and offer additional support to start to reduce
the scale of uncertainty affecting the future of vital services.
6. RECOMMENDATIONS
6.1 Public investment and oversight of Supporting
People needs to be maintained to safeguard vital, high-quality,
services to vulnerable people and save public money in the long
term. Supporting People funding should, as a minimum, be maintained
at its current level with allowance made for inflation and increases
in demand for services due to the effects of the recession.
6.2 Supporting People should be retained
as a named grant and named expenditure within the area based grant.
This will make it easier to focus on and track expenditure on
housing related support within the grant local authorities receive
to deliver priorities in their area.
6.3 CLG should remain a national champion
for housing-related support. This would include monitoring the
patterns of expenditure of local authorities, continuing to collect
and co-ordinate data on the national outcomes framework and an
annual departmental self-assessment of its performance on delivering
on social exclusion.
6.4 CLG should provide a stronger, longer-term,
package of measures to smooth the transition of funding for housing
related support to the area based grant. This should include working
with local authorities, service users and providers to capture
good practice in commissioning.
6.5 The Social Exclusion Task Force in the
Cabinet Office and CLG should work across government to improve
the understanding, at a national and local level, as to how housing
related support can contribute to social inclusion and meet broader
targets on, for example, health, child well-being and crime reduction.
6.6 The Office of Government Commerce should
clarify and promote its guidance on value for money and competitive
tendering to advise on where and when other approaches to purchasing
services can be applied by local authorities. Central government
should work with local authorities to communicate this message
to local commissioners.
6.7 The Government will soon publish a Green
Paper to consult on a range of options to reform social care.
The role of housing related support needs to be recognised across
government as a critical part of the future care and support system.
6.8 In the next Spending Review round, government
should commit to a rejuvenated target on social exclusion which
covers a broad range of socially excluded groups and recognises
people with multiple needs.
6.9 Local authorities should involve older
people when carry out reviews of funding for support services
in sheltered housing. They should consider setting out a strategy
for the long term future of sheltered schemes and support for
older people, prior to any changes in funding.
May 2009
24 Supporting People Client Records and Outcomes Annual
Report 2007-2008, CHR University of St Andrews, www.spclientrecord.org.uk/publications/SP_Annual_Report_2007_08.pdf Back
25
Capgemini, Research into the financial benefits of the Supporting
People programme, CLG, 2008 Back
26
For further information on this work and full versions of the
case studies cited here visit: www.dhcarenetworks.org.uk/csed/Solutions/supportRelatedHousing/ Back
27
Independence and Opportunity. Our Strategy for Supporting People,
Communities and Local Government, June 2007. Back
28
Supporting People: refreshing the national vision, Audit
Commission national report October 2005 Back
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