Memorandum from Brighton & Hove Sheltered
Housing Action Group (SPP 105)
HOW SUPPORTING PEOPLE STRATEGIES ARE AFFECTING
SHELTERED HOUSING
SUMMARY
— Shortcomings in accessibility and accountability
of Supporting People (SP) to client groups and obstacles to obtaining
information about SP and its policies;
— Poor front-line support by SP causing
neglect within Sheltered Housing and how its policies will further
erode a failing service;
— Today most local and national SP policies
are working against Sheltered Housing, not for it;
— One grass-roots Tenant Participation
group has begun to improve the service where SP have failed by
using democratic processes but this is one exception to a national
trend of failure;
— Actions being planned to overcome the
limitations of the SP system in supporting the most vulnerable
elderly need to be backed by both Local and National Government
else government is abdicating its responsibilities to the vulnerable;
— Sheltered Housing (SH) and the care of
the elderly in the greater community is not being successfully
handled by SP. Direct funding through the benefits system would
be far more cost effective and fair.
AUTHORSHIP
This critique of Supporting People (SP) has
been hurriedly written (given the short lead time) by the Vice-Chair
of Brighton and Hove (B&H) Sheltered Housing Action Group
(SHAG) in consultation with the Chair and many of the 24 Tenant
representatives who have been actively engaged in the Council
review of Sheltered Housing as the recognised Tenant Participation
body by Brighton and Hove City Council (BHCC).
SUBMISSION TO
COMMUNITIES AND
LOCAL GOVERNMENT
COMMITTEE
A. What is happening to Sheltered Housing?
1. Sheltered Housing (SH) is threatened
by failures in addressing service users needs. Supporting People
(SP) have been proposing a policy of saving money by reducing
services and calling this reduction an expansion of SH services
into the "wider community". An extract from the
current Strategic Actions for older people listed in the Supporting
People Strategy 2008-09 for Brighton and Hove follows. The
Strategy in full as published March 2008 is attached in Word
format. This document is already in the public domain.
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| Objective 7 | To ensure services are accessible to older people with support needs in the wider community
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| strategic actions |
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— To develop the role of sheltered and extra care housing as centres of information, support, events and activities within local communities to minimise isolation of older people
— Access to services to be based on an assessment of need, whilst recognising the need to provide a balanced community
| — To develop floating support services for older people that are available to the wider community across all tenure-types
— To maximise potential for services to become extra care through changes to Supporting People contracts to deliver different levels of support
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| success criteria | |
| — Increase in the number of floating support provided
| — Increased numbers of people in the wider community accessing information and support in the wider community
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2. The first Strategic Action (SA) appears to be laudable
in including vulnerable elderly in "the wider community",
but represents a cost-saving and box-ticking exercise. It translates
into using the common areas, which are contractually intended
for the enjoyment of tenants, as a Community Centre. It carries
the implication that sheltered tenants do not have the right to
control their social areas and who uses them. In practise our
SH Tenants' Associations reject any unsolicited intrusions into
their homes and successful mixing of SH tenants and others has
only occurred in bona fide Community Centres. This seems to be
a point that has escaped the notice of both Local Authorities
and Supporting People consistently, when there are a plethora
of well-equipped and often under-used Community Centres. We know
of one project in B&H where a Community Centre is being used
quite successfully to engage both SH tenants and older people
from the wider community.
3. The second SA is being addressed by BHCC by proposing
a change to SH entry criteria that will in future only allow people
with a support need access to sheltered housing. While we support
this and other changes to SH policy we hope that this will not
mean an inappropriate inclusion of younger people with support
needs which could lead to situations of social incompatibility
with frail elderly who may be fearful, for instance ex-offenders
or substance-misusers. This SA could also include the implication
that Scheme Managers become involved with local communities when
they are already over-stretched in managing their in-house duties.
It will inevitably mean a gradual increase in the proportions
who have a support need, and thus alter the balance of the community.
This will require that independently policed safeguards for those
who may not be able to advocate for themselves in the future must
be set in stone.
4. The third SA seeks to use Scheme Managers (aka Wardens—a
term with unacceptable associations), already in short supply,
as a resource outside of Sheltered Housing. Because the term "floating
support" has become a Supporting People buzz-word that
may have advantages in non-residential contexts across the 13 service-user
groups it masks a move to stretch human resources to an impossible
degree which will impact directly on the well-being, health, dignity
and mortality of the most frail elderly within Sheltered Housing.
We assure the Honourable Members that there is no hyperbole here.
People are already suffering.
5. The committee will be aware that Help The Aged commissioned
a 90 page report Nobody's Listening based upon a small
sample of Sheltered Housing tenants that condemned the move to
"floating support" services, forecasting that
within three years only 61% of SH will have a Scheme Manager service.
When she tried to dismiss this report Baroness Andrews was reportedly
inundated with hundreds of emails and letters. We understand she
is now supposed to be looking further into the issues with agencies
and individuals speaking for the elderly. She has not, however,
consulted the real experts, us, despite several emails from us.
In Brighton and Hove 92% of approximately 1,000 Sheltered
Tenants signed a petition rejecting "floating support"
or any model of Scheme Manager other than the traditional on-site
model (see Case Study below).
B. The Meaning and Cost of "failures"
1. The author wishes to emphasise that when this submission
speaks of "failures" in the Sheltered Service it is
referring to instances that have led to years of suffering followed
by avoidable deaths, to "service-users" enduring
severe physical and mental suffering, such as walking around with
a broken hip, to falling prey to dementia and Alzheimer's without
anyone noticing, except, as in a case at the author's scheme,
when we as neighbours took up the cases ourselves. We well know,
as does any police officer who has had to attend the scene of
such indignities, there are people right now sitting in their
own excrement for days, living and dying without a shred of dignity
and so on. Many cases are documented, all too often, not documented
where the elderly person is socially isolated, bed-ridden or severely
disabled. This is what we mean by "failure".
C. Accessibility and accountability of Supporting People
1. A further problem with SP is their inaccessibility.
It took the author over 6 months to be made aware that he
and his fellow tenant reps could attend local SP meetings (locally
Supporting People Action Team—SPAT) and only a few weeks
ago was he invited to an SP Core Strategy Group meeting where
he was able to access just a little more information.
2. The Chair and Vice-Chair of SHAG have since last September
been requesting a clarification of the SP formula for adjusting
three-year budgets (in B&H our SH grant is to be cut by 11.5%
over three years). There was a universally unhelpful attitude
and finally we were forced to make an issue out of it with BHCC
Housing Management Consultative Committee in order to increase
pressure on Supporting People by Council Officers to obtain this
information from SP in London and the local offices. (This request
for information may yet be pursued by a resident as a back-burner
project under the FOA, but we are not hopeful.) The information
has been requested by other SHAG officers for about two years.
We were eventually given the following link to information that
is so arcane it is virtually impossible for the lay-person to
understand, and does not answer the question "Why is out
grant being reduced" directly. This information is so unfathomable
it negates any practical call to account by the service user.
http://www.spkweb.org.uk/Subjects/Distribution+Formula/
In effect this information has not been forthcoming. We have
given up trying to get any sense out of Supporting People. They
have been high-handed and arrogant.
D. Problems with the models of front-line support promoted
by Supporting People
1. Two things distinguish Sheltered Housing from standard
social housing. The pull-chord/out-of-hours service for emergencies
and the Scheme Manager. Scheme Managers in BHCC Sheltered Housing
are on duty for a standard working week where the Manager is full-time
at a Scheme, or for five half days where they are shared by two
smaller schemes.
2. In B&H Scheme Managers are advertised to applicants
for Social Housing as part of the deal in the local Homemove
choice-based lettings magazine. Despite this continuing promise,
SP were driving the move to floating or team-based
support (essentially a euphemism for floating support).
Sheltered Housing providers, including the Council, were planning
reductions in front-line staff and their removal from site-based
duties to a centralised office, much like the out-of-hours service,
with the strong suggestion that they would be limiting their service-user
contact to a weekly, daily or monthly telephone call, and only
a very occasional (annual or six-monthly) face to face assessment
interview.
3. We understand the rationale behind the assumption
that such contact in conjunction with a service-user's care package
should ensure their well-being, but this is a fairy-tale.
It is out of touch with the reality of carers from even the best
quality service providers having to make 20 client visits
per day routinely, restricting what should be a 30-45 minute
contact to 15 minutes. Where carers working for organisations
such as those highlighted by a recent Panorama expos
might not visit at all for days this assumption represents
institutionalised bureaucratic neglect.
4. It is unfortunate that what should be a truism, that
the elderly can deteriorate physically and/or mentally in a matter
of days, does not figure in this dangerous rationale. People are
and will continue to suffer all over the UK. Telephoning a frail
elderly person and asking them if they are OK is as useless as
completely neglecting them, and to pretend otherwise is to turn
one's eyes away from an unpalatable truth. Older people's behaviours
range from attention seeking to fierce independence or not wanting
to make a fuss. Many of us "have all our marbles" but
we are aware that some of the most vulnerable may not be used
to or capable of asserting themselves when they need to. A floating
support manager might receive the answer, "I'm fine"
over the telephone from an older person suffering from unreported
dementia which a carer's short visit might not discover. They
could be sitting in their own excrement or urine, they could be
suffering from angina attacks or mini-strokes, the onset of dementia
or Alzheimer's and it could so easily be missed. They might have
had a fall and be confused by concussion. Once again, this is
not exaggeration, it is occurring right now. The 24 Tenant
reps in our Sheltered Housing Action Group are currently engaged
in an ongoing exercise to document these failures as a part of
our drive to improve service delivery.
5. Traditional on-site managers know their service-users.
They have the opportunity to establish a rapport, they will tend
to physically see and speak with their charges day to day, week
to week. They are on-hand to re-assure, re-assess where some rapid
deterioration is in evidence. They are available for other tenants
who may be concerned about a neighbour. Off-site managers, whatever
fancy buzz-words and titles are employed are as good as useless.
The author makes no apology for the strength of these expressions.
Older people are suffering, wandering corridors and even streets
at night, deteriorating and dying needlessly as I write and as
you read this.
E. Case Study: The history of Sheltered Housing in Brighton
and Hove
1. A perfect example exists here in Brighton at the largest
sheltered scheme where the author of this report happens to live.
Some years ago there were two sheltered scheme managers working
here and a caretaker, taking care of 108 "units"
comprising around 130 tenants in single and double occupancy.
Now there is one manager and no caretaker, despite the fact that
the building is not effectively secured against intruders, and
there have been plenty of incidents of intrusion. In theory there
should be one scheme manager per 45 units. The chair of our
Tenants' Association walks the building every night, when his
health permits, to ensure at least that windows and doors
are secured.
2. The current Chair and Vice-Chair of our tenant Group,
Brighton & Hove's Sheltered Housing Action Group (SHAG), inherited
a situation in September 2008 in which Sheltered Housing
Management were proposing a move to floating support City-wide,
with a staff of 17 managers to cover 872 units comprising
24 sheltered schemes varying in size between 15 and
108 units. These managers were projected to be working from
a central location, not onsite with their client group, and
look after people in the wider community.
3. Sheltered Tenants in Brighton and Hove, in common
with many others throughout the UK, feared that a move to floating
support would stretch an already flawed service too thin causing
the service to fail catastrophically. Consequently a first step
was taken by means of a petition to retain the traditional model
of full-time, onsite scheme managers and reject any move to floating
support. This was signed by a huge majority of 92% of BHCC Sheltered
Tenants across all sheltered schemes.
4. Because the rationale for this reduction was presented
as financial necessity, the Chair and Vice-Chair, supported by
a small executive of area representatives and reporting democratically
to the 24 elected reps (one per scheme) of the General Meeting
of SHAG, negotiated an alternative solution by examining how the
Supporting People grant is spent, and where savings could be made
to fund the most important front-line service, the onsite scheme
manager.
5. The result, at least in principle, was a triumph for
self-directed democratic participation. With the support of the
Cabinet Member for Housing we evolved a policy as outlined in
the Agenda, Decisions and Minutes of the Housing Management Consultative
Committee Tuesday, 20th January, 2009 (link to BHCC documentation
follows):
http://present.brighton-hove.gov.uk/ieListDocuments.aspx?CId=163&MId=251&Ver=4
item 58 Sheltered Housing Review—link to pdf file
with full text of Review.
6. The central recommendation that was approved reads:
2.1 The Housing Management Consultative Committee recommends
that the Housing Cabinet Member meeting:
2.2 (1)Notes the proposal, following consultation with
residents, to retain a traditional, on site, scheme manager model
of service, which will continue to be managed as a non residential
service.
7. In addition later in the document there is a commitment
to 21 onsite Scheme Managers and a list of nine areas of
Tenant Consultation and Participation, sufficient to allow us
to adopt a proactive, leading role in the direction of the Sheltered
Housing Review which is ongoing. Our second aim is to ensure excellence
in service delivery, and our final aim will be to try to ensure
the continuity of excellence for the future whatever the changes
in both local and central government, statutory funding or macroeconomics.
8. We contributed to the success of the first stage of
implementation of this policy by amending a proposed advertisement
for the recruitment of the eight Scheme Managers required to reach
a total of 21. As a result of this ad, online and in the press,
approximately 22 high quality candidates attended a Scheme
Manager recruitment open day recently and 19 of them signalled
their continuing interest by leaving their contact details. At
the closing date in excess of 50 applications for the eight
posts have been received and we look forward to having the luxury
of choice of the best candidates.
9. Among the areas of participation in B&H there
will be a tenant on the recruitment panel and up to seven tenant
reps will be involved in other aspects of the recruitment process,
from the preparation of interview material to the examination
of candidate answers.
F. NOT Supporting People
1. We are painfully aware that our success in taking
the bull of democracy by the horns, using both the Housing Act
and the Sustainable Communities Act intelligently and effectively
is almost unique. To our knowledge only Liverpool have matched
our efforts to retain on-site Scheme Managers in public sector
housing, and the position for the private sector is by all reports
far worse.
2. SP have not supported us in this, and in fact their
policy document is currently under review for presentation to
Council in June and only the clause that is struck through in
the extract above has been removed. The rest of the Strategic
Actions remain unchanged, including the words "across
all tenure types" which includes Public Sector Social
Housing, despite the fact that this is now against BHCC policy.
We cannot include this document as it is still in draft form and
not in the public domain.
3. We place this de facto change of policy fully
at the door of Supporting People. It is they who have prescribed
the solution of floating support across all tenure types.
Let us call things by their real names—for floating support
please read institutionalised neglect.
G. Supporting People Strategy in relation to Sheltered
Housing
1. Supporting People's strategy "Independence
and Opportunity: Our strategy for Supporting People":
— Keeping people that need services at the heart of
the programme;
— Enhancing partnership with the Third Sector;
— Delivering in the new local government landscape;
and
— Increasing efficiency and reducing bureaucracy.
2. By no stretch of the imagination have these four key
themes been fulfilled. The people served have not been consulted
by Supporting People, otherwise they would have realised that
our group of service users (92% of approximately 1,000 public
sector Sheltered Housing Tenants) are totally opposed to SP's
ideological fixation upon "floating support".
There was a consultation exercise by B&H Sheltered Housing,
but it was sporadic, unscientific, not representing the majority,
and until the review process was challenged by the Sheltered Housing
Action Group and dragged into the light of accountability and
into the right of proper participation nothing would have stopped
this insidious policy that is destroying sheltered housing nationwide.
At no time, until they realised we were on the winning side, did
SP make any attempt to consult with the representatives and members
of SHAG.
3. These arguments, and the account of the successful
tenant-led initiative described in item E 1-9 above,
also speak to the second key theme. The partnership between BHCC
and SHAG was forged by the intense self-directed efforts of our
democratically elected representative body and its officers, never
by SP. To be brutally frank, although Supporting People are notionally
our funders, they have come to be viewed as an arrogant unapproachable
enemy to democracy and the rights of the elderly. The Council
have turned out to be our committed partners, but we know from
other regions such commitment is rare.
4. Whatever the third key theme means, well, it is hardly
worthy of consideration—if "Delivering into" means
the attempt to dictate Council Policy by a non-accountable quango,
then they have succeeded.
5. The last key theme is frankly risible. How does (in
the case of Sheltered Housing) an unnecessary layer of bureaucracy
increase efficiency and reduce bureaucracy? The money which funds
our Scheme Managers and out-of-hours service could more efficiently
be paid directly to the landlord in the same way as Housing and
Council Tax Benefits. SP adds no value to this payment whatsoever
and has been an obstacle to progress locally in all the ways enumerated
above.
6. Supporting People's involvement in Sheltered Housing
is neither desired nor merited. It cannot be cheaper than paying
direct to those who are entitled to Housing Benefit, in both public
and private social housing. Local Authorities oversee the joined-up
services for the elderly, and areas where the system needs improvement
are in no way supported by SP.
H. Possible Futures
1. Those who believe that "floating support"
is some kind of solution also quite often espouse the idea of
"individual budgets". We do not see any rational advantage
to this idea when it comes to housing. Unless a government wants
to do away with communal sheltered housing altogether such a strategy
would bring nothing but chaos into the equation and destroy sheltered
housing.
2. We in Brighton and Hove are so committed to the welfare
of our most frail and vulnerable neighbours that we have been
prepared to lead the development of the local Sheltered Housing
Review—we are assured of success with the genuine support
of BHCC, specifically the Councillors on the Housing Management
Consultative Committee, and especially the support of the Cabinet
Member for Housing. But as a local authority BHCC are very much
in the minority in promoting real consultation, and we feel for
the hundreds of local authority areas and several million people
who are not supported by their Authorities. Many officers and
councillors in B&H are excited by the opportunities for direct
participation that our partnership has and promises further to
produce.
3. We are aware that changes in macroeconomics, local
and national politics etc could undermine all the work we have
done, and so we at SHAG are considering some form of Local
Delivery Vehicle (officer speak for service funding organisation)
to employ Scheme Managers and even eventually carers, owned and
administered by a partnership of the real stakeholders, us, and
the Council with inputs by the NHS, Social Services and other
providers under our joint direction. By gradual expansion into
the community we could guarantee funding for Support Services
into the future. However, we know that this unconventional option
needs the support of both Local and Central Government to be successfully
rolled out to the entire nation and made accessible where tenants
are unable to advocate for themselves. Without such support or
a better mechanism to protect the most vulnerable elderly Parliament
as an institution would be guilty of institutional neglect.
I. Conclusion
1. Sheltered Housing is different to most other categories
of service user in that there is no next step, except changes
in their care package for which an on-site empathetic Manager
is vital. Ex-offenders will move from one band to another in a
progression that hopefully means they will be able to participate
equally within society, and similar outcomes are available for
rough sleepers, substance misusers, teenage parents, young people
with learning disabilities and so on. There is no such outcome
for Older People. For the majority Sheltered Housing is their
last home. The only progression will be a wooden box.
2. The one problem area of a progressively less able
population as more providers restrict entry to those with a support
need is: who will advocate for the invisible frail elderly who
increasingly will not be able to advocate for themselves? Certainly
not Supporting People who seem, in our case, to be concerned only
about reducing expenditure. They should ask themselves what more
cost effective solution is there than Sheltered Housing for the
elderly with a support need and no nuclear family?
3. With this one exception, which we hope to address
in the Articles of a Local Delivery Vehicle for the vulnerable
elderly, our conclusion is simple. As far as Sheltered Housing,
both public and private, is concerned, we would be much better
off allowing the Local Authorities to administer funding for front-line
services, namely Scheme Managers and Out-of-hours cover, through
the Housing Benefit system. Those who claim the Support Charges
all claim Housing Benefit. It does not need to be any more complicated
than that. Who needs Supporting People? Not us. We do need, however,
some kind of national standard or mechanism to protect those who
today do not have advocates such as our executive.
4. We therefore request that along with any other recommendations
the Honourable members ensure that a working party of some kind
is set up to examine the particular case of Sheltered Housing
and how it can truly live up to its name in the future. Age calls
for credit, not neglect.
May 2009
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