The Supporting People Programme - Communities and Local Government Committee Contents


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.

Objective 7To ensure services are accessible to older people with support needs in the wider community
strategic actions
  
  —  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
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


  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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