Examination of Witnesses (Questions 32
- 39)
MONDAY 8 JUNE 2009
MS VIC
RAYNER, MR
NIGEL HAMILTON
AND MS
HELEN WILLIAMS
Q32 Chair: Could you tell us very
briefly what the benefits are that the Supporting People programme
has delivered to date?
Ms Williams: We have seen the
benefits that Supporting People has brought to the lives of individuals
and helping them maintain their tenancies, and the huge impact
that has had in terms of reducing admissions to hospitals for
people with mental health problems, reducing expenditure of other
bits of public service—reduce levels of police intervention,
for example—so really helping people to maintain their tenancy
and having a positive effect on their wellbeing. There are a lot
of studies to demonstrate the value for money for Supporting People.
The 2008 Capgemini for CLG showed that of the £1.55 billion
budget the actual savings on other public services were £2.77
billion. We have recently done a lot of work with the Department
of Health looking at how services, for example for women who have
complex problems, are actually saving on children at risk, increasing
take up of employment, so some real demonstrable cashable savings
as well as massive improvements to the lives of people.
Ms Rayner: I think one of the
other great benefits of Supporting People has been the growth
of floating support so the growth of services which are enabling
people to remain independent within their own home. It is a programme
which has developed with service users at the heart of this and
this has been very strongly reinforced within the quality programme
that has been applied to it. There is a framework called the quality
assessment framework which has recently been refreshed by the
CLG in partnership with providers and commissioners and that quality
assessment framework ensures that service users have to be integrated
throughout the organisation, throughout the strategic and operational
element of the organisation and that is a real strength in relation
to Supporting People. I think some of the other areas that are
beginning to emerge, partly because of that service user focus
as the personalisation agenda comes forward, are the ability of
Supporting People services to think about how they can interact
with that regime and interact with that government agenda.
Q33 Anne Main: Just on older people,
there is quite a disconnect at the moment between people who have
been discharged from hospital into a care home environment and
then to go back into their own home. The management of people's
expectations of support they can expect to receive in their home
is not delivering on the ground. I think people are told things
are going to happen and these things are not being put in place.
I would like you to robustly defend the expectations that people
are given when they are told they will get back into their own
homes and many of them do not.
Mr Hamilton: There is a very important
point there I think about service planning and making sure that
the support plan is honestly and openly discussed with the service
user so that they are very clear that they do know what they will
get and that the provider and the commissioner can be held accountable
for that.
Q34 Chair: Whose responsibility is
that?
Mr Hamilton: Ultimately it must
be the commissioner's responsibility to ensure that those procedures
are there, but certainly in terms of the present arrangements
whereby someone is referred to a service then it will be the service
provider's responsibility to have that discussion in an open and
honest way. I give that slight caveat because obviously with the
personalised service there might be a completely different arrangement
where somebody is going out and buying a service with the support
of a broker or an advocate.
Anne Main: I can give you examples—which
I will not trouble you with now—of where people are told
what is going to happen and it never happens. I would like to
know where the user in this—or their families who are anxious
about them—can possibly find out exactly what they are supposed
to be being told. If it is the case of being told they will go
home when you get the package together and the package never appears,
as in the case of my constituent, then that is not good enough.
I heard a eulogy from Ms Williams here and that is great, but
I can tell you on the ground that people who are terminally ill
or whatever and want to go back to their own homes are finding
life very, very difficult. I do not know where this is going to
come to light that people can know what they can expect and also
then find out where the system is going wrong and whose chain
they can pull to make it work properly.
Q35 Chair: Presumably the answer
is the local authority since they are the commissioner?
Ms Williams: In part it is that
challenge of what local money can prioritise and what falls on
the care side and what is funded through Supporting People, and
the extent to which older people are involved in those decisions
if there are reviews about where that investment is going to go,
whether that is going to be for support for people to move back
into their own home, or whether that is going to be in the future
funding of warden services in sheltered or extra care arrangements.
There are big questions about which older people are getting a
look in and real risks to that with pressures on public expenditure
in the future.
Q36 Chair: That brings me to the
question about the ring-fence which is that when the ring-fence
is lifted are you concerned that local authorities will then raid
the money and not provide the service to all the groups that are
currently receiving it, let alone improving it.
Ms Williams: I think there is
a real risk that money will be diverted away from the preventative
services that have traditionally been funded through Supporting
People to more statutory obligations or to more acute services,
especially if you think it is happening in the context of an economic
downturn and enormous pressures on local authorities' budgets.
There is a real risk that will happen.
Ms Rayner: Certainly information
from our members is a great amount of concern particularly about
the socially excluded groups feeling very concerned that when
the decision making moves into local strategic partnerships that
there will be a loss of funding for those socially excluded groups.
You were asking earlier about evidence in relation to that and
it does seem too early to give that evidence because obviously
a lot of contracts are still in place for services and it is quite
difficult to see what the longer term impact of that will be.
Within our submission we mentioned looking towards Scotland as
an example because the ring-fence has been removed there since
2008 and there is some growing evidence from there that is emerging
that there has been some transfer away from funding those socially
excluded groups.
Q37 Chair: Did you provide the detail
of that in your memorandum?
Ms Rayner: Yes.
Q38 Mr Betts: We have obviously had
a change in terms of the ring-fencing which was there to ensure
that resources went into these particular services. We now find
it is going out in the grant and therefore does not have to be
spent on these services. What are you finding the effect of this
to be so far? Are you getting any reports back that services that
previously were being provided are now being dropped because local
authorities are using this money for something else? Do you have
concerns about this?
Mr Hamilton: We have concerns
but I think again it is very early to say, not least because so
many contracts are running on. A number of authorities have actually
deliberately extended contracts so that they can review the impact
and review their strategies. It is early to say, but one of the
concerns we have is that there is increasing financial pressure
anyway and actually the money available for services across the
board has reduced which can impact on things like inflationary
uplift which are offered to services, the contract price which
actually squeezes providers to a point where it is quite difficult
to provide quality services. That has been happening and continues
to happen, but as to the effect of the ring-fencing it is very
early to say whether there will be a wholesale withdrawal of services.
Ms Williams: With the ring-fence
coming off in April in one way it is too early to say, but when
you look at the priorities that local strategic partnerships have
adopted, very few have adopted targets that relate to Supporting
People groups. So with the ring-fence coming off there could be
a real pressure locally to divert expenditure away from those
preventative services into things that have been adopted locally
as targets.
Q39 Emily Thornberry: What about
the quality assessment framework? Will that be of any assistance
in obtaining appropriate levels of service?
Ms Rayner: We see the quality
assessment framework as fundamental in terms of maintaining the
high and excellent service that many providers are offering. The
quality assessment framework has not been mandatory since 2006
but it is contained within the contracts which 148 out of 150
of the commissioning authorities were using, so there was a high
level of take up of it. Our concern throughout all of this is
that as we move from the national programme to a national policy
framework and there is less central pressure about how things
should be done, things like the quality assessment framework may
fall away from use and that would be a real shame in terms of
sustaining that high level of quality that has been achieved.
I think that one of the issues around that and what we are already
seeing is some of the dismantling of Supporting People teams,
which were in place within local authorities and as that programme
has turned to policy there has already been efforts in place to
take apart some of those teams and without that kind of local
expertise we are concerned that those who have the knowledge of
Supporting People and therefore those who might insist on compliance
with the quality assessment framework, for example, may be less
present within contracting terms.
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