Uncorrected Evidence m092

Memorandum from NAT (SPP 92)

Summary of recommendations

Recommendation: The Government should develop up-to-date and accurate guidance to assist local authorities in carrying out needs assessments for housing support for people living with HIV.

Recommendation: The Government should collate good practice models of projects funded by Supporting People and make these available to local authorities as examples of how Supporting People funding can be used.

Recommendation: Local authorities should develop systems to ensure the removal of ring fencing does not result in a reduction or loss of services for people living with HIV.

Recommendation: Government must assess the impact of the removal of the ring fencing to ensure local authorities are not failing to meet the housing needs of vulnerable groups. This assessment should occur within 18 months of the end of ring fencing.

Recommendation: Guidance for local authorities and PCTs around Joint Strategic Needs Assessments should contain information about consulting groups covered by the Supporting People programme, including people living with HIV.

Recommendation: Support organisations and people living with HIV should be assisted to ensure they can participate in local needs assessments and decision making processes to ensure HIV is not ignored.

Introduction

1. NAT (National AIDS Trust) is the UK's leading independent policy and campaigning charity on HIV. NAT develops policies and campaigns to halt the spread of HIV and improve the quality of life of people affected by HIV, both in the UK and internationally.

2. NAT welcomes the chance to submit evidence to the Communities and Local Government Committee's inquiry into Supporting People.

3. NAT particularly welcomes the Committee's decision to look at this programme at this time, due to concerns about the implications of the end of ring fencing for people living with HIV.

4. This submission looks of the importance of housing support for people living with HIV and the success of the Supporting People programme to date. It then goes on to consider the potential implications of the end of ring fencing, making recommendations for the future.

HIV and housing: the need for Supporting People

5. Although the Supporting People programme can provide services to any vulnerable person who can benefit from housing-related support, people with HIV have been identified as one group for whom support should be made available.

6. Effective treatment in the UK has transformed HIV from being a terminal illness to, for most people, a long-term manageable condition. HIV infection does, however, remain a complex condition which has an impact on many areas of life and which can be challenging to manage. Good quality and stable housing is particularly important in maintaining the health and well-being of an HIV positive person. By contrast, poor quality, inappropriate or unstable housing can seriously undermine an individual's health, for example by:

- Making adherence to treatment difficult - which causes treatment to stop working thus endangering future health

- Making people more vulnerable to certain illnesses, such as tuberculosis

- Accelerating ill-health and a decline in the immune system, meaning treatment has to be begun earlier than would otherwise be the case

- Causing stress and/or depression which reduce the effectiveness of treatment

- Undermining privacy, making individuals vulnerable to discrimination and harassment

- Causing real difficulty in managing or mitigating side-effects and health impacts resulting from HIV infection.

7. Despite the importance of stable and appropriate housing, Sigma research's recent national survey of people living with HIV found that 24% of all respondents had experienced housing problems in the last year. Problems cited relate to financial issues, inappropriate housing (e.g. damp, disrepair, inadequate heating) and problems related to harassment from neighbours.[1]

8. The two groups most affected by HIV in the UK are gay men and black Africans. The needs of black Africans living with HIV are particularly acute in relation to housing. A London study found around 40 per cent of black African respondents living with HIV reported they did not have enough money to meet their basic needs.[2] Black Africans living with HIV are also less likely to own their own home, more likely to be staying with friends and family, and more likely to have moved more than three times in the previous three years than white, gay men living with HIV.[3]

9. While gay men are less likely to report problems than black Africans, they still face problems that Supporting People can assist with. Sigma research found that 18% of gay and bisexual men reported housing problems. Stonewall Housing collects information on the support needs and problems reported by their HIV-positive clients. In the period April 2007 - August 2008, 8 per cent of clients reported family or relationship breakdown as an issue, and 7 per cent reported domestic violence. For gay men domestic violence may be difficult to deal with as the vast majority of domestic violence services are set up to assist women and may exclude men. The link is highlighted in Stonewall Housing's data, with 6 per cent of those reporting either of these problems also reporting homelessness as an issue.[4]

Success of the programme to date

10. Supporting People is designed to respond to individual needs. However, a briefing by the then Office of the Deputy Prime Minister (ODPM) on HIV and Supporting People noted that Supporting People authorities were finding assessing the level of need around HIV difficult.[5] Individuals were not coming forward when conventional assessment methods were used and therefore their needs were not being identified. As a result authorities were assuming that there was no need for HIV-specific service provision in their area, when in reality it was that they were not reaching these people.

11. The ODPM briefing note makes clear the importance of providing services, highlighting the problems stigma and discrimination could pose in accessing people living with HIV. The briefing provides some limited guidance for local authorities on what sort of services people living with HIV may need. However, the information is not very detailed and many issues are neglected.

12. Up-to-date and accurate guidance for local authorities is needed to ensure they can assess and meet need properly.[6] This is all the more important given the decision to remove ring fencing from Supporting People funding.

Recommendation: The Government should develop up-to-date and accurate guidance to assist local authorities in carrying out needs assessments for housing support for people living with HIV.

13. Although ODPM's report highlighted concerns about how needs assessments were carried out for Supporting People projects, it is clear that the programme has provided valuable services for many people living with HIV. For example Hestia Housing provide much valued housing support

services to people living with HIV funded through the Supporting People programme.

14. The provision of needs assessment and good practice guidance will be particularly important if the central Community and Local Government Supporting People Team is disbanded.

Implications of the removal of the ring-fence

15. There is widespread concern amongst HIV organisations about the decision to remove the ring fence from Supporting People funding. Local authorities will now be able to spend the funding as they see fit, in line with the priorities in their Local Area Agreement. Local authorities identify 35 key performance indicators (KPI) from 198, which are of greatest importance in their area. Two of these KPIs are linked to Supporting People, but local authorities could choose not to include them in their key targets and therefore they may lose priority.[7]

16. The concern is that local authorities will focus on high profile indicators to meet the needs of the vocal majority in their area and the needs of marginalised and vulnerable groups could be ignored. In 2007 the Audit Commission's co-ordinator of Supporting People inspections warned that the removal of the ring fence could hit services for unpopular groups such as refugees and offenders.[8] With the stigma that exists both around HIV and the groups most affected by HIV (i.e. gay men and black Africans) these services could be at risk. Many HIV support organisations that provide a lifeline to these groups rely on Supporting People funding and may find it difficult to continue to operate if this funding is cut.

17. Given that the ODPM previously stated that local authorities find it difficult to identify needs of people living with HIV, this is potentially an area where services may be cut in favour of easier to reach groups. The introduction of Comprehensive Area Assessments (CAA) to assess how well local areas are meeting the needs of their community will allow for some scrutiny of whether the needs of socially disadvantaged groups are being met. The Audit Commission's guidance on CAAs does stress the need to pay particular attention to these groups during the inspection process.[9]

18. For people living with HIV the end of ring fencing could mean reduced access to specialist HIV workers who have a good understanding of the issues people face. Generic workers may not have the same in-depth knowledge and may not be able to provide the same level of support.

Recommendation: Local authorities should develop systems to ensure the removal of ring fencing does not result in a reduction or loss of services for people living with HIV.

Future opportunities

19. While there are real concerns over the removal of ring fencing, there are also some potential benefits. Currently Supporting People services are confined to providing housing support services alone, although clients may have much wider needs. The end of ring fencing would allow for more services to be provided, such as help getting into employment or training.

20. The introduction of Joint Strategic Needs Assessments (JSNA), requiring Primary Care Trusts (PCTs) and local authorities to work together to assess the health and wellbeing needs of their local population could be a tool to ensure vulnerable groups are not ignored. By bringing PCTs and local authorities together it allows for a more integrated approach to planning.

21. For HIV this is an important approach as people will have needs that relate to health, social care and other issues. Housing is one area that is impacted on by many different factors and the integration of planning around health and more general wellbeing could help to address many of these issues.

Recommendation: Guidance for local authorities and PCTS around Joint Strategic Needs Assessments should contain information about consulting groups covered by the Supporting People programme, including people living with HIV.

NAT

May 2009

[1] Weatherburn P, Keogh P, Reid D, Dodds C, Bourne A, Owuar J, Hammond G, Jessup K (2009) What do you need? 2007-2008: findings from a national survey of people living with HIV www.sigmaresearch.org.uk

[2] Ibrahim, Anderson, Bukutu & Elford (2008) Social and economic hardship among people living with HIV in London, HIV Medicine pp1-9

[3] Ibrahim, Anderson, Bukutu & Elford (2008)

[4] Stonewall Housing data April 2007 - August 2008

[5] ODPM (undated), Supporting People Briefing Note: housing related support for people with HIV/AIDS http://tinyurl.com/2nuxjy

[6] NAT's recent publication, HIV and Housing, has detailed information about the housing needs of people living with HIV. The resource is available at: www.nat.org.uk

[7] The two KPIs are: NI 141 - Service users who have been supported to move on in a planned way from temporary living arrangements and NI 142 - Service users who are supported to establish and maintain independent living.

[8] Supporting People: projects at risk when ring fence goes, Community Care, 17 Sept 2007 http://www.communitycare.co.uk/Articles/2007/09/17/105810/supporting-people-projects-at-risk-when-ring-fence.html

[9] For more information see www.auditcommission.gov.uk