Memorandum from the London Borough of Greenwich (SPP 19)

 

1. Summary

 

1.1 On 31 March 2009 the Communities and Local Government Select Committee announced an inquiry into success of the Supporting People national strategy Independence and Opportunity: Our Strategy for Supporting People. The strategy identified four key themes for the programme. These are:

 

Keeping service users at the heart of the programme

Enhancing partnerships with the Third Sector

Delivering in the new local government landscape

Increasing efficiency and reducing bureaucracy.

 

1.2 For each theme the strategy set out what Central Government would do to achieve these ends and also what Local Authorities and Providers were expected to do to help. This paper will focus on:

 

the steps that the London Borough of Greenwich and its Providers have taken to meet the objectives of the strategy.

the implications of the removal of the ring-fence and maintaining the successes of the programme.

opportunities for building on those successes and delivering, further innovative solutions to meet the needs of vulnerable adults in need of housing support.

 

1.3 This paper has been prepared by Jason McCulloch, Supporting People Manager for London Borough of Greenwich. Jason has 12 years' experience of administering funding for and monitoring the quality of supported housing. He has managed the team in Greenwich since 2006 and has worked in Supporting People since 2004. Before that he worked for the Housing Corporation administering Supported Housing Management Grant and for the Dept of Social Security administering Section 30 funding. Both of these funding streams were amalgamated into the Supporting People programme at its inception in April 2003.

 

2. Keeping Service Users at the Heart of the Programme

 

Supporting People in Greenwich continues to place a strong emphasis on service user involvement. The team employs an Information and Service User Involvement Officer who is responsible for leading on service user engagement. The team holds four Service User and Carer Forums a year and publishes a twice yearly newsletter. Service users' views are central to the service review process and we continue to judge the quality of services using the Quality Assessment Framework (QAF), which has the principle of service user involvement at its heart. When contracts are put out to tender (potential) service users are consulted throughout the process to ensure that their views are taken into account by the selection panel.

 

At a local level we are using the introduction of Extra Care Housing to explore the development of a single assessment process to consider the health, social care and housing support needs of service users.

 

Supporting People is involved in the development of a local pilot for Individual Budgets as part of the Council's strategy for delivering choice and control for service users.

 

The Supporting People Team uses its Service Users and Carers' Forum to disseminate information about the Supporting People programme, to ask service users for their views and ideas, to "road test" new literature and to promote health and well-being. Each forum, will usually have a guest speaker and in the past we have had presentations such as:

 

healthy cooking demonstrations

fire safety

safeguarding

developing independence through healthy living.

 

3. Enhancing Partnerships with the Third Sector

 

The Supporting People Team in Greenwich continues to work closely with its provider organisations and other third sector stakeholders to deliver positive outcomes for service users. There are four Inclusive/Provider Forums a year (two of which are sub-regional, covering Bexley, Bromley and Greenwich). Greenwich has three provider representatives on its Core Strategic Group.

 

Historically, other than statutory providers such as the Council and the local NHS Trust, all of Greenwich's Supporting People services were managed by Registered Social Landlords or voluntary organisations. At the introduction of Supporting People in 2003 there were approximately 50 provider organisations in receipt of Supporting People funds. Today, there are still approximately 40 provider organisations contracted to provide services and non-statutory providers are still all third sector organisations.

 

When considering the cost of services Greenwich Supporting People asks organisations to submit income and expenditure budgets that show clearly how costs are split between Housing Support, housing management and other costs. We also ask that these budgets clearly show which costs are staff costs. Reasonable levels of overheads are not challenged and we recognise that smaller organisation will not be able to demonstrate economies of scale. However, if overheads appear to be particularly high we will ask for a further breakdown and justification of those costs.

 

For most services Greenwich Supporting People has offered providers three year contracts, which contain an option for us to extend for a further two years. In a small number of cases, where concerns exist about a service or provider we have offered one-year rolling contracts with a maximum term of five years.

 

The Supporting People programme in Greenwich has piloted a number of new support models and other innovative approaches to delivering positive outcomes for service users.

 

We have commissioned a supported lodgings service for Young People at Risk where service users live with a Householder who acts as a mentor. The service user is also supported by a floating support worker who is directly employed by the provider organisation. We are currently considering extending this model to support Teenage Parents.

 

Age Concern has been commissioned to provide long-term floating support to Older People with Support Needs. Traditional floating support services will usually end within two years. It is anticipated that, with continuous low level support, Age Concern's clients will be able to continue living in their own homes, will have reduced hospital admissions and remain active in their communities. The service is currently being reviewed.

 

The Supporting People Team has also worked with the local Teaching Primary Care Trust (TPCT) to adapt its Community Health Promoters course for support workers. The intention is that support workers will use their key-work sessions with clients to promote healthy living and embed health and well-being in their support planning. The first course has recently finished and we will evaluate its success later this year.

 

4. Delivering in the New Local Government Landscape

 

Although the ring-fence has now been removed from Supporting People allocations, Greenwich Council has agreed to maintain its current commissioning structure for the Supporting People programme. The programme is overseen by the Commissioning Body, which has representatives from Adult Social Care, Housing, TPCT and Probation. Beneath the Commissioning Body is the Core Strategic Group. The Core Group's membership reflects the Commissioning Body's but also includes provider representatives, Children's Services and a Finance representative. The Council's Cabinet has already agreed the Supporting People budget for 2009/10 and 20010/11.

 

Furthermore Supporting People is represented at a number of strategic and commissioning groups including the Mental Health Joint Commissioning Group, the Learning Disabilities Joint Commissioning Group, the Physical and Sensory Impairment Strategy Group, the Teenage Parents Partnership Board and the Domestic Violence Project Management Board. In addition to these groups Supporting People is also represented at the Multi-Agency Safeguarding Adults Group, the Homelessness Forum and the Quality Advisory Board.

 

Greenwich was pleased to note the inclusion of Supporting People key performance indicators in the National Indicator Set. Although neither of these was included in the main 35 indicators of the Local Area Agreement (LAA) we have included them as local targets for the LAA. Furthermore the Supporting People team is collaborating with colleagues in Adult Social Care to ensure that Supporting People outcomes, performance and review data is included in the Care Quality Commission's Self-Assessment.

 

5. Increasing Efficiency and Reducing Bureaucracy

 

Supporting People in Greenwich has already taken steps to reduce the bureaucratic burden on providers. The team does not cyclically review services, but rather has introduced a programme of regular contract monitoring meetings with providers. The frequency of these meetings will depend on the perceived risks around the contract based on a number of issues including size of contract, performance, numbers of incidents and number of complaints.

 

The Supporting People Team does still ask providers to submit annual QAF returns, but we understand that small providers will not necessarily have the capacity to achieve Levels B and A. Hence for services such as Abbeyfields and almshouses we expect them to maintain a Level C service (other than for Protection of Vulnerable Adults where Level B is our minimum acceptable standard.) Typically, contract monitoring meetings with smaller providers will not take place more than once a year.

 

We are striving to introduce technology that will allow providers to submit all required information electronically. However, to date we have not been able to achieve this.

 

6. Implications of the Removal of the Ring-Fence and Maintaining the Successes of the Programme

 

Recent consultation has shown, as might be expected, that provider organisations are concerned that the ring-fence has been removed from Supporting People allocations. Providers are also unsure about the impact of Individual Budgets. They are seeking assurances around continued funding of their services, and also of the Council's general commitment to the provision of housing support services. These concerns are heightened by the current economic situation.

 

Although the concerns from the provider sector are understandable, the removal of the ring-fence offers Supporting People Teams (and other commissioners) opportunities to be more creative in delivering positive outcomes for vulnerable adults. Furthermore, the increasing emphasis that is being placed on maintaining independence and preventative services gives housing support providers a significant opportunity to demonstrate the effectiveness of housing support services in areas such as supporting people to maintain their independence, reducing admissions to hospital, reducing offending behaviour, maintaining abstinence and managing debt.

 

Supporting People in Greenwich has already offered providers some joint contracts with Adult Social Care to provide holistic services that address individuals' full range of care and support needs. We have increasingly sought to consider the overall aims and objectives of a service in our monitoring processes. Greater emphasis is placed on service outcomes rather than inputs, particularly those labelled "general social care." We are concerned that services promote independence and do not create dependence.

 

The removal of the ring-fence does put an onus on housing support providers to demonstrate their qualities and to promote their services in an increasingly commercialised market. As far as possible Supporting People in Greenwich will work with providers to assist them in this area, but providers must understand the importance of submitting outcomes and performance data, of demonstrating service user satisfaction and of using the QAF objectively when assessing the quality of their own services.

 

7. Opportunities for Building on those Successes and Delivering, Further Innovative Solutions to Meet the Needs of Vulnerable Adults in Need of Housing Support.

 

Supporting People in Greenwich welcomes the recent reports that have been produced by Care Services Improvement Partnership (CSIP) and Care Services Efficiency Delivery (CSED) that promote the benefits of housing support services.

 

We will continue to work in partnership with the TPCT to deliver preventative services as well as re-ablement and rehabilitation services to prevent hospital admissions and improve the number of people that can return home after a period in hospital.

 

Greenwich has also agreed to join CSED's learning set on opportunities for Support Related Housing and Assistive Technology and other possible CSED solutions. The first meeting of the London and South East Group will be in May 2009.

 

Supporting People in Greenwich will also work with colleagues in Housing to consider how we can use the PSA16 toolkit, devised by CLG, to improve services and outcomes for offenders, care leavers and people with a learning disability or mental health problem.

 

The Supporting People team will separately explore innovative solutions for meeting the needs of vulnerable adults with complex needs, often labelled "people with chaotic lifestyles." In particular, Greenwich is interested to see the outcomes of the Adults with Chronic Exclusion (ACE) pilots.

 

May 2009