Memorandum from Thames Reach (SPP 96)

 

Summary

 

1. The Supporting People programme has been of immense value and significantly improved the quality of services delivered to people with support needs. The positive aspects of the programme far outweigh the negative and have brought cost savings to the Exchequer, which can be evidenced.

2. The ending of the ring-fence brings risks but offers enormous opportunities to offer a far broader package of support to service users if funding streams can converge effectively.

3. At their best, Supporting People contracts have delivered flexible and imaginative services to vulnerable people and attracted funding from other quarters, leading to the development of some highly effective, cutting-edge services.

4. There is a danger that with the move to Area Based Grants, the continued and increasing importance of supporting vulnerable people, particularly those who do not have a statutory right to support and assistance, is not reflected in the distribution of grant with the more complex and difficult groups, for example, ex-offenders, people with substance misuse problems and the entrenched homeless, losing out.

5. Intelligent and flexible commissioning which is responsive to changing need encourages innovation and partnership and balances cost and quality must prevail over rigid procurement driven by price alone.

6. The Supporting People programme's greatly welcomed focus on continuous improvement based around a straightforward performance framework with the emphasis on outcomes must be retained and developed under the Area Based Grants arrangements.

7. Personalisation - giving service users more influence and greater control over the services deliver to them - offers particularly exciting opportunities for providers. It will fail if a rigid approach is imposed that is not calibrated to take into account the level of independence service users have achieved.

8. There is no reason why, over the next few years, the range and quality of services offered to people with support needs in this country should not be further improved and be the envy of the world. To ensure this happens, learning from across government must be disseminated and directly affect commissioning responses. We would particularly note the importance of pilots and research underway in the area of social exclusion.

 

1. Thames Reach

 

1.1 Thames Reach works with almost 5,000 homeless and vulnerable people every year in London, providing a range of services including street outreach, hostels, specialist accommodation for people with drink, drug and mental health problems, tenancy support services and employment, training and education programmes.

 

1.2 Thames Reach has grown considerably since the inception of Supporting People and has been highly successful in winning contracts through this programme particularly, but by no means solely, in the area of floating support. Supporting People funding has also enabled the organisation to attract other funding streams which has led to the development of some particularly innovative schemes. In total, Thames Reach's turnover has increased from £12 million annually in 2003 at the inception of Supporting People to almost £20 million by 2009; much of this increase in turnover is related to Supporting People. Most importantly, the number of people we are now able to assist has grown equally substantially.

 

2. How far has the government delivered its commitments made through the Supporting People strategy?

 

2.1 The Supporting People programme has been of immense value as a means of improving the quality and range of services provided to people with support needs, especially those for whom local authorities do not have a statutory responsibility. Our view is that the gains derived from the programme far outweigh the negative aspects and that the government should be immensely gratified by the success of the programme overall.

 

2.2 The inquiry is an important opportunity to illustrate the importance of the Supporting People approach as we enter a new era based around distribution of funding via Area Based Grants. In our view there is a danger of organisations becoming obsessed with the ending of the Supporting People ring-fence and trying to predict the impact of this change which, after all, has only just taken place. Whilst there are clearly risks inherent in terms of the funding priorities that commissioners may select, particularly in a recession, Supporting People has brought a greatly needed focus to bear on people for whom it is of paramount importance to provide support but whose needs are usually not at the level to trigger statutory interventions.

 

2.3 The objective therefore from the point of view of Thames Reach, a major provider of services to the vulnerable and socially excluded, is to evidence the need to continue and indeed increase the range and variety of support available. 'Housing-related' support has always had its limitations and Area Based Grant offers wider opportunities to achieve a more effective and imaginative mix of services. The coalescing of health and employment funding streams with current Supporting People funding linked with new ways of offering more personalised services offers some really possibilities of developing world class services in this country over the next few years.

 

3. Supporting People successes

 

3.1 Growth and effectiveness

 

3.1.1 Since 2003, the range of services on offer to people with support needs has grown, notably in the area of preventative services which are more cost effective than those focused on crisis intervention. Alongside this, the disciplines imposed through the requirement to raise the quality of our services driven by the Quality Assessment Framework (QAF) and to work hard to develop imaginative and effective ways of delivering them has been good for Thames Reach and our service users. There is no doubt that as a result of Supporting People, Thames Reach is a more effective organisation providing stronger services. Looking across the voluntary and community sector landscape, it is also apparent that some of the poor providers who have not risen to the challenge have either reduced in size or disappeared altogether, and the beneficiaries of this development are the service users who are receiving an improved service.

 

3.2 Attracting other income streams

 

3.2.1 Supporting People funding has led to a welcome shift in attitude and approach to joint working. As a result we have also managed to lever in additional funding, for example Drug and Alcohol Action Team (DAAT), Drug Intervention Programme (DIP) and social services funding. This has given us the opportunity to develop innovative, specialist schemes for our service users. For example, we manage a very effective treatment project for people with drug and alcohol problems in Brixton, South London, developed through these mixed funding streams. Please let me know if you would like more details of the scheme and the funding mix, or indeed if members of the committee would like to visit. This can be quickly and easily arranged.

 

3.3 Flexible contracts

 

3.3.1 Supporting People contracts vary in their degree of flexibility, but at their best have offered the opportunity of developing new, innovative ways of working with service users. One example of this is the vulnerable adults floating support contract we manage for the London Borough of Southwark. This contract offered the opportunity to develop a shop-front advice centre to give housing, welfare benefit and employment advice to local people in order to prevent homelessness. Additionally, the commissioners agreed that caseloads should be set with enough spare capacity to give local people the opportunity to refer family or friends to the team for support, making this service into a genuine, and greatly appreciated, community resource.

 

3.4 Aligning the needs of people without statutory rights but requiring support more closely with local authority priorities

 

3.4.1 We believe that the Supporting People programme and its achievements has brought a much stronger focus to bear on meeting the needs of vulnerable people for whom there are usually no statutory obligations. There is more to do to ensure that commissioners do not retreat from this commitment with the introduction of Area Based Grant, but it is undoubtedly true that great strides have been made in raising the profile of the groups whose needs Supporting People was primarily intended to meet. The evidence for this progress can be seen in the selection of National Indicators (NI) by local authorities; for example:

 

· 74 local authorities selected NI 141: % of vulnerable people achieving independent living

· 74 local authorities selected NI 040: Number of drug users recorded as being in effective treatment

· 83 local authorities selected NI 030: Re-offending rate of prolific and other priority offenders

· 75 local authorities selected NI 039: Rate of hospital admissions per 100,000 for alcohol-related harm.

 

3.5 Cost benefit realisation

 

3.5.1 It is extremely difficult to measure precisely the cost savings achieved through Supporting People, but there is now enough evidence to show that the overall savings to the Exchequer considerably outweigh the cost of the programme. There have been a number of different surveys undertaken to illustrate this, one of the best being in our view, the research commissioned by Spirals for Space East which showed that for every £1 of housing related support funding, benefits of £1.37 were derived.

4. Going forward: key issues to address

 

4.1 Commissioning is more than procurement

 

4.1.1 There is considerable variety in the approach that local authorities and partners are taking to commissioning services and it is important that the more imaginative and least restrictive forms of commissioning are encouraged as the outcome will be a stronger range of responsive services. Some local authorities have in place processes which they consult on widely and a broad commissioning framework that offers the opportunity of a flexible response with, for example, some specialist services being commissioned outside the main 'framework agreements'.

4.1.2 However, other local authorities are moving towards a rigid commissioning format which is essentially a limited procurement process based almost wholly on cost. Advocates of this approach apply the mantra of 'testing the market' for all services. In our view this is short-sighted because:

 

· It fails to recognise that value for money is important but that a quality measure must also be applied, especially if vulnerable adults are not to be put at risk by under-qualified, cut-price providers.

· Keeping a market of providers, including some smaller niche providers, offers choice both to the service user and to the commissioner.

· It fails to acknowledge that the historic partnership approach that has delivered many highly effective and innovative projects with multiple funding streams will be destroyed (see below).

 

In short, the difference between intelligent commissioning and blunt procurement must be understood.

 

4.2 Avoiding undermining of the partnership approach

 

4.2.1 Thames Reach has always worked closely with local authority and RSL partners to develop new projects for homeless and vulnerable people. As new homelessness projects are invariably contentious, working closely with partners from when the project is first conceived through to the point when the project is officially opened is absolutely essential and we have always contributed a great deal of 'at risk' time and commitment during this development phase.

 

4.2.2 If commissioning were to become a standard procurement exercise, the incentive for organisations to invest resources during the development phase reduces considerably. Why would Thames Reach as the support provider/managing agent invest time and energy when the project developed with our considerable assistance could eventually be managed by another organisation following a procurement process?

 

4.2.3 Furthermore, the support provider often leads on securing additional funding streams to ensure that the project is sustainable. This very significant 'added value' will also disappear if there is no reasonable flexibility around commissioning to incentivise the engagement of the support provider. One solution could be for local authorities to commission support providers well before a project becomes operational and to give extended contracts under special circumstances.

4.2.4 Linked with this, we have illustrated early in this paper that where commissioners are prepared to offer opportunities for the provider to address emerging needs in the community and to shape the service accordingly, positive outcomes can be substantially increased and we would urge commissioners to leave a degree of 'headspace' so that services can mature in this way.

4.3 Continue the drive for improved quality

 

4.3.1 The Supporting People Quality Assessment Framework has been beneficial as a means of raising standards of housing related support and it is important that support providers continue to receive a level of scrutiny that is proportionate. One emerging problem is that some commissioners appear to be adopting the enhanced QAF, whilst others are choosing not to. Thames Reach's strong preference is for a set of comprehensive but straightforward quality measures that are accepted by commissioners and providers. We would expect a level of scrutiny that reflects the historical relationship we have with commissioners. In practice, this means that where we have routinely met the standards required by the commissioner and more, the level of monitoring and regulation should reflect this.

 

4.3.2 As we move into the new era of Are Based Grants we would urge commissioners to continue to expect clear, consistent evidence of high standards of service delivery with, wherever possible, verification provided through direct contact with service users. We would also expect commissioners to welcome and reward innovative approaches to delivering services and we would like to see the development of performance related payments that have been experimented with by some commissioners.

 

4.3.3 The QAF monitoring process has ensured that providers give increased opportunities for service users to influence how the service they receive is delivered. Service user involvement is no longer tokenistic or an optional add-on and it is vitally important that commissioners retain this approach and ensure that the service user voice impacts on service delivery.

 

4.3.4 There has been great advances in understanding about the need to measure outcome and impact in service delivery. Again, we would urge commissioners to continue the progress in this area by avoidance of micro-managing providers who have proved that they have appropriate processes in place and are routinely able to demonstrate their accountability. There are a number of outcome systems around which providers should be encouraged to embrace. For example, the outcome star is used by many organisations currently receiving Supporting People funding and its effectiveness now proven beyond doubt. There is no point in creating further new outcome systems (though existing models can be developed) and risk losing the opportunity of benchmarking that is offered through a shared approach.

 

4.4 Personalisation

 

4.4.1 Personalisation offers exciting opportunities for service users to take greater control over the support provided to them and to influence commissioned organisations. Many of Thames Reach floating support services have already developed effective approaches based on the personalisation model. We hope that commissioners will be prepared to pilot new forms of personalised service delivery and that providers will embrace the chance to empower service users.

 

4.4.2 It is important that the full spectrum of personalisation approaches is considered that reflect the great range of people receiving support services. For example, Thames Reach works with many people with multiple needs, notably drug, alcohol and mental health problems, for whom an individual budget approach would need to be very different in terms of the necessary restraints on how money is spent than would be the case for other service users who perhaps are on the cusp of getting work and are in settled accommodation, when the freedoms offered should be very different.

 

4.4.3 One way forward is to find ways in which people receiving a service can also work for the service provider. 71 of Thames Reach's 400 staff are former or current service users and we would urge commissioners to have higher expectations on providers to attract into their own work-force individuals who have direct and extremely valuable experience of using the service.

 

4.4.4 We look forward to working closely with commissioners to pilot imaginative personalisation approaches. A few commissioners are apparently seeing personalisation as a way of reducing costs. This is puzzling as, at least in the piloting phase, personalisation may not offer cost benefits. A simplistic approach is likely to benefit those at the more able end of the market and disadvantage further those groups already suffering from considerable socially exclusion

 

4.5 World class commissioning

 

4.5.1 We remain optimistic about the possibilities of Area Based Grant tying together formerly disparate funding streams to offer a much broader package of opportunities to service users. The frustrating limitations of 'housing related' support can be broken down if an amalgamation of housing, employment and health-related funding streams can successfully converge.

 

4.5.2 To do this, it is important that commissioners raise their awareness of the range of initiatives that are already in place and build on the opportunities that they offer. One example of this is the enormously important work underway concerning social exclusion. The Social Exclusion Task Force has been funding a number of initiatives aimed at assisting those who are most excluded to gain stability, find work and develop fulfilling and sustaining support networks. The rich learning derived from these initiatives must not be wasted but directly affect the commissioning process. Similarly, via the Economic and Social Research Council (ESRC), a number of research programmes are about to commence which will help us to understand how to prevent social exclusion amongst homeless people. We look to both central and local government to demonstrate how the best practice across departments and specialist areas can combine to deliver world class commissioning in this country.

 

May 2009