Examination of Witnesses (Questions 40
- 57)
MONDAY 8 JUNE 2009
MS VIC
RAYNER, MR
NIGEL HAMILTON
AND MS
HELEN WILLIAMS
Q40 Emily Thornberry: Should we change
the law? Should we make it obligatory that people within the Supporting
People client group are looked after?
Ms Rayner: At the heart of all
of this is that the provider organisations and the commissioners
that we are working with are trying to ensure that service users
are provided with the most effective and appropriate services
so anything that can be done to reinforce that, but we are not
calling for a law around that.
Ms Williams: One of the possibilities
for the future which could be of benefit is if you look at the
way in which traditionally money has been spent in different pots—whether
that is for health or adult social care and housing related support—so
people have had to push themselves into one of those boxes to
get a need met. In the future there could be more joining up across
those pots of money; there is real potential to actually do things
differently to benefit service users and do things at better value
for the public purse. However, I think with the ring-fence coming
off this year in many local authorities, areas that cross-dialogue
and joint commissioning are not happening and those systems are
not in place. In some areas there are real worries that with the
lifting of the ring-fence we are not going to move towards better
commissioning.
Q41 Chair: Are you suggesting that
the lifting of the ring-fence is maybe a bit premature; you are
not against it but it is just a bit quick?
Mr Hamilton: I think the pilots
did not even operate for a year before that decision was made
and, given the current economic circumstances as well, it may
well have been too soon for the ring-fence to come off. We would
certainly argue, given where we are now, that it would be right
to keep Supporting People as a named grant and it would be good
if local authorities could report locally what services they are
investing in against that named grant.
Q42 Mr Betts: Should local authorities
be encouraged to report and demonstrate their commitment to a
certain amount of resources and level of service in these sorts
of provisions?
Ms Williams: Yes.
Mr Hamilton: We would argue for
local authorities being required to have a strategy for displaying
how they will provide housing related support. We would not necessarily
be prescriptive about how they do it, but they must have that
strategy and combine that with rigorous department outcomes monitoring
which will demonstrate how well they are doing at it.
Q43 Sir Paul Beresford: Would you
not agree that ring-fencing means that government decides on high.
Removing the ring-fence means the local democratically elected
councillors will make a decision on priorities et cetera.
They are on the ground; they know what is happening; they know
the numbers and they know the way in which they want to approach
it. So your fears might be groundless because presumably you are
going to judge on the quality of the service rather than the amount
of money spent on it.
Ms Williams: I think in some areas
the lifting of the ring-fence does give an enormous opportunity
and you might see that great joining up of health, adult social
care and housing related support budgets to the real benefit of
local taxpayers and service users. However, our feeling is that
that kind of maturity and joint commissioning across traditional
silos is not there in every area so it is perhaps too early for
that to have happened. I think one of the things that could perhaps
be looked at is what more the Department of Health and CLG could
do to encourage health and adult social services to invest in
preventative services.
Q44 Mr Betts: In terms of your comments
before about the possibility that you take the money out of the
silos and use the money with more innovation, that is great. It
may work in one area and things go well. Do you see part of your
role to ensure that where good things are happening that those
ideas and projects are actually made known to a wider group of
people so they can be replicated in other areas?
Ms Rayner: Absolutely. I think
as membership organisations—speaking for both organisations—that
is something we actively do anyway and would continue to see us
having a very strong role in terms of doing that.
Q45 John Cummings: Can you tell this
Committee how capacity building is helping small and Third Sector
providers compete in the current market?
Mr Hamilton: We are beginning
to work with the Office of the Third Sector on their work to build
capacity for small providers. We are very concerned that skills
in providing support may not be the same as commercial skills
and tender writing skills, so we are able as an organisation to
offer training, consultancy and support, but in the wider world
I think there needs to be an understanding amongst commissioners
that they need to work with their local provider sector to build
its capacity if, for example, they want to let ever larger contracts
for a wider range of services. That will mean that small providers
will need to come together in consortia to provide that range
of services. That takes time and it takes capacity so there is
an onus on local commissioners to understand the reality of that
and allow time and put resources into capacity building. I think
across the sector it is a really important issue that we recognise
that the best providers of services may need to learn new skills
to become good at competing in a tendering environment.
Q46 Mr Betts: Can you give any practical
examples on the success of collaborate approaches to service delivery?
You have mentioned consortia bids for contracts; do you have any
practical examples to give the Committee?
Ms Rayner: We can certainly provide
some written examples of that. We are involved in some work with
Hact, a project called Collaborate, where a number of different
models of consortia working were tested and piloted. That has
been written up into some very effective research and we can certainly
send that to the Committee if it would be helpful.
Ms Williams: I also think there
is a challenge there to the way in which commissioning is done
because some of the cycles we have seen of tendering have not
necessarily been the most cost effective way of getting the best
services and there are examples where local authorities have worked
in partnership with service users to ask them what they want and
work with providers on a kind of partnership arrangement that
has assessed value for money and looked at redesigning the service,
whereas the cost of having to re-tender every couple of years
can actually take money away from delivering services to vulnerable
people. So there are problems with the way that contracting has
gone in some areas.
Q47 Anne Main: Could you tell the
Committee if the comprehensive area assessment will be effective
in assessing the quality and effectiveness of housing related
support services in the future?
Ms Williams: I think one of the
challenges is if, in an area, a local strategic partnership has
not adopted targets that are focussed on meeting housing related
support needs, how effective in those circumstances will the comprehensive
area assessment be at looking at the needs of vulnerable people.
We heard from the Audit Commission and I think in their framework
there is an emphasis that they will look at how services reach
vulnerable people and reach the socially excluded, but if targets
have not been adopted locally then I think there is a question
as we move through to the new comprehensive area assessments how
effective it will be in that regard.
Q48 Anne Main: So you are in favour
of having targets?
Ms Williams: I am certainly in
favour of targets being adopted locally that meet the needs of
vulnerable people.
Q49 Anne Main: If you believe in
having targets, will it be helpful to have a mandatory indicator?
Ms Williams: I think there are
some benefits to that but I am not sure that is the way necessarily
to go. I would go back to the issue that I think time will tell
in terms of the lifting of the ring-fence. If we can get to a
situation where there is better joined up commissioning across
health, adult social services and housing related support then
that would be good, but there are real worries that certain social
excluded and vulnerable groups will lose out in areas.
Q50 Anne Main: In answer to a colleague
earlier on you said that you did not believe the local strategic
partnerships are necessarily mature enough to take on the perplexities
of Supporting People through local area agreements.
Ms Williams: I think there are
real concerns that some local strategic partnerships have not
adopted targets or not adopted a focus on the needs of vulnerable
people.
Q51 Anne Main: Does that mean they
are not doing it? If they do not have a target does that mean
they are just not doing it or is it just not specifically put
somewhere as a target?
Ms Williams: With the risk of
the pressures on public expenditure and with the ring-fence coming
off, that is an added pressure about whether money will be diverted
away from preventative services. Some local strategic partnerships
are not well set up to hear the needs of vulnerable people or
to listen to those needs locally. There is a real challenge and
perhaps a role for CLG there in terms of guidance and encouragement
and spreading good practice to local strategic partnerships.
Q52 Chair: You and the previous witnesses
kept stressing that actually the Supporting People programme was
great value for money. There may be some local authorities who
do not listen to vulnerable people and do not care about them
but all of them would presumably nevertheless want to save resources.
Would that not be a sufficient trigger to make sure they do it?
Ms Williams: I think that is true
to a degree but some of the savings of local authority expenditure
are actually savings to another government department, so they
are a saving to the health budget or they are a saving to the
benefits budget. I think we need a huge cultural change in what
the incentives are to different departments about how they spend
their money. We have done work with the Department of Health (which
we noted in our submission) which demonstrates the cashable gains
to health but because that money has traditionally been spent
by local authorities there is a huge question about what will
incentivise that.
Q53 Anne Main: It is very difficult
to measure a lot of what you are saying. It is difficult to measure
and there seems to be—correct me if I am wrong—an
implication that you are actually not sure you can trust people
to deliver something that has not got a measurable target on it,
and yet you say it is difficult to measure.
Ms Williams: We did find a way
of measuring it which we worked on with the Department of Health
and that looked at what would happen to people if those support
services were not in place and it compared people who did not
have those support services and the amount of admissions to institutions
or the lack of take-up of jobs. There is well-established methodology
for looking at the benefits.
Mr Hamilton: That methodology
has just been expanded with some work we are doing with the CLG
so that the cost benefit model can now work on a local level so
a local authority can be given the model, enter its local data
and can examine the savings it will make from a certain level
of investment.
Q54 Anne Main: So it will not be
mandatory then because it will be self-evident.
Mr Hamilton: If they choose to
do that, it will.
Q55 Anne Main: Why would they choose
not to do it?
Mr Hamilton: The expenditure is
very much with the local authority and the savings may be a couple
of years down the line and the savings may be to the criminal
justice system or the health services, so there is not this year
when a local authority has to find five per cent savings; there
is not necessarily five per cent savings to come out of funding
preventative services. I think that is the difficulty so we need
to be able to demonstrate positive outcomes and to encourage authorities
to take that longer term view.
Q56 Chair: Can I just ask a final
question on personalisation which I think one of you mentioned
before. What do you think are the real challenges for delivering
Supporting People services under the personalisation agenda? Do
you think there are any specific user groups who might struggle
with the concept?
Ms Rayner: We have spent quite
a bit of time within our organisation with members looking at
the challenges of personalisation. There have been a number of
pilots and evaluations that happened around that. Some of the
most significant challenges come from accommodation based services
where there is a service model which is based around fixed numbers
of users living within an accommodation based project and using
the services that the support provider, who is running that accommodation
generally or a contracted-in support provider. There are challenges
then about the business model that is in existence within a sector
about how you can plan long term around services where people
might be purchasing from a range of different support providers.
That is one of the issues that needs to be looked at and that
obviously brings in a range of issues around personnel and staffing
issues.
Q57 Chair: This is a problem for
the provider.
Ms Rayner: It is all about sectoral
changes I think. So there is that side of it and then in terms
of particular clients who may find it difficult to utilise the
personalisation agenda there is some piloting that is going on
at the moment, particularly around personalisation in the homelessness
sector; that is clearly one of the areas identified where people
have more chaotic lifestyles, who may find it much more difficult
to work in a way where they either have direct control of their
own spending on their support provision or they have that managed
through some kind of brokerage or other support service. I think
there are longer term challenges that need to be explored in relation
to that. For many of the client groups that are within the Supporting
People agenda there has been some active work about how personalisation
can work in that context or indeed many of the services that are
offered are actually very personalised in the way that they are
built around the service user's life. As a sector there is an
embracing certainly of the philosophy of personalisation; it is
about trying to work out and work through some of the changes
we need to make in response.
Ms Williams: I would agree with
that and I think that that means in some cases you have to have
parameters. For example, I know of one organisation where, in
a supported housing setting for people with very chaotic lives,
there is a kind of block purchase of some of the core care and
support. If you think about the supervision that people need,
the encouragement to take up drug and alcohol treatment, the core
funding is there for that which is important not only in terms
of their own well-being but the wider safety of the community,
yet an amount of the budget has been devolved to individuals to
spend on services they want.
Chair: Thank you very much indeed.
| 
