Feasibility Study into a Disabled Persons Housing Service
Copyright Clive Durdle MSc BA (Econ) Hons FCIH Feb 2003
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What is a Disabled Persons Housing Service?
A 2002 report to Powys Council reports that Disabled Persons Housing Services have been developed in various parts of England and Scotland to overcome some of the barriers to housing faced by disabled people. A local Disabled Persons Housing Service (DPHS) is:
A specialist housing advice service providing and/or co-ordinating all aspects required to solve housing related problems available to all disabled people, irrespective of income, age and housing tenure
Powys reports that there is no standard way in which a DPHS should be, or is, organised; the existing DPHS’s have a range of different structures and emphases. The following features are typical of a DPHS:
v A user-centred approach, with the disabled person fully involved
v Assessment – full consideration of the needs of the disabled person and property, including future as well as present needs
v A Disability Housing Register – a register of housing needs of disabled people and database of supply of suitable purpose-built and adapted property
v Information, advice and support as required on all aspects of housing to achieve a solution – identifying all the possible options – often using the Personal Housing Plan approach
v Assistance with adaptations – including, when needed, design, planning permission and contract management; and help with advice on repair and renovation
v Inter-agency co-ordination – facilitating involvement and co-operation of the relevant statutory and voluntary agencies
v Training and practice in the skills of independent living – using accommodation set aside for the purpose, either to try out equipment or as short-stay housing
v Specialist Occupational Therapy advice – including a full consideration of short and long term needs
v Specialist architectural and other technical advice – as appropriate – information, design input and project management
v Specialist financial advice and assistance – information about costs of options available, welfare benefits advice, grant payments, shared ownership and interest only mortgages
v Specialist housing advice – including identifying suitable alternative accommodation; and information about the housing needs of disabled people to plan better housing provision
v Identifying and negotiating appropriate assistance and support – including information and advice about the employment and management of personal assistants
v Design advice to housing and other agencies
v Static and working displays of equipment – providing a resource of information and advice about availability and purpose
According to HoDis, the National Disabled Persons Housing Service, there are currently 13 DPHS covering a variety of urban and county areas. HoDis, is developing accreditation standards that include as a minimum:
v Customer centred approach. This includes:
v Ensuring empowerment, choice, dignity and control by disabled people
v An holistic, person centred approach to the housing needs of the disabled person
v Full consideration of the needs of the disabled person, including identifying possible options
v A casework approach
v Involvement in co-ordination of multi-agency responses
v The social model of disability must be central to the underpinning philosophy.
v Disability Housing Register, consisting of:
v A database of accessible (purpose built and adapted property)
v A register of disabled people who require accessible housing
v A service of matching people to property.
v Adaptations service
v Information, advice and support on adaptations options
v The practical services and funding needed to carry them out
The DPHS around Britain have aims that include being user centred, holistic, comprehensive and solution oriented.
Management structures vary, including being companies limited by guarantee, ad hoc arrangements, parts of Social Services, and parts of Housing Associations.
Budgets and staffing are generally very small, with great use of “free” services from partner organisations, secondment, lottery, seed and charitable funds.
Establishing a DPHS
Powys’ definition includes the phrase:
Providing and/or co-ordinating all aspects required to solve housing related problems
There are currently several types of organisation being constructed that have very similar aims and objectives, although client groups and the organisations being coordinated differ. These include Care Trusts, Children’s Trusts and the Supporting People Framework. Local Authorities must challenge how and why they are working, and strive to continuously improve their services. These organisational structures are attempts to achieve this.
An example of current government thinking is Children’s Trusts. The Government is inviting proposals to set up Children’s Trusts. They have written:
Children who need help from social services very often need help from other services as well. But the boundaries between the different organisations – who are there to help them – and the different processes and the different bureaucracies mean that too often those services don’t join up. It’s the child and the child’s parents who have to adapt to the needs of the services, not the other way round.
This is wasteful of time and resource, frustrating for the people trying to deliver the services and is not delivering for the children who most need help.
Government recommends a three-pronged attack:
v Strengthen existing local partnerships and pilot new children’s trust models for integrated services.
v Better focus mainstream children and young people’s services to ensure they respond better to those most in need.
v Early identification of need to ensure preventative services are available before children, young people and families hit crisis.
A Disabled Persons Housing Services would work to similar principles of strengthening partnerships, better focus, prevention and early identification of need.
The differences are client groups and range of organisations creating partnerships. The type of structural relationship – for example – a form of Trust – is a later decision dependent on the ability of existing structures to deliver equivalent qualities of services.
Government has stated:
Children’s Trusts will enable local partners to jointly plan, commission, finance and deliver services for children. We want to put children’s needs rather than agency boundaries at the centre of policy.
We do not want to dictate the coverage of Trusts – local partners will need to look at what works for local circumstances. The range of services that could be included in Trusts is very wide, and might include
v Services for disabled children
v Children with special educational needs
v Child protection
v Identification, referral and tracking of children at risk
v Speech and language therapy
v Child and adolescent mental health services
v Areas where social care, health and education services need to work together.
Trusts are intended to ensure children and their parents get better co-ordinated services geared to meeting individual needs, rather than being centred on organisational structures.
Government states work on precise models is at an early stage of development.
We will build on experience from Care Trusts. The aim is to create a model, which recognises and facilitates the complex multi-agency work needed to provide services for children.
We want children, young people and their families to be at the heart of service design and delivery, across both mainstream and more specialist services. Through joining up education, social care and health services – and building closer links to other key services within and outside local government – Children’s Trusts provide an important new opportunity to deliver integrated services which are more accessible to users
Children’s Trusts will provide an important vehicle to improve outcomes, through greater strategic coherence, better integration of services, and improved access. There is no single model for Children’s Trusts. We want local authorities and health bodies to engage with their users, communities, local voluntary organisations, and independent providers to consider how Children’s Trusts can be used in their area to improve the way in which services are planned, organised and provided.
Establishing Partnership working
A consistent danger of these and similar cross cutting exercises is that, when focussing on a different way of putting together a set of services, new barriers are created. A common one is the interface between childhood and adulthood. For example, youth offending teams successfully working with young people stop working with them just because of a birthday – the needs were unchanged, but a bureaucratic and external reason is used to stop valuable work. Unfinished projects are commonly stopped when incomplete for bureaucratic reasons – irrelevant to the needs of the individual.
Joining up is complex, and requires flexibility, imagination and willingness to work at the boundaries and interfaces. It is about constructing relationships and processes that have aims and objectives of finding sustainable solutions. The whole systems approach is a shorthand way of describing these relationships. Recently, a level of subtlety has been added to this – emergence.
The NHS Modernisation Agency and Audit Commission are using these ideas.
Various studies have found that sometimes we cannot explain the outcomes of a situation by studying the individual elements. For example, when a natural disaster strikes a community, spontaneous organization where there is no obvious leader, controller or designer has been seen. In these contexts, groups of people create outcomes and have impacts that are far greater than would have been predicted by summing up the resources and skills available within the group. This is self-organization – outcomes emerge which are highly dependent on the relationships and context rather than merely the parts. This has been called “order for free” or “creating something out of nothing.”
The Virtual Disabled Persons Housing Service
A Disabled Persons Housing Service to start with would be a virtual one, evolving on the basis of existing services and practices, agreeing lead partners and best ways of working. Formal structures would be agreed as required – a trust model may have advantages. It will enable successful outcomes to emerge.
The parts, home improvement agencies, design, council allocation services, grant services, welfare rights, occupational therapy, health and social services would work together in agreed formal and informal relationships, to agreed standards.
The Government Spending Review has significantly affected monies available and we therefore recommend a partnership and best practice benchmarking solution that uses existing resources and structures to construct a virtual disabled persons housing service.
No new expenditure on bureaucratic structures is envisaged.
Significant parts of a DPHS already exist. This means there is a reasonably sound base upon which to build best practice and ensure all citizens with disabilities are receiving prompt appropriate well -designed services.
Supporting People is evolving appropriate quality standards in relation to two parts of an ideal disabled persons housing service – home improvement agencies and housing related support. Quality standards also exist in the other key areas.
Home improvement agencies can form one of the main parts of a DPHS.
Councils already have a significant number of the parts of an ideal DPHS in place.
A Housing Strategy, for example, includes the following statements that are directly related to a Disabled Persons Housing Service.
Promote local solutions
Meet the needs of people with disabilities and older people using DFG’s and home repair assistance, wherever appropriate
Provide an adequate supply of suitable housing for people with special needs through new build, spot purchase and adaptations.
Continue to improve information on adapted council and housing association homes
Maintain adequate funding for adaptations and disabled facilities grants, and manage the increased demand on this budget
Use the supported housing index, housing needs register and supporting people information to inform priorities and plans for targeting future developments
Enable the purchase and adaptation of properties for people with disabilities, where this would provide better value for money than adapting their present home.
Including bungalows and one – bedroom houses for people with special needs when negotiating Section 106 planning agreements.
A comprehensive disabled persons housing service would have the following features:
v Defined quality standards that all partners are working towards
v Means of auditing those standards
v Comprehensive training, participation, and quality procedures
v Very significant powers to join up differing funding sources and managerial structures to enable the correct solutions for citizens
The process of setting up Supporting People took considerable effort and political agreement. A Disabled Persons Housing Service is best established by building upon this existing and similar work and understanding.
A comprehensive framework of services, contractual agreements, agreed quality standards and working practices is envisaged. This is best constructed on a sub regional basis, using existing structures. A local group of Councils would work together to agree ways of working. They would agree for example, common practices about strategy, assessment, databases, decision – making about grants, and related matters.
Because a disabled persons’ housing service is primarily about managing a process – ensuring a person with a disability has a comprehensive assessment and then is enabled to construct appropriate solutions, there are many other key stakeholders – especially health and social services – who must be working together well.
A disabled persons housing service will need to be working across boundaries continuously to find appropriate solutions – major resources like hospitals are in neighbouring areas.
A series of sub regional implementation working groups is envisaged – in a similar pattern to the Best Value for Older People Local Implementation Plans – their remit would be to agree best practice and take steps towards implementation.
In some ways, the establishment of a DPHS would be a secondary aim, the primary aim is to establish high quality joined up person centred ways of working, independent of specific client groups, but with the specialist input as required.
All working groups would work to agreed standards that include, for example, inclusive membership, participation and transparency.
There are the following parts of the whole.
A comprehensive framework of assessment would be developed covering the entire population. Risk assessment and process mapping would be key. The main routes into disability would be mapped and the necessary preventative actions taken. However a disability arises or is acquired, there will be agreed processes and routes to minimise adverse affects and enable independence. The National Service Frameworks often spell out these routes. The intention would be to create a reasonably standard set of solutions, with the required flexibility.
“Barefoot doctors” like occupational therapy assistants, technical staff, housing officers, support officers, sheltered scheme managers and similar posts would be trained to agreed levels of competence and ability to risk assess. They would be parts of teams who they would work with to find the appropriate solution for the person concerned.
The teams of which they were members would change according to the individual “project”.
The appropriate stakeholders have agreed minimum standards of assessment, using appropriate models like Lothian’s Personal Housing Plan.
Council and relevant stakeholders working to a common assessment process.
The comprehensive assessment would have highlighted the main issues, and proposed possible solutions. There are differences currently in the solutions possible dependent on client group and post-code. There are for example reasonably well-developed sets of services for people with learning difficulties – including innovative property purchase solutions. This is less developed for people with physical difficulties, and there may be institutionally discriminatory practices around.
Ways should be found to transfer the experience and knowledge in some areas to others. For example, innovative house purchase solutions for people with learning difficulties are appropriate to other client groups.
Government proposals around delayed discharge make excellent project and process management critical.
Sub regional groups of Local authorities, health bodies, social services and partners would agree appropriate project management arrangements.
People with disabilities would experience well- designed and managed appropriate services
A comprehensive database of properties and people should be constructed. Government initiatives about selling properties are of note here. It has been proposed that properties should be sold with a survey document that includes items like energy efficiency – there is no reason why this should not be developed to include disability friendliness of the design and location.
Much of this already exists – it is a matter of managing this information properly. Some local authorities have reasonably well developed systems – these should be rolled out and improved across the region.
A working group is recommended to agree sub regional databases, and management arrangements. This may be a single database or linked local ones – the resulting method of working is not as important as its effectiveness and quality.
Need and resource maps
Part of the assessment must include review of all possible funding sources. The vision would be of a detailed review of all possible sources of capital and revenue and how they might be applied in a particular case. All sources of money – health, social services, grants, charitable, and personal would be put in the pot to work out a good person centred solution. This would include the ability to arrange low cost loan finance as needed. Sources of loan finance would also be agreed and contracts given to organisations that prove their competence.
The various statutory and voluntary welfare rights organisations are already able to carry out much of this work. The availability of financial solutions probably needs more work.
Finance officers, building society and bank managers, auditors and welfare rights officers would work together to agree appropriate ways of working.
Standard quality of financial assessments
Standard set of financial solutions
Comprehensive strategic costing and value for money of services
Specialist designers would be available to recommend solutions as required. A common demand is for disability access showers to replace baths. An agreed standard range would be available, with agreed contractors, prices, installation times and standards of workmanship. There are currently different systems for this dependent on policy of landlord, and in reality, owner occupiers are often left to find their own – often inadequate and inappropriate solutions.
Standard design solutions
Specialist design as needed
Agreed standards of contractors and ways of working.
There are already government standards about the quality of equipment services. The development of centres for independent living at key points is part of this. There are several possibilities for this. Already existing specialist, out patients and rehabilitation units should be developed to provide a full range of services and possibilities of experiencing solutions. Some counties have also developed mobile units using caravans. An HGV or bus based solution, similar to mobile breast screening units, is also feasible.
Agreed set of services in appropriate locations
Many Housing Associations are creating group structures. It is recommended that experience here is used to develop appropriate management structures for the variety of partners involved.
Variety of regional, sub regional and local networks of management structures.
The complexity and variety of issues related to disability means that Councils would struggle by themselves to deliver the quality of service now expected of them by government and citizens.
Historically, the development of the National Health Service from the wartime Emergency Medical Service is equivalent. Before the Second World War, health services were an uncoordinated organic growth of voluntary, local and national government and educational provision. Disabled Persons Housing Services are in a similar position to health services in the 1930’s.
The health services are currently experiencing radical restructuring, with National Service Frameworks, and various quality initiatives. Disabled Persons Housing Services require two jumps – recognition of the concept of a national disability service and a move to what this means in the twenty first century.
Quality standards are being introduced through Supporting People and the National Service Frameworks in the NHS. These quality standards could easily be extended to the other main parts of a virtual disabled persons housing service, including the allocation service, centres for independent living, and architectural advice. Quality standards already exist for advice and legal services.
As with the Supporting People Quality Assessment Framework, all partners should be audited about their ability to provide the required standards, and produce relevant action plans.
The Supporting People framework is particularly relevant as it grades a service D – failing but with action plan through to A – excellent. It lays out clear standards to achieve.
Whilst this is not currently part of the Supporting People Commissioning Body or Administering Authority’s role, this is a logical extension of their remit and clearly fits with the challenge requirement of best value. Supporting People already has responsibility for the quality of home improvement agencies.
The composition and location of a standards setting body is for discussion and negotiation. Options include a form of Care Trust, form of local strategic partnership and Supporting People. It should be a statutorily based organisation.
All partners must agree a common vision, quality standards framework and action plan on similar lines to the Supporting People strategy. This would formally agree who would carry out the various functions of the disabled persons housing service. For example, have all parties formally agreed to work to the social model of disability?
Management of operations
It is logical to share responsibilities with other bodies, which might be other councils, primary care trusts, non profit organisations or companies. A variety of options are possible, including secondment of staff, partnerships, and formal tenders.
It was reported that different councils made different decisions in similar cases of claims for Disabled Facilities Grant. The Government has already taken action to improve the quality of services through the Regulatory Reform (Housing Assistance) (England and Wales) Order 2002. This replaces prescriptive grant and loan giving powers with a new general power to give assistance, subject to very few restrictions. The new legislation gives local authorities more freedom over where and how they give housing renewal assistance, and more opportunities to offer preferential or interest-free loans, including equity release products where appropriate. Specifically, authorities will now have greater scope to help people with contributions towards the cost of adaptations and enables authorities to assist with the cost of purchasing another property, where this is a better option than improving or adapting the person’s existing home.
Management of Information
A clear weakness both nationally and locally is around management of information. Statistical services should for example be provided by one competent body – councils, council departments and health bodies should not be employing their own statisticians, but a specialist service should be created by combining existing staff in one properly managed unit. Financial audit may also be included.
This report includes a Scottish example of a Personal Housing Plan, that has related databases. This example of management of information should be used as a template to evolve common ways of working for example around allocations. A specialist management of information unit would be very helpful in defining and then auditing the required practices.
Management of finance
The habit of dividing all monies into smaller and smaller pots or silos means everyone complains they do not have enough resources, when the reality is no one has a comprehensive view of what resources are available. Auditors have a critical role in establishing real costs and cost effective ways of delivering services.
Management of People
Health and Social Services have started the process of creating joint teams, and there are moves to joint funding of Occupational Therapists from housing and social services. More can be done here. One council officer commented – the occupational therapists should be based here – across this desk – not miles away.
Joint training and ways of working should become the norm. The vision is of good generally competent people working in strong networks of local strategic partnerships, of local teams with the required specialists finding appropriate solutions with citizens.
There needs to be a culture that supports innovation and acknowledgement about the need for change.
Often this involves the painful acknowledgement that things are not as good as they can be. In many places, a willingness to try new things, a culture of partnership, and good joint training opportunities have all been important factors.
The biggest barrier is not funding, nor bureaucracy, but the belief that the change cannot be made.
Government wishes to achieve a just society. Social exclusion is about multiple, tangled webs of problems that are persistent; there may be beliefs that it is permanent. Ways out of this morass include:
v Deal with real problems
v Tackle problems that cross-organizational boundaries – that fall between the cracks
v Give power to local people – ask them to be catalysts for change. They will need support, training and encouragement.
v Let people who implement things be a bit strange
v Involve local people from the start – change from doing to to doing with
The Housing Corporation Report bIGPicture Disability (Sept 2002) comments:
v Disabled people experience significant discrimination and consequent disadvantage in accessing and enjoying appropriate housing.
v Service providers continue to prioritise medical needs.
v Policy-makers and service providers suffer from a lack of information – data collected on disabled people and their needs is both insufficient and incomplete.
v Many service providers equate disabled people with wheelchair users.
v There is significant unmet need for adaptations among disabled and older people.
v Disabled people have limited housing options, because of low incomes and lack of appropriate housing.
v When housing agencies need to work with social care or health agencies, joint working and co-ordination of services is poor.
v Although user involvement is a central principle of housing and social care, service providers have experienced difficulties in getting people to participate effectively.
v There is very little data that could inform policy on appropriate services for ethnic minority disabled people.
The Parts of the Whole
World class services
v Achieve world class public services
v Invest more in public services – record funding for the NHS
v Drive up service quality
v Establish consistently high standards
v Make services more responsive to the needs of their users
The price of investment is reform
Out – hidebound ways and entrenched interests
In – flexible, modern services built around the convenience of citizens
Old structures and attitudes must be replaced. What works is what counts. The public sector will not automatically provide public services; private firms and charities will play a bigger role, as the state becomes an enabler, rather than a provider of services. It will devolve power and resources to local level, rewarding those frontline staff and organizations that deliver results. For those that fail to deliver there is the threat of punishment.
Inspection and audit
A bureaucracy of inspection and audit has grown up to monitor performance:
v the best value regime in local government and social services
v the commission for health improvement in health
v the national care standards commission for social care
There is an Office for Public Service Reform – fresh thinking on how to transform public services and a delivery unit – to implement the government’s reforms across departments. “It’s not reform that is the enemy of the public services,” Mr Blair told Labour’s 2001 annual conference, “It’s the status quo.”
Public Services of the future will look very different. They will be:
v Joined up in ways that make sense to the citizen.
v Accessible at times and places most convenient to the citizen, who will have more choice over the way in which they contact and receive public services.
v Delivered or supported electronically, facilitating faster, more reliable and better value services.
v Delivered jointly, where appropriate, by local and regional partnerships, and connected to a national infrastructure.
v Delivered seamlessly, so that citizens are not asked to provide the same information more than once and service providers are better able to identify, reach and meet the needs of service users.
v Open and accountable so that information about the objectives, standards and performance of local service providers and their elected representatives will be freely and easily available.
v Used by e-citizens through effective promotion of available and accessible new technologies and helping local people to gain the necessary skills to take advantage of the Internet.
Community Well Being
The Government has given councils powers (Local Government Act 2000) to promote the economic social and environmental well-being of their areas and work with other bodies to prepare community strategies. Community well-being means improving the conditions that help make healthy, contented and prosperous local communities.
Many different organisations provide services to local people. If those services are to be provided in ways that people want, organisations must work closely together and talk to local people about what is needed. Local authorities can take the lead. Councils must prepare community strategies in partnership.
Government has stated that Councils will be allowed to work out the best way of approaching this task, but they must base their strategies on a proper assessment of local needs and involve local communities in establishing priorities for action.
Local councils have much more scope to take action they believe contributes to the economic, social or environmental well-being of their areas or the people who live, work or visit there. They are able to work closely with other local bodies, like health authorities, the voluntary and business sectors and social services to provide services in ways that people want.
Rules of joined up thinking
There is now agreement about best practice in joined up working.
Networks of support and care – multidisciplinary learning – emphasis on what the person needs not on organisational boundaries
Easy access – Make access easy, one stop, always available, rapid, and responsive
Effective assessment – Focus on rapid, effective, appropriately shared, detailed assessments that mobilise needed services
Avoiding personal crisis – Practise prevention and education to intervene and help early and avoid crisis
Easy information flow – Make information flow so that what someone knows about a person, everyone in the system knows
Blurred boundaries – Find ways to share budgets and resources to blur organisational boundaries
Continued feedback – Build in evaluation and feedback loops, be flexible, and continually review the whole system.
There are four main objectives for the ‘Supporting People’ initiative.
v To target public expenditure on agreed local priorities within a national policy framework
v To promote a comprehensive response to the variety of needs presented by vulnerable people.
v To improve the quality of existing services and promote preventative strategies to avoid or delay the need for more expensive forms of care.
v To develop a broader spectrum of supported housing than existing specialist housing projects.
These objectives – especially “to promote a comprehensive response to the variety of needs presented by vulnerable people” are identical to the objectives of a disabled persons housing service.
Meeting black and minority ethnic needs
The ODPM has commented in detail about the key requirement to ensure Supporting People services are non – discriminatory in relation to black and minority ethnic groups. The principles below apply equally to citizens with disabilities.
Available information on black and minority ethnic needs in the user groups that will benefit from Supporting People is patchy, as is information on supply. The limited information on current services suggests services specifically aimed at the needs of black and minority ethnic groups, including older people, are limited. There is an over-representation of black and minority ethnic groups amongst care leavers, ex-offenders, and adults with mental health problems; and while there is a low representation amongst rough sleepers, homeless people generally show an over-representation of black and minority ethnic groups. Priorities for further research are the needs of black and minority ethnic drug and alcohol users and adults with learning difficulties and disabilities.
Supporting People will allow local authorities, for the first time, to take a strategic look at how housing related support serves the needs of different users. It is a chance to ensure that the widest range of needs are sensitively met, as well as facilitating the development of a diverse group of providers.
Supporting People brings a number of opportunities for black and minority ethnic users and providers, and also some risks both of which must be addressed at each stage of the Supporting People process, including:
v Needs analysis – ensuring that unidentified and unmet needs are met.
v Supply – identifying existing mainstream and specialist provision for black and minority ethnic service users and the opportunities for new service development,
v Service users and providers must be involved and consulted in the development of local authority Supporting People strategies. These must reflect the needs of black and minority ethnic service users.
v Services must be delivered fairly, including provision of and access to appropriate services.
v Commissioning and purchasing arrangements must take proper account of the ability of providers to meet the cultural, linguistic and religious diversity of black and minority ethnic service users.
v Scheme reviews – this process must recognise the legitimate constraints of specialist providers.
v Quality and monitoring arrangements must be applied in an open, transparent and open handed manner.
Local Housing Authorities
The ODPM has published the Allocation of Accommodation Code of guidance for local housing authorities. Chapter 3 states:
Allocations: General Partnership working
A housing authority has a strategic responsibility for meeting its district’s housing needs and the Secretary of State regards it as essential that housing authorities work closely with RSLs, other housing providers and voluntary agencies to meet those needs.
Housing authorities will need to develop working relationships with other organisations at a strategic and operational level to ensure that the housing, care and support needs of vulnerable people are appropriately met. These organisations will include Supporting People teams, Connexions partnerships, housing related support providers, health authorities, social services authorities, the police and probation service.
There need to be effective mechanisms in place for developing an interface with other services and providers. The Supporting People process provides a useful model. Housing authorities will also wish to take advantage of the partnership working arrangements which they develop in drawing up their homelessness strategies.
To plan for and meet need properly, structured individual need and risk assessments should be carried out. There are several models available, and these will evolve into reasonably standard forms of assessment.
Supporting People enables the development of a key group of staff – currently wardens, floating support workers, key workers, outreach workers and similar who will become the gatekeepers to and local managers of the new joined up services.
Support services are currently tenancy based – people move home to get support. When support is available regardless of where you live – even if you do not have a home – the roles of the face to face staff can change radically.
The sheltered scheme manager could take responsibility not only for people in their scheme, but for anyone living in a locality. Their role can become one of finding appropriate solutions for individuals and households.
The barefoot doctor concept is a valuable model. Properly trained, the neighbourhood support managers would assess all of someone’s needs – housing, domiciliary, support, disability, care, health, finance and refer on to appropriate specialists as needed. They would act as an advocate, ensuring the agreed services were delivered properly. They would be skilled leaders and enablers of participation.
Personal Housing Plans for People with Physical Disabilities
Fundamental to a successful disabled persons housing service is the personal housing plan. The following is from Lothian DPHS.
People with physical disabilities have a greater problem than their able-bodied counterparts in finding suitable housing in Scotland. Few properties are built to be fully accessible to wheelchairs or to people with restricted mobility, and existing properties with adaptations are often lost at change of tenancy or ownership.
In 1994 The Wheelchair Housing Group in Edinburgh, with a grant from HomePoint, commissioned a study to test the need for a disabled persons housing service and the feasibility of establishing one in Edinburgh. In April 1996 the Disabled Persons Housing Service (DPHS) was established. The management committee of the emerging service had examined the Personal Housing Plan (PHP) Technique developed by Di Alexander and Rural Forum, currently being piloted in Skye & Lochalsh, and felt that this service was one which they would like to offer to users of the DPHS. It was agreed that the technique required further development for use with disabled people and that a Housing Options Database would require development for the Edinburgh area.
The Personal Housing Plan Technique
What is a Personal Housing Plan?
The Personal Housing Plan Technique was originally pioneered with HomePoint funding in Skye & Lochalsh as an aid to matching people to houses in rural areas. It begins with a structured and confidential interview and discussion in the home of the applicant. The interviewer using the Interview Guide ascertains the applicant’s housing needs, preferences and financial situation and compares them with the full range of housing options available in the area. Following the interview a report for the client is prepared summarising the findings and offering a step by step plan of action for following up all the housing options in which the client has expressed interest. This is a Personal Housing Plan.
The Housing Options Information Base
After the home interview is complete, the interviewer enters the details into a confidential computer database and may contact a range of housing providers to ascertain the availability of any of the preferred options that the client has expressed. In preparation for the operation of this service the researcher compiles a housing options information database which holds data about all housing provided by local landlords in the public, voluntary and private housing sectors. Regular contact with the providers will supplement this database that must be updated regularly. Intelligence about developments in the owner-occupier market is also compiled.
The Strategic Database
The third important component of the Technique is the strategic database. Information derived from the interview schedules builds a picture of housing demand coupled to information about preferred location, family size and composition and financial resources. This information is compiled into a strategic database that can then be conveyed to the Council and Scottish Homes to inform future housing plans and local housing system analysis, ensuring better provision of suitable housing in the future.
Aids and Adaptations
The Department of Health has written:
Community equipment services play a vital role in helping disabled people of all ages, including children, to develop their full potential and to maintain their health and independence. In a recent report the Audit Commission said: “These services have the potential to make or break the quality of life of many older or disabled people, and of the 1.7 million people who provide informal care.”
Over the next few years there will be some big changes in the way that community equipment services are provided. Services will be:
v Integrated — to make it easier for people to get the equipment and help they need
v Modernised — to take full advantage of the latest advances in technology
v Expanded — so that more people, including more children, can benefit from them
To do these things health services and social services will have to work together in new and different ways and involve users and carers more closely than ever before.
The Government is making a significant investment in modernising and expanding these services so that more people can benefit from an integrated approach to meeting their needs. The NHS Plan set out our aims.
The challenge is now with service providers to:
v Meet the NHS Plan target to modernise service delivery by combining health and social care provision into single, integrated community equipment services by 2004.
v Increase by 50% the number of individuals who benefit from these services, and to improve the quality and range of equipment on offer.
v Increase efficiency by modernising purchasing, supply and recall systems.
v Extend the use of new tele care technologies in supporting frail and vulnerable people.
Until now health and social services have largely responded to their differing statutory obligations by developing equipment services that run in parallel. Organisational boundaries and pressures on funding have worked against the interests of equipment users.
But now, NHS organisations and local councils should use the Health Act 1999 to remove those boundaries by pooling budgets and integrating services. Community equipment services will need to work closely with housing, education, employment, and voluntary sectors, and with specialist equipment providers. We also expect to see users and their representatives helping to plan and monitor service developments to achieve tangible benefits.
This is a large agenda of complex organisational change for health and social services. The Department of Health will take forward a three-year implementation programme to support the delivery of change at a local level.
What is Community Equipment?
Community equipment (or “assistive technology”) services providing nursing and daily living equipment are vital in helping older people and disabled people live independently at home.
Equipment includes simple care equipment and adaptations, such as grab rails and pressure relief mattresses, and will increasingly include more sophisticated equipment such as automatic fall alarms and remote sensor devices. It can keep people out of residential care, prevent accidents, reduce hospital admissions, and give a more effective and safer discharge following hospital care.
How are we doing?
These services have been criticised in Audit Commission reports, Fully Equipped 2001 and again in Fully Equipped 2002 for being badly organised and poorly co-ordinated across health and social services in many areas of the country.
Extra resources for the NHS and social services will enable the modernisation of these services over three years from 2001/02 and increase by 50% the number of clients served. All community equipment services will be integrated across health and social services by 2004, using the Health Act partnership flexibilities, particularly pooled budgets.
One important aspect of joint working arises from the different VAT regimes in health and social care. This will involve a radical programme of change and The Department of Health will support local NHS and social services managers through the implementation process.
The Department wants to see service users and carers involved in reviewing services at local level and will consult voluntary organisations at national level. It is already funding the Disabled Living Centres Council (DLCC) to promote and disseminate good practice in these services through conferences and a website. The National Implementation Team will also do this across their areas of work.
Supporting Service Leads
Despite the lack of identified service leads in some areas the Implementation Team decided to be proactive and hosted a series of eight regional seminars during February and March of 2002. Each event constituted a programme of four workshops to explore areas of finance, consultation, standards and criteria and developing an IT strategy. The events have been very well attended and the evaluations from each event confirm the success of this initiative.
There were a number of common issues at each of these events. The opportunity to network and to share good practice and innovation was very well received. This networking was a huge success and we have been approached by several delegates for contact information for colleagues they had not previously known.
Establishing the current situation
We have engaged with a group of twenty-four services, three from each region, to assist us with our strategy and to pilot documentation. We will be developing performance measures with this group prior to a national launch. This group are also assisting our discussions with the Audit Commission around the development of information to help with the work they are doing on the provision of an effective audit tool for these services.
Manchester’s Equipment and Adaptations Service (‘Adequip’) has carried out research into best practice – Counting the Cost of Independence.
Equipment and Adaptations Services play a major role in improving the independence of disabled and older people. Yet many local authorities are struggling to cope with the increase in demands for assessment and have introduced rationing processes, such as eligibility criteria, to scale down demand. At the same time, it is now well documented that one of the main national concerns is the shortage of Occupational Therapists.
Within this framework, it is difficult to grasp how the move towards Integrated Community Equipment Services by April 2004 will be realised with a key performance target of achieving a 50% increase in customers.
The research focuses on a prevention service for older people, delivered predominantly by unqualified Occupational Therapy Assistants (OTAs).
The project was conceptualised by recognising that older people could be ‘screened’ for equipment and adaptations. At the same time, the scope of the project was extended beyond equipment and adaptations provision to include a home safety audit, a detailed health and community care profile, and a home electrical appliance inspection. Widespread research has highlighted that older people are significantly at risk in their home due to falls and that the primary approach to prevention is by direct advice.
The results of the research are surprising: 316 residents, across 26 sheltered housing schemes, were fully assessed and identified as needing at least one piece of equipment or minor/major adaptation, with over 40% going to those aged 80 or over. In addition, the electrical appliance audit demonstrated its value with 451 appliances being found faulty and needing electrical repair.
In summary, this research highlights the cost of meeting the identified needs for equipment and adaptations and provides ample background and literature evidence that sets the research within a wider community care setting. It clearly demonstrates the benefits to older people of appropriate equipment and adaptations and concludes with a series of recommendations aimed at extending such preventive projects to other older people, primarily by making greater use of Occupational Therapist Assistants and funding such as Promoting Independence Grants.
Single point of contact for equipment services established Nov 2002
The system should provide a single point of contact for all the information, assessment and equipment provision that people may need. The intention is to prevent buck-passing and people being bounced around the system. A single point of contact could be, for example, part of a call centre or be separate designated lines. Once contact has been made this single point takes responsibility for passing the information to the appropriate department/organisation.
State of the art demonstration centre
The aspiration is that people have equitable access to a centre(s) where equipment and services can be demonstrated in a clean, inviting environment which is fully accessible and where privacy and confidentiality can be assured. This could be a single centre meeting the needs of all disabilities or a network of local specialist facilities. Provision could be by statutory or voluntary agencies or through partnership agreements.
Identified outcomes for users from every contact
User outcomes keep the focus on user needs. Guidelines on suitable user outcome tools are being developed nationally. In the interim services should concentrate on developing systems to review individual users needs.
The involvement of service users in the monitoring and review of services
User views should be actively sought regarding the development and changes in services.
A quality-management system for continuous service improvement
It is expected that the management board will ensure that appropriate systems are in place for establishing standards and monitoring performance and that these lead to improvements.
Equipment adverse incidents reported
Protocols in place for working relationships with services run by other agencies
The Housing Corporation study “bIGPicture Disability September 2002 comments:
Policy-makers and service providers suffer from a lack of information – data collected on disabled people and their needs is both insufficient and incomplete.
A study “Wheelchair Housing and the Estimation of Need by Dr Jennifer Harris, Bob Sapey and John Stewart, June 1997 found:
Different approaches to estimating the need for wheelchair dwellings have resulted in widely varying conclusions. Our report shows deficiencies in knowledge concerning specialist housing need relating to both the official housing data and analyses of it. At the moment we have a meaningless national estimate of dwellings for disabled people. Basically, it is statistically unreliable, but in addition it is neither applicable to local circumstances, nor related to the needs of actual service users.
It is strongly recommended that the various statisticians in Health, Social Services and Government work together to produce coherent and comprehensive statistics, with guidelines on quality standards for managing, collecting and disseminating information across .
In line with the national trends, only a small proportion of those with impairments have chosen to register themselves as disabled people with the Social Services Directorate:
Home Improvement Agencies
Ensuring a comprehensive coverage of Home Improvement Agencies, who are working well with each other is fundamental. Good examples of processes and contractual arrangements exist that can be built upon.
A life like yours
Asked what he wanted from his social worker one disabled man replied:
‘I want a life like yours. One where I don’t have to battle every day to get the basic things done. A life where I can do the fun things in life not just bump along the bottom all the time. ’
Social services Inspectorate Annual report
The core problem for government is that it has inherited from the nineteenth century a model of organisation that is structured around functions and services rather than around solving problems. Budgets are divided into separate silos for health, education, law and order and so on.
The vertical links between departments and agencies in any one field and professional groups such as the police, teachers, doctors and nurses are strong.
The horizontal links are weak or non-existent. (Demos)