Memorandum from Adult Social Care & Housing in Harrow (SPP 88)
This response is written from the
Director of Adult Social Care & Housing in Harrow in response to the call
for evidence for the Supporting People Inquiry.
1.
Supporting People what has the programme delivered?
1.1
Supporting People (SP) has delivered clear improvements in a number of areas
for the service users in Harrow.
1.2 The key
achievement of the programme is to enable over 1,800 vulnerable people to
sustain their independence at any one time through housing related support
1.3 The SP programme has
helps on average 150 people per annum (to move on to greater independence in a planned way from accommodation based
support services).
1.4 The programme
delivers clear outcomes for service users as evidenced in case studies included
in Appendix 1.
1.5 The
programme has delivered significant Gershon efficiency savings in Harrow an
estimated 10% of the programme grant per year.
1.6 Evidence shows that the programme saves
statutory services in Harrow in the region of £6.2 million a year for a £3.2 m
investment. Please see Appendix 2 for further information.
1.7 The
Supporting People programme offers funding for preventative services for
socially excluded groups e.g. Offenders, Homeless.
1.8 Services
are now more flexible with more services being tailored to the individual and
not being linked to a building.
1.9 SP has been able to commission a range of new services
to address gaps in provision for 150 service users for:
Young People , Drug
& Alcohol , Learning Disabilities, Older People with mental ill health,
Offenders , Older People, Single Homeless , Blind and sensory impaired.,
Domestic Violence as well as supporting an extra care housing bid.
1.10 There have also been
innovative short term pilots for: Somali community, telecare, Handyperson.
1.11 Service Users have been trained and
qualified as Peer Consultants who form a west London team who can be engaged in
contract monitoring and consultation exercises.
1.12 Quality improvements & Value for
Money (VFM). Harrow has developed a robust contract monitoring process
which has resulted in improved service quality. We have conducted annual
contract monitoring of providers seen QAF scores rise in 2008 and agreed
improvement plans as well as having developed Value for Money (VFM) policy to
ensure that contracts offer VFM.
1.13 Performance. The SP
programme has performed to continuously improve against the Key Performance
Indicators (KPIs) 1 & 2 (now National
Indicators (NI) 142 & NI141). Supporting People is now collecting
and monitoring outcome measures that providers are reporting on. The evidence
is that the programme gets people into jobs, and training, tenancy maintenance
and provides services for the socially excluded.
1.14 Processes. It is not just provision but also processes
that are key to maximizing the benefits of the Supporting People
programme. The programme acts as a
catalyst to change. The Supporting people team has led on development of a
revised Move On process that sees a provider panel decide upon move on
priorities on the basis of need which is a welcome development in transparent
allocation of accommodation which moves away from a strict quota system.
1.15 Governance. The SP programme has
led to well developed governance arrangements for the programme including: a Members Advisory Panel; a
cross-council PCT , and Probation
Commissioning Body model; a core strategy group; Provider forums; and ongoing Service User engagement. The
Supporting People model could be considered as good practice by the Strategic
Partnership as it considers how to model its governance and commissioning
functions for the Local Area Agreement (LAA).
1.16 Procurement. Harrow has delivered efficiencies through
procurement particularly as part of the West London Procurement project meaning
that we have access to a framework agreement that will make procurement of
services better Value for money and more timely in future.
1.17 West London. Supporting
People in Harrow has effectively worked with the West London sub region to
deliver a Value Improvement Programme which provided a West London Homelessness
floating support service and West London Procurement activity, as well as work
around Benchmarking, VFM, and accreditation.
1.18 Community safety agenda
Supporting People provision particularly for older people has contributed to
towards the delivery of the community safety agenda with funding for e.g. Domestic
Violence services
2. The implications of the removal of the
ring-fence what needs to be done to ensure that the successes of the programme
so far are not lost or services cut, following the change;
2.1 In
order to retain the preventative work that SP achieves a stronger definition is
required of what SP funding can be used potentially for in respect of
preventative services and a stronger definition of what can't be funded.
2.2 A
stronger requirement through the Comprehensive Area Assessment (CAA) or
inspection regime for local authorities to provide services for socially
excluded people.
2.3 A
mechanism is needed whereby the SP surpluses that authorities have created
through their efficient management of the programme can be used to fund for preventative services and 3rd sector
provider development.
2.4 Retention of the strengths identified in section 1 of
this response.
3.
What opportunities this change in the funding mechanism will offer for
innovation and improvement in the delivery of housing-related support services?
3.1
Introducing a preventative services rule and definition that a percentage of the
funding can be used for non-housing related support.
3.2 This
will enable services that include low level social care or that enhance the
outcomes that service users will achieve for example employment or training
services to be provided.
3.3 This
will give more flexibility in terms of what can be funded
3.4 If
this was done we could get some really innovative and cross cutting services as
it would enable providers to extend their range slightly or enter into
partnerships for services with other voluntary organisations.
3.5 We
need to retain the carry-forward but offer flexibility re its use.
Appendix 1 - Case Studies
Case
Study 1. Vulnerable woman who had to be removed from her previous accommodation
by the police for her own safety arrived at Vernon Lodge without any essentials
or any source of income.
As an initial priority an application
was made for a Social Fund /Crisis Loan so she could buy food and other basics.
Her initial support plan included:
·Support in finding secured
accommodation'
Support in securing benefits·
Support in securing employment·
'Support to improve personal safety'
Staff supported to successfully
obtain relevant benefits and attended the job centre and offered advise and
support and explained why certain documentation etc ere missing. Staff
encouraged her to maintain contact with Victims' Support for ongoing support,
which she found beneficial in relation to her wellbeing and mental health.
After much liaison and contact with
Harrow Council regarding her housing where initially they would only offer
temporary accommodation she was offered more secure accommodation.
Also the customer was interested in
doing and EXCEL course. With staff support she liaised with Adult Community
Centre in Harrow and was enrolled on a waiting list. Her support worker applied to a charity for funds towards the
cost of her course. We are unable to confirm if the funding was secured as the
customer then moved out of Vernon Lodge after a few days the funding was
applied for. Customer has also found employment with an Accountancy firm and
this is due to her previous work experience.
The customer also began to start
proceedings for divorcing her husband.
Case Study 2 - Young People Accommodation Service
Service User A
Circumstances at commencement of service
Service user A
was referred via Harrow Youth Offending Team (YOT). The main need identified
was maintaining Education as A had a low attendance rate at college.
From the Self
Assessment of Needs and the jointly completed Assessment of Needs and Personal
Growth form, A was assessed to have support needs in these areas:
Budgeting: Only experienced budgeting small sums of
money and had not lived independently before.
Benefits: A had
submitted an application for Income Support but had lived in family home and
not dealt with benefits agencies before.
Social and Community: A was cautious in meeting new people and would rather he could speak to
'known, trusted people.'
Training: A is studying a Foundation Certificate in
electronics at Uxbridge College however Harrow YOT had to appeal on A behalf
to continue the course due to poor attendance.
Offending: A was
referred by the YOT and had previous convictions for Disorderly Behaviour,
Shoplifting and Robbery
Healthy Eating: A said that with limited budget he had been living off cereal and bread.
Present Circumstances
Budgeting: A needed assistance when moving in for the
first 2 months in managing his rent but has since had an excellent record with
limited reminders sent for any outstanding rent. A also managed his
personal finances so he could have broadband installed in his room. A maximized
his income by working with the Support Worker in claiming EMA for the 2007/8
academic year. A required
minimum assistance in completing the EMA paperwork for 2008/9.
Benefits: A had
initial assistance in dealing with Income Support and ensuring that payments
moved from a GIRO to BACs payment to his account. Since then A has
managed Income Support. Housing Benefit had to be initially completed with a
high level of assistance which has reduced dramatically with A checking
through Housing Benefit check form with Support Worker and putting together any
supporting documents himself.
Social and Community: A volunteered to assist West London YMCA in presenting a new Housing Scheme
to local Churches with coaching from the scheme project manager. A spoke
to a variety of audiences including the Mayor and Councillors at the launch of
the scheme and church congregations. A presented on what
homelessness meant for a young person through talking about his personal
experiences and met with members of the church for Question & Answer
sessions afterwards.
A has also
attended Anti-Knife Crime meetings via a friend who is at another YMCA and
under his own initiative.
A is
currently assessing whether to attend Harrow Council's Supporting People Service
Users panel and attended the Information Day with their Support Worker in
November 2008.
Training: A needed assistance in maintaining his
attendance in co-ordination with the College Attendance Officer, support worker
and YOT. Before we started supporting him his attendance was poor but at a
meeting with A's lecturer A's attendance had improved to 80% from
an initial 29%. In addition his course performance was discussed and it was
noted that A had started working harder but still needed to catch up due
to previous absences.
As a result of A's
overall attendance record a disciplinary hearing was held in June 08 when
the college contacted the West London YMCA to advise on dates and location.
When A's previous circumstances were clarified at the panel and it was
realized that the poor attendance was due to lack of stable accommodation A was
allowed to complete the course and passed.
A has now
been accepted onto the Electrics Installation course at the same college with
the intention of becoming a qualified electrician. A has required
assistance from their Support Worker due to an incident with another student at
the college but was able to demonstrate that he was not the aggressor in the
incident by reviewing CCTV with the College staff, Support Worker and A. A
was given a final warning by the college however due to their policy on
incidents where violence occurs A accepted the warning and understands
the implications.
Offending: A has
concentrated on his studying and being an active community member. A has
since worked on Anti-Knife crime panels (see above) and has not shown any
inclination to return to his previous lifestyle. As a result of A's progress
and discussions with the YOT A was part of the interview panel for
volunteers looking to act as mentoring trainers for the YOT in August 2008.
Healthy Eating: A is able to cook for himself as a result of maximizing his Income (see
Benefits). A says his diet is more balanced now however there is further
work to be done in expanding A's cooking skills, which needs to be
explored. A had attended some of the cookery sessions which were run in
conjunction with Volunteers from a local church and West London YMCA where
there was a focus on healthy/low cost cooking.
Case
Study 3. I am a service user with a learning disability who
moved into Independent Living in Oct 07.
I previously lived in a residential care home in Harrow.
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Distance Travelled
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Managing my money and budgeting
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Previously my money and card
were looked after by staff. Since I moved I have started looking after my own
money and card. I don't take my card out with me except when I need to
withdraw cash. I have managed to make some savings and learning to live with
in my budget.
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Gaining employment: I work for the Wembley stadium during event days
and for a fast food chain for a few hours a week. Expressed a desire for more employment opportunities where i
can meet members of the public
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I continue to work on event
days for the Emirates and Wembley Stadium and Mcdonalds at the weekend. I
used to call in stating that I am unable to attend but since moving my
attendance is much improved. I am also working at a Red Brick Café 2 days a
week in Harrow.
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Life Events
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I was supported to attend person
centred facilitation training with Adepta (3 days) I am currently helping a
tenant in another home with their circle of support.
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Arranging my own reviews
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Prior to moving my reviews were
arranged for me. I now arrange my own reviews, from setting the date to
inviting people over the phone and letters. I also prepare my reviews by
writing what I am going to discuss.
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Doing my own shopping
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When I first moved to 46 staff
supported me to prepare shopping lists and shop. I am now prepare my own
lists and shop without support. I
have been taught how to check for out of date food before doing my shopping
lists.
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Case Study 4.
One
service user who moved to the service a little over two years ago is now ready
to move - on into a flat of his own. They have made great strides as far as independent
skills are concerned. They are now able to manage their finances and budget for
future spending, Are able to do own shopping, prepare meals and aware of
personal safety and health and safety issues. Their aspiration is to find paid
employment and this hope has been achieved, as they currently work as the Head
of Communications for Harrow Council's service users' News 'n' Views
newsletter.
Case Study 5.
A service user moved to the service February of this year with
over £1,600 debt (rent arrears) from their previous accommodation. It has been
an ongoing challenge to support them with this as they are not prepared to face
up to their financial obligations and does not want to discuss money issues.
With time, they are opening up in this area. For example, informing support
staff of other debts that they owed to previous phone companies, Thames Water
etc. They are in employment and earn a decent wage. Staff agreed with him a
workable payment plan to pay off debts and subsequently reached agreements with
his debtors. So far, they are keeping with their payment plans even though
occasionally they slip back on this.
Case Study 6.
- Domestic Violence Service Refuge
This case study describes a service user who was
receiving support at the refuge and was referred onto the Hestia Harrow
Resettlement Service.
Mrs X is an Iraqi female, with ILR in the UK. Mrs X was fleeing a dominating and
controlling husband who was abusing her physically/emotionally/financially and
possibly sexually as well.
Mrs X was referred to Hestia
Harrow WA refuge project in December 07 via sister agency Hestia Brent WA
Outreach Project. There was difficulty
in placing this family for 2 main reasons. Firstly as the family was a female
with 3 children and not all refuges are able to accommodate larger
families. The second reason was because
Mrs X only spoke limited English and therefore would require an interpreter to
ensure her needs were met fully at the project.
A budget for interpreting was agreed
by Group Manager to enable Mrs X to receive 90 minutes of interpreting time a
week, so needs assessments, support plans, reviews and key session's could be
completed.
Mrs X arrived in the refuge in
Harrow Jan 08, accompanied by the Brent Outreach worker and the service user's
3 children aged 3, 5, and 7 months. Mrs
X was very tearful and frightened about coming into a refuge, and she was
experiencing frustration because of her language barrier.
After completing a comprehensive
needs assessment, it became clear that there were many areas Mrs X and her
children would require support in. It
appeared that Mrs X had been suffering with severe depression and possibly
episodes of paranoia prior to coming into the refuge and that she had been
seeing Community Mental Health Services for some time in another borough. Mrs X
was referred onto the Harrow Mental Health Services where she received ongoing
support with a consultant Psychiatrist and a referral was made for her to be
visited by a Community Mental Health nurse at the refuge.
Mrs X required extensive support
upon arriving at the refuge. Mrs X's needs would be highlighted through a
weekly key session of 90 minutes. Additionally she was supported to apply for
welfare benefits and writing letters to various agencies/applying for school
and nursery for her two eldest children/referring the client onto Home start
services/applying for ESOL classes/encouraging the client to access the health
visitors Fresh start programme that was currently starting/attending all
external agency meetings and appointments with Mrs X and ensuring interpreting
services were available for her. These appointments included GP/Mental
Health/College/School/Hospital appointments/Physiotherapy appointments. Due to the severity of the domestic violence
that Mrs X has endured she had no idea of how to even take monies out of her
bank account as her husband had controlled everything in her life. Mrs X
struggled with being responsible for things she had never had to be aware of
for many years, and so the work with Mrs X was quite intensive at this time.
The children and families worker
was also able to provide key session's to the two older children to ensure they
had a safe place to speak about their feelings and emotions.
Approximately after 4 months Mrs
X's confidence and self-esteem started to grow and she started to be able to
venture out of the refuge on her own, without the worry that she initially had
when she first came to the refuge. Staff encouraged her to start reading her
own letters that came through the post box and started to empower her to become
more self reliant, as the license was due to expire in July of 2008, so we
aimed to assist her in being more self reliant and confident. Mrs X was able to
start attending the coffee mornings which Hestia WA in Harrow had recently
introduced and she seemed to appear less emotional and dependent on others.
However at times Mrs X's depression would appear to worsen and she would
receive more regular support from the Community Mental Health Nurse.
Mrs X and her key-worker completed a
comprehensive housing application to the local authority of her choice, and she
was finally accepted duty by Harrow Council in August 2008. Upon leaving the
refuge in August 2008 Mrs X with her consent, was referred onto Hestia Harrow
Resettlement Service for an additional 6 months of support which was provided
to ensure her move into independent living was made as smoothly as possible.
This case study highlights the complex
issues that staff are faced with when supporting women fleeing domestic
violence. They have been able to
support Mrs X through contacts with a variety of sources, from interpreters,
health, welfare and children's services. This support has enabled Mrs X to
build on the skills required that has given her the confidence to move on into
her own home in the community with the additional support from the resettlement
service also provided by Hestia Women's Aid.
Appendix 2 - Cost Benefit analysis
1. Cost Benefit Analysis
exercise Supporting People Harrow
Headline
The annual
investment of £3.2 million into
Supporting People services results in an estimated net financial benefit of £6.2
million to the borough and Exchequer.
Background
Cap Gemini undertook work on behalf of the CLG to report on
the financial benefits of the SP programme and the cost of withdrawing SP
funding.
This work published in January 2008 identified that overall
the cost of investing £1 of SP funding delivered £2 of savings from other
services (i.e.net financial benefit to the Exchequer or individual).
Harrow have used the methodology deployed here to undertake
a cost benefit analysis of its own Supporting People Services so making the
work locally relevant and to allow Harrow to examine the effect of service
withdrawal on the wider health , social care and community safety economy.
2. Methodology
National
The principle of the exercise undertaken by Cap Gemini was
to cost the amount of SP funding invested in services and account for the cost
of the removal of these services on other services hence the net financial
effect of the withdrawl of services.
The methodology was to consider for each of the following
groups:
i. Women escaping domestic violence
ii People with drug
problems
iii. Homeless families in settled and TA
iv. Homeless single people in settled and TA
v. People with Learning disabilities
vi. Offenders and those at risk of offending
vii. Older People receiving floating support / very
sheltered / sheltered accommodation
viii. Young people at risk in TA / settled
accommodation
Two assumptions were used to produce the research:
1. For some clients the most
appropriate alternatives would be arrangements which they receive at the moment
but without the support enabled by Supporting People.
2. For others the best
alternatives would be arrangements requiring a different more intensive form of
intervention.
The research then defined the following for each group:
1. Basic Package costs: total
cost of packages including SP costs as well as accommodation costs etc.
2. Alternative provision costs :
the likely alternatives e.g. residential care
3. Event costs : the impact
costs of withdrawal of a service on e.g. the event costs for someone with a learning disability
relate to the average costs of:
- being admitted to hospital due to general health issue
- visiting an A&E dept
- Being admitted to an acute mental health ward
- Visiting a GP due to general health issue
- Visiting a community mental health nurse
Note: what the Cap Gemini methodology isn't able to do is
quantify the cost benefits of the outcomes achieved by service users which
deliver additional cost benefits e.g. entering employment, avoiding eviction
etc.
There are also some services funded for client groups by SP
that aren't included in the research due to a lack of available data , e.g. HIV
, Generic F/S.
Therefore it is important to note that there are additional
benefits that the programme offers that aren't quantified here.
Local
In order to make the work relevant to Harrow the Supporting
People costs that are paid in contracts for the service categories listed above
were applied to the wider financial model provided by Cap Gemini.
Given the complexity of the models to cost alternatives and
events the national Cap Gemini figures were used to cost the model for Harrow.
This means that costs are a national average, and so it is likely that the net
benefits could be higher because the event costs of visiting an A&E dept or
being a victim of burglary in Harrow are likely to be higher than the national
average.
3. Output
The output from the
exercise is provided in Appendix 1 and details what the net financial benefits
of Supporting People investment in all services is as well as by client
group.
Further detail about the type of alternative provision
available as well as the detailed definition and cost of the event costs that
the figures were predicated on is available from the SP team.
Graphs to show the
Net Financial Benefits Amount compared to the Current Cost of Harrow SP Budget
May 2009
