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Memorandum
from the Cornwall Supporting People Team (SPP 36)
1.0 Summary
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1.1
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The Supporting People (SP) programme has delivered tangible value
within Cornwall, specifically relating to increased efficiencies, and
increase in the number of vulnerable people supported, and a reduction in the
need to access more costly crisis interventions.
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1.2
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Cornwall's Supporting People team believe that the government's
national strategy has largely been delivered successfully, adding real value
to the most vulnerable people in our society.
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1.3
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The Supporting People team has embedded the needs of service users at
the heart of its programme through its service reviews and communications. Providers
are better equipped to engage with service user requirements as a result of
the programme, and the commissioning undertaken in Cornwall is based on real
needs evidence, with strong levels of service user engagement.
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1.4
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The value of the Voluntary and Community Sector cannot be
underestimated. The Supporting People programme has ensured close partnership
working which has added tangible benefits and value to service users as well
as the voluntary sector agencies themselves.
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1.5
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Cornwall has
had to meet specific challenges following the change to a unitary authority
from a two tier system on 1st April 2009. This has added additional pressure
to the local team, however has also offered opportunities to streamline
decision making processes. Cornwall has prioritised Supporting People and the
needs of vulnerable adults in a number of its Local Area Agreement (LAA)
targets which give added credence to the value of the preventative work
undertaken.
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1.6
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While it is
evident that bureaucracy has not diminished since the start of the programme,
it is also true that providers value the efficiencies that the SP programme
framework has put on them. While there are some difficulties with the level
of paperwork and so on, provider agencies in Cornwall have made it clear that
they would not wish to remove the Quality Assessment Framework and associated
reporting, as it adds real value to their service.
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1.7
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The removal
of the ring fence offers both opportunities and risks. Some of the core
messages received by the Cornwall SP team when discussing this with providers
and stakeholders were that government could support the local programmes by
putting in place the following:
· Remove the national grant conditions and allow
local ones to be put in place
· Preserve the SP administration grant
· Mandate that SP sits on the Local Strategic
Partnership (LSP) to ensure a local voice at the highest level
· Develop a national framework for commissioning
preventative services
· Develop a national communication strategy on the
value of preventative services
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2.0 Introduction
2.1 The local context
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2.1.1
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With a resident population of circa 540,000,
Cornwall is a diverse rural County with a patchwork of areas with relative
affluence and pockets of marked overall deprivation, notably in West Cornwall
but also in the Mid-Cornwall area. Like most rural counties Cornwall lacks
frequent and effective transport services and this can present significant
challenges. Based upon these
estimates the population will grow from 540,000 currently to circa 640,000 by
2028. The most marked rise is likely to be in the 60 plus age group and
particularly for those aged over 75.
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2.1.2
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The SP grant allocation for SP in Cornwall for 2009
/ 10 is £14,204,036 and the allocation will remain the same for 2010/11.
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2.1.3
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Putting
People First is the driving force behind the personalisation agenda. Supporting
People are the driving force for delivering the preventative agenda to
vulnerable people across a range of partners.
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2.1.4
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The table below gives some core statistics around
the services provided in Cornwall that are directly funded by Supporting
People. This clearly shows in the six years since the programme started there
have been significant efficiencies made, at the same time as an increase in the
number of vulnerable people receiving service provision.
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SP Service
provision in Cornwall
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Description
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2003/04
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2008/09
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Number of Supported Accommodation
Units in Cornwall
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No figures available
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6368
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Number of People Supported by
Floating Support
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No figures available
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1434
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Number of Services funded
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510
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312
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Number of Service Providers
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134
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66
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Total number of Service Users
accessing SP funded services
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9600
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10653
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2.1.5
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It should also
be noted that in 2003/04 there was no service provision in the county for people
with HIV and Aids, Gypsy & Travellers, Owner Occupiers (other than
through Home Improvement Agencies) and no floating support for people with
physical and sensory impairment. Services
are now available for all of these groups.
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2.1.6
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Specific
examples of where Supporting People commissioned services have made a
tangible difference to people's lives in Cornwall are included in appendix C.
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2.2 Aims and
Objectives for the Supporting People programme in Cornwall
3.0
Delivery of the National Supporting People Strategy
3.1 Keeping people that need services at the
heart of the programme
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3.1.1
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Supporting People Team
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3.1.1.1
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One of the
most positive elements of the Supporting People programme has been the
emphasis on service user focus and engagement.
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3.1.1.2
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Service
users are involved in service reviews and their views are heard. Service user
feedback and influence, has directed service delivery improvement.
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3.1.1.3
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Service
Users in Cornwall are empowered to raise concerns and complaints about their
service direct to the Supporting People Team.
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3.1.1.4
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Cornwall's
Supporting People quarterly newsletter includes pages specifically aimed at
service users. This allows service users to remain in contact with the
programme as a whole, and also to share information and stories with other
service users.
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3.1.2
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Providers
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3.1.2.1
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Providers
have stated that the support planning process that the Quality Assessment Framework
(QAF) provides and the attainment of higher level achievement has ensured
greater service user involvement and provider accountability.
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3.1.2.2
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Service
contracts require a higher performance level against the QAF for core
objective 1.4: protection from abuse, this has improved safeguarding of
vulnerable adults and has ensured that the housing related support sector is
embedded in the multi agency culture.
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3.1.3
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Commissioning
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3.1.3.1
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Commissioning
is based on needs evidence. We have agreed commissioning priorities that
deliver the recommendations of the revised 5 year strategy. These
recommendations support the preventative agenda and link very closely to the
work carried out by other agencies such as Adult Care and Support, Health and
Probation.
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3.1.3.2
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Commissioned
services are responsive to need and their development has not been limited by
local political priorities. We have successfully commissioned services for
some of societies most excluded groups of people including prolific
offenders, gypsies, travellers and migrant workers. The 'independence' of the
ring fenced grant has enabled us to remain focussed on responding to local
need.
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3.1.3.3
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In 2007, Cornwall was chosen to run the Value
Improvement Project (VIP). This has enabled us to commission wider floating
support services that are now (following a re-commissioning exercise) responding
well to the needs of service users with complex needs. Floating support
offers a preventative approach to people with low level needs, prevents
homelessness providing a cost benefit to the public purse. As part of the VIP service users emphasised the
need for out of hours support for a range of vulnerable client groups. This
was therefore included in the specification for the service.
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3.1.3.4
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Service users have improved access to floating
support services, meaning a more positive transition into independent living,
and therefore better outcomes. The SP programme through partnership working
has improved the links between accommodation based services and floating
support. Information sharing protocols and handovers between services have
also improved outcomes for services, and therefore for service users.
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3.1.3.5
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The SP Programme
has enabled us to challenge and change the current delivery models of older
people services. We have set up an Independent Living Service pilot that is
examining and changing outmoded older persons sheltered services. The pilot
follows on from the guidance the National Housing Strategy for an Ageing
Society. The aim of the pilot is to promote change within the sector
providing flexible needs led services that are responsive to service user
need and will promote personalisation, a range of housing and tenure neutral
support options for older people and the development of Extra Care Housing in
Cornwall. The overall aim of the project is to meet the challenge of
demographic change in the County.
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3.1.3.6
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The
Supporting People team is working with Adult Care and Support to develop
specialist support service for people with Learning Disabilities through
Individual Budgets, thereby beginning the implementation of the
personalisation agenda. Lessons learnt from this pilot will be used to
improve processes for other client groups in time.
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3.2 Enhancing
partnership with the Third Sector (Voluntary and Community Sector)
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3.2.1
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As a result
of the SP programme, the Voluntary and Community Sector has been
professionalised and staff have better benefits, working conditions and
better access to training. SP have been able to assist by facilitating
training and funding some specialist training. SP have also, in partnership
with the local College, brought a professional support worker qualification
into Cornwall.
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3.2.2
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It should be
recognised that tendering can be a barrier to partnership with the Voluntary
and Community Sector. However as part of the VIP Supporting People were able
to provide networking opportunities and support all interested parties to
prepare their tender.
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3.2.3
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Raised
awareness of the Voluntary and Community Sector in local government and the
implementation of the Compact has provided the Voluntary and Community Sector
with more opportunities to joint work.
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3.2.4
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The
Voluntary & Community Sector has been actively encouraged to work a full
cost recovery model, however this has been difficult to implement due to
grant level restrictions.
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3.2.5
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Cornwall's
SP strategy acknowledges the value of small and Voluntary and Community Sector
providers.
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3.2.6
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The range of
services offered by the Voluntary and Community Sector provides greater
choice to service users.
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3.2.7
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As a result
of the SP programme, there is significantly more engagement and transparency
between Voluntary and Community Sector providers than there was previously.
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3.2.8
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The
Providers Fora in Cornwall are inclusive of all sectors with good models of
collaboration. The Voluntary and Community Sector in particular have a strong
voice and high profile roles within Provider Fora within Cornwall (e.g. Chair
of Forum) enabling them to influence policy/strategy etc.
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3.2.9
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A Risk
Information Sharing Protocol has been developed in conjunction with the
Voluntary and Community Sector and welcomed by all providers regardless of
sector.
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3.2.10
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The programme
has made the Voluntary and Community Sector open to and more comfortable with
scrutiny - the training needs audit is fully engaged and open to comparison
to statutory and private sector.
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3.3 Delivering in
the new local government landscape
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3.3.1
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Cornwall
will continue to use the Quality Assessment Framework, in assessing service
standards. We have found that the QAF has raised standards and keeps service
users at the centre of the support service.
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3.3.2
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Local Government Reorganisation
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3.3.2.1
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Cornwall has
its own specific challenges due to local government reorganisation, and the
change on 1st April 2009 to become a unitary authority, with the
amalgamation of the county council and the six district councils in Cornwall.
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3.3.2.2
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Until 31st
March 2009, the Commissioning Body membership comprised six district councils
(Housing), the county council (Adult Social Care), the local primary care
trust, and the local probation area. Since 1st April 2009 when the
district and county councils merged to become a single unitary authority, the
membership comprises Cornwall Council's Housing and Adult Care & Support
departments, the local primary care trust, and local probation area.
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3.3.3
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Governance Structures
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3.3.3.1
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As a result of
the changes in local government in April 2009, the Supporting People team
have taken the opportunity in the changing landscape to redesign the SP
governance structures.
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3.3.3.2
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In conjunction
with the new Cornwall Council we have developed a new governance structure. This
means that the Commissioning Body now reports into Cornwall's Local Strategic
Partnership, to ensure effective links with key decision makers in the
county, and to ensure that the governance arrangements for the SP programme
remain clear and up to date
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3.3.3.3
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A copy of the
new governance structure can be found at appendix A.
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3.3.4
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Local Area Agreement
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3.3.4.1
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The Supporting
People team were key contributors to the Sustainable Community Strategy for
Cornwall, published in 2008. This led to the development of a specific issues
paper around the needs of Vulnerable Adults in the county being written to
inform the final strategy.
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3.3.4.2
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Cornwall's Local
Area Agreement includes National Indicator 141[1]
as a designated target. National Indicator 142[2]
is also included as a local target, giving high profile to the Supporting
People programme in Cornwall.
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3.3.4.3
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In addition,
there are another 23 of the National Indicator set which have been allocated
as either designated or local priorities within Cornwall's Local Area
Agreement, on which the Supporting People programme will have a positive
impact.
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3.3.4.4
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A list of the
designated and local indicators included within Cornwall's LAA for vulnerable
adults is included in appendix B.
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3.4
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Increasing efficiency and
reducing bureaucracy
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3.4.1
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Providers
have stated that services are more efficient due to the requirements of and
the structure the QAF provides. Use of the QAF and Outcomes Framework provides robust
monitoring and provides evidence of need.
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3.4.2
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Bureaucracy
levels are still high detracting from front line delivery, however, providers
do not want to reduce monitoring levels or service reviews. Struggles with
bureaucracy seem to stem from Provider organisational infrastructure and
systems rather than an onerous reporting framework.
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3.4.3
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Reporting is
especially difficult for services that are jointly commissioned - there is no
single reporting structure to cover all commissioners and providers often
feel there is duplication in the paperwork.
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3.4.4
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Providers
feel that paperwork can detract from the amount of front line service
delivery and that in some instances the amount of paperwork can lead to a
high staff turnover. In particular this is true where providers find that
support staff who are excellent at support work may have poor administrative
skills. This adds stress to the staff, increasing turnover.
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3.4.5
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It can be
difficult for the Voluntary and Community Sector to engage at the level they
wish to. This is due to a lack of funding for back-office functions. Where
Supporting People grant has funded the front line support staff, there has
been no additional funding available to provide administrative support,
management etc. In small charitable organisations it can be difficult to find
the extra resources available to provide these functions, meaning front line
staff are diverted into carrying out these rather than specialist
administrative / office staff.
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3.4.6
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Locally
Police have been shadowing support workers. This has led to a much better
understanding between both parties and has led to improved outcomes for
service users. This has also led to increased professional respect between
the parties.
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4.0 Removal
of Ring Fence
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4.1
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There have been
no significant changes in Cornwall at this early stage following the ring
fence removal. Despite this, anxiety across the whole SP programme has
increased due to concerns that the removal of ring fencing will result in
service cuts as funds are diverted to other priorities in the county.
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4.2
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33% of the Area
Based Grant in Cornwall will be made up of previously ring fenced SP grant. This
leads to uncertainty about future funding decisions.
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4.3
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Concerns over removal of ring fence
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4.3.1
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Some of the
following concerns have been raised regarding the removal of the ring fence
in Cornwall:
· Competition for SP grant may be vast
and politically motivated when it is within the Area Based Grant. The removal
of the ring fence will expose the SP grant to other priorities of the LSP.
· Loss of SP teams and the experience
they hold is a real risk. In particular this could jeopardise the
relationship between SP teams and providers. SP teams and providers have
worked hard over the last 6 years to add real value and trust between
commissioners and providers.
· Despite the work to raise the
profile, there remains insufficient profile and understanding at both
national and local level for the SP programme to guarantee the safeguarding
of SP services
· The survival of small providers who
provide niche services
· Lack of financial security for larger
organisations will reduce willingness to invest in the development of new
services
· The direction of the SP programme may
be driven by the department in which it is located and their priorities,
rather than those of identified need. This may lead to the demise of the
partnership and the working relationships established in the county.
· There is a potential threat in the
lack of understanding and knowledge about SP and the long term value of
preventative services. Local decision makers may not recognise the value of
preventative services when higher profile is given to crisis services.
· Without the ring fence decision
making will become a political decision and is more exposed to NIMBY-ism (Not
In My Back Yard).
· Without a robust independent
governance structure, funding could be reduced for non voting groups. This
could politicise the support delivery for vulnerable people - in turn jeopardising
the needs based process, and further marginalise less popular groups.
· The current economic climate means a
likely increase in the client base as more people become at risk of
homelessness and require support. This poses a threat at a time when there is
less security in funding and no guarantee of longer term funding.
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4.3.2
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Some
of these risks could be minimised by government taking some or all of the
following actions:
· Provide a separate administration
grant to allow the Local Authority to continue investing in a specific SP
team to support the SP programme with a raised profile.
· Comprehensive Area Assessment (CAA)
needs to remain focussed on vulnerable people in future years - not just in
the first year after the removal of the ring fence
· Reinstatement of the ring fence with
removal, or increased flexibility, of grant conditions. Enable SP Teams to
develop local grant conditions
· Mandated SP representation at the LSP
· Clear guidance from Communities &
Local Government for the local Commissioning Body on its role
· Continue the development of a
national framework for service commissioning and decommissioning
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4.4
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Opportunities
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4.4.1
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It is also recognised that the removal of the
ring-fence can offer opportunities and flexibility in the delivery of the
objectives of the national strategy. These include:
· The ability to work in different ways
and using innovative models
· The ease of joint commissioning is
increased, leading to greater efficiencies with public spending
· Removal of grant conditions is
welcomed as this increases perceived flexibility to achieve the benefits
without risks to the sector.
· The
possibility of securing extra funding to preventative services from the LSP
· The
joint delivery of services
· Developing
own local performance framework
· The
development of Service User focussed delivery models, particularly in line
with the personalisation agenda
· The option to build evidence for
'extra' provision outside of the current framework - the current system
compartmentalises clients and services e.g. responsive holistic services
delivered regardless of the service user's primary need.
The development
of local flexibilities in service development - for example flexibility in
contracting.
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4.4.2
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It should be noted, however, that many of these opportunities could be
delivered simply through the removal or relaxation of the grant conditions,
without the added risk to funding of the removal of the ring-fence.
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Prepared by:
Supporting
People Team
Cornwall Council
8 May 2009
Cornwall's Supporting People team would
like to thank their providers, partners and stakeholders for their valuable
contributions to this response.
Index of
Appendices
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Appendix
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Title
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Relates to
point
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A
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Supporting People Governance
Structure
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3.3.2.3
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B
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National Indicators in Cornwall's LAA with a specific
impact on Vulnerable Adults
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3.3.3.4
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C1
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Case Study
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2.1.6
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C2
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Case Study
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2.1.6
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C3
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Case Study
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2.1.6
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Supporting People Governance Structure
National
Indicators in Cornwall's LAA with a specific impact on Vulnerable Adults
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Designated / Local
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NI
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Description
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Designated
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18
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Adult re-offending rates for those
under probation supervision
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Designated
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26
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Specialist support to victims of a
serious sexual assault
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Designated
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39
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Alcohol-harm related hospital
admission rates
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Designated
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112
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Under 18 conception rate
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Designated
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116
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Proportion of children in poverty
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Designated
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117
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16 to 18 year olds who are not in
education, training or employment (NEET)
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Designated
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125
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Achieving independence for older
people through rehabilitation / intermediate care
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Designated
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130
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Social Care clients receiving
self-directed support
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Designated
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135
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Carers receiving needs assessment or
review and a specific carer's service, or advice and information
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Designated
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141
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Percentage of vulnerable people achieving independent
living
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Designated
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145
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Adults with Learning Disabilities in
settled accommodation
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Designated
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146
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Adults with Learning Disabilities in
employment
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Designated
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153
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Working age people claiming out of
work benefits in the worst performing neighbourhoods
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Designated
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156
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Number of households living in
temporary accommodation
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Designated
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187
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Tackling fuel poverty
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Local
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13
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Migrant's English Language skills and
knowledge
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Local
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19
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Rate of proven reoffending by young
offenders
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Local
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32
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Repeat incidents of domestic violence
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Local
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40
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Drug users in effective treatment
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Local
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45
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Young offenders engagement in
suitable education, employment or training
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Local
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46
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Young offenders access to suitable
accommodation
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Local
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142
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Percentage of vulnerable people who are supported to
maintain independent living
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Local
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143
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Offenders under Probation supervision
living in settled and suitable accommodation at the end of their licence
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Local
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144
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Offenders under Probation supervision
in employment at the end of their licence
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Local
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148
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Care leavers in employment, education
or training
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Case study 1
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Overview of Service User History
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The client was referred by probation.
He was abusing drugs at the time and had a recent history of self-harm. He
also has bipolar disorder. During assessment he came across very well. He was
sofa surfing and was supported to move within a week. In his first week in
supported accommodation, he cut his wrists and began to abuse his
prescription drugs.
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Service delivered by Provider
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He was supported in a residential
setting through maintaining his tenancy, ensuring he was receiving the
correct benefits and to engage with agencies surrounding his drug use, mental
health issues and offending. The provider is meeting with Shelter to
facilitate partner agency support.
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Outcome for Service User
Housing
Education
Training
Employment etc
|
He has just been awarded a council
property and has also successfully completed 2 interviews for a college
course which he starts in September. Through this, he has greater
independence and confidence and now has a home that he can have access to his
son (as children are not allowed at the supported accommodation he lived at).
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Service Users current situation
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He has just received his Community
Care Grant and is furnishing his new home. He is in liaison with Pathways who
are sorting out the funding for his college course.
His mental health issues are stable,
as is his drug use.
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|
Estimate of the number and type of 'statutory'
interventions avoided due to support.
|
Prison/arrest may have been avoided
as the client was housed in stable accommodation.
Admission to hospital due to mental
health issues / self harm has been avoided.
Treatment for drug abuse has been
avoided as he has stabilised without the need for this.
Homelessness avoided.
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Case Study 2
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Overview of Service User History
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The client grew up in severely
dysfunctional family - all children were sexually abused and went in and out
of care. Siblings have a history of drug abuse, mental health issues, self
harming and sex working. The client has been in prison on a number of
occasions as have many other members of the family. The client also has many
complex health issues including heart problems, severe hearing loss,
epilepsy, learning disability, severe arthritis. The client cannot read or
write. On assessment of this client this person was living in a freezing cold
house with no money for heating. There was no food in the house and the dog
was using the house to urinate and defecate.
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Service delivered by Provider
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The provider helped this client
downsize into a more appropriate property. Supported in managing finances. Applied
for a Community Care Grant for a cooker which was successful. Applied to
Glasspool Charity for a new washing machine which was successful. Re-homed
the dog. Got this client a bus pass and supported this person in getting up
to date hearing tests and new hearing aids (the previous ones had been
destroyed by the dog). Made a referral to Link into Learning to learn to read
and write. A referral was made to social services and a social worker has now
been assigned. A medical advocate is in place and providing a college place.
|
|
Outcome for Service User
Housing
Education
Training
Employment etc
|
The client is now living in a more
manageable property. Is improving reading and writing skills as he has
maintained the placement at Link into Learning. Is getting about more now
that the bus pass is in place. Is preparing for college with support from the
Department for Adult Care & Support. Is managing finances better - with
support.
|
|
Service Users current situation
|
The client has a learning disability
and will need on-going support which will now be provided as the referral to
DASC was successful. This client fully engages with services. This client is
now writing their own file notes - with support and would like to be more
involved in service user opportunities.
|
|
Estimate of the number and type of 'statutory'
interventions avoided due to support.
|
Homelessness / Prison / Hospital
Admission / physical or mental ill health due to property condition.
|
Case Study 3
|
Overview of Service User History
|
The client was in an abusive relationship,
had a young child (2 years old) and wanted to leave the relationship. She had
very low self-esteem and was experiencing depression. Also feeling isolated
within the community due to having moved from Ghana 3 years ago and feeling
the cultural differences. Was dependent on partner for money having no
separate income.
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|
Service delivered by Provider
|
Support to move to independent
accommodation and set up tenancy, services, bills etc and leave the
relationship safely - involved domestic violence agencies and police. Support
to claim benefits (Income Support, Child benefit and Child tax credit)
Support to access legal aid due to child custody and divorce issues. Referral
to the Black and Ethnic minority service at Pentreath.
|
|
Outcome for Service User
Housing
Education
Training
Employment etc
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The client is now settled in a 2
bedroom private rental property in Penzance with her son and managing her tenancy
independently. She intends to apply to the police and wants to work as a Police
Community Support Officer. In receipt of full benefit entitlement and has
built up a strong social network in Penzance and also has much higher
self-esteem.
Resolved child custody issues through
court and divorce has gone through.
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Service Users current situation
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Continuing to maintain tenancy and
waiting for a vacancy to arise as a PCSO. Works part-time as a play worker in
a children's centre.
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Estimate of the number and type of 'statutory'
interventions avoided due to support.
|
Homelessness
Ongoing domestic abuse
Hospital admission
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Case Study 4
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Overview of Service User History
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The client had a family abuse
background and was in foster care for the majority of his childhood. As an
adult / teenager he spent three years rough sleeping, plus some stays in a
small flat with a large number of other young people and sofa surfing on
occasion. He had poor literacy levels and was barely able to read.
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Service delivered by Provider
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He entered the supported
accommodation project. His 16 year old girlfriend was pregnant. He was living
a chaotic lifestyle with a combination of falling back into negative
behaviour patterns of bad money management and nearly losing his
accommodation due to not fulfilling responsibilities.
|
|
Outcome for Service User
Housing
Education
Training
Employment etc
|
He is due to successfully move on in
one week's time. He has accommodation arranged for this. He can now
successfully cook healthy meals, manage his money and reliably attend appointments.
His literacy has improved - he is able to read letters and other information
for himself. He has learned to make mature decisions for himself and to keep
appointments and commitments.
|
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Service Users current situation
|
The client is due to move out of
supported accommodation and into independent living in one week's time. It is
anticipated that this will be fully successful.
|
|
Estimate of the number and type of 'statutory'
interventions avoided due to support.
|
The client did not have the ability
to maintain a tenancy, and without support would have been evicted from
accommodation, meaning he was street homeless again.
|
May
2009
[1] NI141 -
Percentage of vulnerable people achieving independent living
[2] NI142 -
Percentage of vulnerable people who are supported to maintain independent
living
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