Memorandum from the Stoke-on-Trent Supporting People (SPP 33)

1. Summary

1.1. The Supporting People partnership for Stoke-on-Trent believes that the programme has delivered significant benefits for service users and communities since its inception in April 2003.

· Since its inception Supporting People has always focused on the needs of service users at the heart of the programme. Supporting People is an archetypal 'personalised' and flexible service for vulnerable people and households.

· Supporting People is a significant funder of Third Sector services. In our experience, the Supporting People programme has helped significantly to strengthen the relationship between statutory and non-statutory sector partners - particularly the voluntary sector.

· Sitting at the intersection between social care, housing, health, and community safety services, Supporting People is a force for understanding, coalition, and partnership working. The outcomes framework is further strengthening the evidence base for this partnership and the importance of the intersection (particularly in relation to preventative services). However, we believe that the impact of applying individual budgets or direct payments to the programme is little understood. Therefore, we remain cautious in relation to our implementation of this aspect of the personalisation agenda as we would not wish to destabilise the valuable contribution of Third Sector partners.

· We believe that efficiency has been increased and, since the inception of the programme, bureaucracy reduced. However, we also believe that the anomalies in the distribution of funding have not been sufficiently addressed in the implementation of the distribution formula. This has disadvantaged vulnerable people in the Local Authority areas that were disproportionately affected such as Stoke-on-Trent. We would like to see the pace of change within the distribution formula increased for authorities that are significantly underfunded such that they achieve their target allocation within three years.

1.2. Given the relative differences between authority areas in terms of the level of awareness of Supporting People and integration of housing-related support in to relevant strategies, we believe that removal of the ring fence would risk losing the benefits gained to date. Further, it is also our view that the impact of individualised budgets and direct payments on the provider market, particularly the Third Sector, is not yet sufficiently understood for large scale implementation in Supporting People markets. It is our concern, that removal of the Supporting People ring fence, combined with a general drive in social care and health for individual budgets and direct payments, poses a significant risk to the benefits gained by the Supporting People programme thus far.

1.2.1.
Introduction

1.3. In responding to the request for evidence we have considered each element of the CLG strategy for Supporting People: Independence and Opportunity; Our Strategy for Supporting People. This is divided in to the four key headings with sub-heading and paragraphs as numbered.

1.4. Where the Supporting People partnership for Stoke-on-Trent has a view on the national issues this is expressed. However, we have relied largely on our experience of delivering the Supporting People programme in Stoke-on-Trent as the basis of our evidence for the select committee.

2. Keeping people that need services at the heart of the programme

2.1. Putting the service user in charge

2.1.1. The Supporting People programme has been delivering personalised services, with the needs of the user at the centre, since its inception in April 2003. This is underpinned by the Quality Assessment Framework (QAF) which provides a robust, widely understood, and popular basis for quality assurance and continuous improvement in the programme.

2.1.2. In Stoke-on-Trent, we have worked with and through service providers to implement the standards set out in the QAF for consulting and involving service users at the level where we believe it counts most - their own services. In the recently revised QAF, this part of the QAF has become a 'core standard' of the framework.

Supporting evidence from Stoke-on-Trent

Supporting People in Stoke-on-Trent worked in partnership with Brighter Futures Housing Association, Staffordshire Fire and Rescue Service, and the Local Authority Housing Solutions Service to develop a service directory for people sleeping rough in the city. Rough sleepers and former rough sleepers were central to the design and content of the service directory (which can be downloaded from (www.stoke.gov.uk/supportingpeople).

Service user involvement through this work also led to the establishment of a single free-phone telephone number for rough sleepers. Previously, two different mobile numbers had been provided and service users highlighted during the consultation that they found this both confusing and costly.

 

2.1.3. However, service users are involved increasingly in decisions at a strategic level. For example, information derived from:

2.1.3.1. the aggregation of interviews with individual service users performed as part of contract management arrangements

2.1.3.2. project specific consultations with service users in relation to service improvements, new services, or redesigned systems

2.1.3.3. the aggregations of comments, compliments, or complaints from service users

2.1.3.4. the routine involvement of service users in governance arrangements; such as, through commissioning bodies, strategy groups, inclusive forums, provider forums, or service user specific forums

2.1.4. We believe that this aspect of Supporting People has been strong from the outset of the programme. It has improved continuously as the programme has matured which can be evidenced via QAF scores as well as via the independent assessments of Audit Commission inspection reports. Further, we believe that other parts of the social care, health, and wider public sector could learn from the best practice achieved by many Supporting People partnerships.

2.2. Challenging barriers to joined up interventions

2.2.1. The tripartite partnership in Supporting People between the Local Authority, Probation Service, and Health Service has produced demonstrable results for local people. There are many clear examples from across the country including extra care sheltered housing for older people and people with learning disabilities. However, Supporting People has also brought about joined up interventions for service users in short-term services such as homeless people and people with drug or alcohol problems.

Supporting evidence from Stoke-on-Trent

Supporting People in Stoke-on-Trent worked in partnership with the local Community Safety Partnership, Drug and Alcohol Action Team, Crime Reduction Initiatives, and Beth Johnson Housing Association to establish a new accommodation-based service for people with drug problems.

The partners worked together to develop a service model, identify a site, and apply for housing corporation funding. This included extensive work with Elected Members and the local community.

The City now has a purpose built supported housing facility for people with drug problems. This is integrated in to drug treatment pathways through onsite health and treatment interventions. Service users experience a comprehensive service through to resettlement and treatment in the community. The service has been running since September 2007.

 

2.3. Getting more service users involved and empowered

2.3.1. While we are unaware of a lead from central government on the development of "Charters for independent living", we are aware that many Supporting People partnerships have developed methods for informing service users of their rights and responsibilities in respect of housing-related support services.

2.3.2. In Stoke-on-Trent, we produce a leaflet for service users entitled "Supporting People: What you can expect". The Supporting People team in the City has committed through the comments, compliments, and complaints policy to fully investigate service user complaints. This is where either the providers' complaints process has been exhausted or where the service user simply feels more comfortable for us to look in to the complaint.

2.4. Developing more integrated assessments

2.4.1. A number of Supporting People partnerships have developed integrated systems of assessment and referral with social care and health partners. Stoke-on-Trent was recently unsuccessful in its bid to become a pilot site for the Adult Common Assessment Framework (ACAF). However, partners in Stoke-on-Trent remained committed to the principle of integrated assessment and referral mechanisms. This is a key priority for the Supporting People programme in the city.

2.4.2. In implementing the single assessment and referral system, we will be keen to learn from the experiences of the ACAF pilot areas as well as from places such as Nottingham City Council and Southwark where we understand a lot of progress has already been made.

2.5. Meeting the needs of mobile groups and individuals

2.5.1. In our experience, there is little regional planning of services for mobile groups. This is perhaps due to the lack of a regional infrastructure with any resources to allocate to the commissioning of services.

2.5.2. Similarly, we understand that some local authorities still operate a local connections policy for short-term Supporting People services against the explicit guidance of CLG. We believe that such policies work against the interests of mobile groups and individuals. At the same time, such policies also increase the demand for service in areas that do not have a local connections policy.

2.5.3. There is, however, evidence that sub-regional working has brought about clear benefits for service users and local communities.

Supporting evidence from Stoke-on-Trent

Supporting People in Stoke-on-Trent worked in partnership with the Staffordshire Supporting People partnership on two services for mobile groups and individuals; for example:

· joint commissioning of a floating support service for high risk offenders

· joint commissioning of a floating support service for people with HIV or AIDS

 

Supporting People in Stoke-on-Trent has also developed a new culturally sensitive service for Asian women fleeing domestic violence. This has been developed in partnership with Refuge and Beth Johnson Housing Association. Refuge are able to use the service as part of a network of similar refuges to help ensure that women feel safe during an extremely difficult time.

 

2.6. Developing better communication and consultation with service users

2.6.1. Nationally, the Supporting People programme - spurred on by the QAF and Audit Commission inspection programme - has been at the forefront of public sector development in consultation and communication with service users. There are many examples of service users being involved in consultations leading to decisions and innovative ways of communicating.

2.6.2. Many Supporting People partnerships, including Stoke-on-Trent, involve service users in the evaluation of service performance as part of the contract management frameworks and also communicate the outcomes from these evaluations.

2.6.3. In Stoke-on-Trent, we are also in the process of developing an on-line social network for service users and other stakeholders to contribute their views and ideas about the programme which we intend to deliver through a well known channel such as "Facebook".

2.7. Exploring alternative provision models and helping service users to make the right choices

2.7.1. In Stoke-on-Trent we have not yet applied the Individual Budgets approach to delivering Supporting People services. This is partly due to relative underfunding. However, we will also be keen to learn from the experience of early implementing authorities in relation to both long-term and short-term services. Around two-thirds of the Supporting People programme in Stoke-on-Trent is commissioned via the Third Sector. Supporting People is a significant funder of local Third Sector providers. We are concerned to understand the impact that individual budgets and direct payments could have on the Third Sector in the city. Similarly, we will be keen to understand further how the benefits of the QAF, safeguarding, and adult protection arrangements can be maintained and improved through micro commissioning arrangements.

2.8. Enhancing the Supporting People Directory of Services

2.8.1. We understand that this service is being discontinued. We regret the loss of this service as it is - in principle - a strong idea and a useful source of information to a wide range of interested parties as well as service users and carers.

3. Enhancing partnership with the Third Sector

3.1. The role of the Third Sector

3.1.1. The Supporting People programme in Stoke-on-Trent is largely delivered through Third Sector partners. We are concerned that their appears to be little understanding of the potential impact of the 'personalisation agenda', as expressed through individual budgets and direct payments, on the established markets for services delivered to vulnerable people. This is particularly the case in relation to small and local Third Sector providers.

3.2. Our expectations on Providers and having the right level of reporting, accountability and transparency

3.2.1. In our experience, providers are a vital route to involving service users in the review, evaluation, and development of the Supporting People programme. It is our view that the Supporting People programme has strengthened both the formal and informal relationships with service providers. The Audit Commission noted that the Supporting People partnership in Stoke-on-Trent maintained very good relationships with providers.

3.2.2. As a partnership, we value highly the role of providers as critical friend in relation to the provision of services as well as the administration and management of commissioning. We formally involve providers in the strategy groups that make recommendations to the Commissioning Body as well as recognising the independent Provider Forum as a key reference group. Administration of the programme is 5% of the programme budget. The commissioning function of the Supporting People team has benefits across local authority partnerships and adds capacity to the commissioning functions of other areas such as housing, social care, and community safety.

3.3. Support and capacity building

3.3.1. In Stoke-on-Trent we have supported providers to be involved in the national benchmarking group managed by SITRA and supported by CLG and Housemark. This initiative followed provider feedback on a local framework designed to evaluate value for money in services.

3.3.2. Through the contract management arrangements we also help benchmarking by encouraging the sharing of best practice and joint working between providers. This has, for example, helped to establish a relationship for - where necessary - moving customers between homeless hostels to reduce evictions and, thereby, rough sleeping.

3.3.3. Where, on rare occasions, providers have got in to difficulties (e.g. through contract default), our approach has been to provide training and support concentrating our efforts on where the risk is greatest. In such cases, we have commissioned expert help to build the skills and confidence of frontline staff (for example, in managing the risks associated with drug users in a hostel environment).

3.3.4. However, where necessary - in the interests of service users - we have also been able to decommission services that were unable or unwilling to meet minimum standards of quality or safety. Prior to the implementation of the Supporting People programme there was no mechanism where this type of safeguarding would take place for housing-related support services.

4. Delivering in the new local government landscape

4.1. Forging new relationships and making the right links

4.1.1. In Stoke-on-Trent, particularly with the support of data from the Supporting People outcomes framework, we are increasingly able to attract resources to housing-related support services or other ancillary services that facilitate service user outcomes. For example:

4.1.1.1. We have been able to work with NHS Stoke-on-Trent to attract funding to expand the Home Improvement Agency to better link with hospital discharge arrangements

4.1.1.2. We have been able to attract funding from NHS Stoke-on-Trent for a floating support service for older people and to research how sheltered housing could be a hub for services to the nearby community of older people

4.1.1.3. Working in partnership with the Housing Solutions Service and Economic Development section we have successfully bid for funding from CLG to develop an Enhanced Housing Options service that integrates housing, employment, and training advice for vulnerable people

4.2. Developing stronger, more effective governance

4.2.1. The Audit Commission noted that governance arrangements in Stoke-on-Trent are effective. However, we have continued to strengthen these arrangements by working to improve the involvement of Elected Members and service users.

4.2.2. We believe that governance is a key strength of the programme generally and that Local Strategic Partnerships could benefit from the approach to governance developed in Supporting People. In particular:

4.2.2.1. the clearly delegated powers of Commissioning Body

4.2.2.2. the supporting advisory sub-groups with a work programme and clear portfolio (often called Core Strategy Groups)

4.2.2.3. the roles of the accountable officer, lead officer, and Chair of the Commissioning Body

4.3. Integrating Supporting People in to Local Area Agreements and developing new PSAs

4.3.1. We believe that the inclusion of the Supporting People performance indicators in the set of national indicators (NI141 and NI142) is beneficial for the programme.

4.3.2. In Stoke-on-Trent, we have been successful in securing the inclusion of number of vulnerable people achieving independent living in the top 35 priorities for the City. This represents recognition of both the strategic importance and wider value of the Supporting People programme for vulnerable people.

4.3.3. Supporting People has been aligned with the Healthier Communities and Older People pillar of the LSP and provides regular performance reports on both NI141 and NI142.

4.3.4. Increasingly, through the LSP arrangements, Commissioning Body members are able to raise awareness of Supporting People and its links to wider services for vulnerable people.

4.4. Developing a Supporting People outcomes set

4.4.1. The outcomes framework for the Supporting People programme is proving to be extremely valuable in relation to demonstrating the impact of housing related support. We believe that enough data has now been accumulated to begin to release this potential and that this approach is a model from which other public sector services could benefit. For example, we are able to identify easily that in the first three quarters of 2008/09 the following outcomes were achieved:

4.4.1.1. 518 people or households maximised their income

4.4.1.2. 148 people or households managed their debts

4.4.1.3. 34 people gained paid employment

4.4.1.4. 227 people engaged in training or education

4.4.1.5. 203 people achieved outcomes related to their physical health

4.4.1.6. 156 people achieved outcomes related to their mental health

4.4.1.7. 111 people achieved outcomes related to substance misuse

4.4.2. Such information has already been valuable in promoting the Supporting People programme and we believe will be strengthened through time and development.

4.5. Minimising the burdens and bureaucracy for local government

4.5.1. It is too early to assess the impact of the decision to cease the rolling programme of Supporting People specific inspections by the Audit Commission and integrate inspection in to the CAA.

4.6. Introducing a stronger statutory basis for Supporting People?

4.6.1. We do not believe that it would be beneficial to introduce a stronger statutory basis for Supporting People. While we welcome the decision not to proceed with establishing housing-related support as a statutory duty at this stage, we would reiterate our concerns in relation to the removal of the Supporting People ring fence and integration of the funding in to the area based grant.

4.7. Promoting and sharing positive practice

4.7.1. Supporting People in Stoke-on-Trent has benefited from a wide range of CLG promoted, supported, or attended events to share positive practice. This has ranged from the annual Supporting People conference to events held by partnerships achieving three-star status at inspection.

4.8. Funding and investment

4.8.1. The report in to the Supporting People programme carried out by Robson Rhodes on behalf of CLG clearly documented the uneven distribution of Supporting People funding across the country. Although the CLG has implemented the needs based distribution formula for the programme, we believe that the pace of change applied to the formula disadvantages partnerships such as Stoke-on-Trent.

4.8.2. The distribution formula estimates that the funding needed for Stoke-on-Trent is £13.5m. The Supporting People budget for 2009/10 in Stoke-on-Trent is £6.2m. Although the programme has benefited from an annual rise of 7% or more between 2007/08 and 2011/12, this will not bring the programme in the city to the target allocation for some considerable time.

4.8.3. The Supporting People partnership for Stoke-on-Trent would like the pace of change in the distribution formula to be accelerated for underfunded authorities that are outliers in the distribution formula. We would like the programme to move to the allocation estimated by the distribution formula over a three year period. An illustration of the uneven distribution that is more up-to-date than that provided in the Robson Rhodes report is as follows:

Supporting People Partnership	Population	Supporting People Grant 2009/10	Supporting People Grant Per Capita
Stoke-on-Trent	240,636	£6,273,683	£26.07
Liverpool City Council	439,473	£39,068,629	£88.90
Nottingham City Council	266,988	£23,512,499	£88.06
Birmingham City Council	977,087	£51,912,681	£53.13

 

5. Increasing efficiency and reducing bureaucracy

5.1. The value improvement programme

5.1.1. We are aware of the value improvement programme and have attended past events sharing the practice that emerged. With our partners, we have applied some of the lessons from the programme to services for young people locally - such as the YMCA.

5.2. Reducing bureaucracy

5.2.1. Following the original service review programme the Supporting People partnership in Stoke-on-Trent sought to ensure that contract management interventions were based on a clear assessment of risk. In consultation with providers, we developed a value for money framework that integrates risk, performance, and quality in to contract management. This was highlighted by the Audit Commission and featured on the Housemark benchmarking website. In a recent review, the providers expressed a high degree of satisfaction with the approach. Since the implementation of the value for money framework we have further rationalised the approach by reducing the frequency of contract management review for services measured as high and medium value for money.

5.3. Using new technology and business process to improve efficiency

5.3.1. We believe that this is an area in which the Supporting People partnership and Local Authority in particular can take a lead. As part of our considerations in relation to and Adult Common Assessment Framework, we are looking at the IT systems used by Adult Social Care to perform assessment and care planning. We intend to work with providers to evaluate the feasibility of making this system available to partners in an integrated approach through mobile networking technologies.

5.3.2. However, we recognise that many large providers have already made substantial investments in IT infrastructure to support their staff and service users. While we would see this as largely beneficial, we are concerned that this may enable large providers to 'outcompete' small, local, and Third Sector providers in competitive tendering processes if this element has a significant weighting in the considerations of the Supporting People partnership.

 

May 2009