Supporting People Service Review

Service: Barnabas House. Service ID Number: 151. Service Provider: Bath Churches Housing Association. Service Provider Address: 55 New King Street, Bath, BA1 2BN. Date: August - October 2005. Review Officer: Ann Robins on behalf of Bath & NE Somerset Supporting People Team.

3. Rental Income

4. Strategic Relevance

Supporting People 5 Year Strategy.

The review found that the service provided by the Barnabas House fits with the local and national context of strategic relevance. The hostel provides a valuable service that enables vulnerable people to stabilise their lives and to develop the skills needed to successfully re-establish themselves in their own homes and the community generally.

The review found that the services did not include the provision of general health, social or personal care.

The B&NES Supporting People Five Year Strategy has a number of strategic objectives in addition to specific aims for individual service user groups.  In the context of this review Barnabas House is able to demonstrate that its services meet a number of strategic objectives and service user aims.

Objective 4 – Decrease Levels of homelessness through the provision of preventative services. Staff at Barnabas House work with clients to enable them to stabilise their lives and to develop the skills needed to sustain their accommodation, both at Barnabas House and in later, more permanent accommodation. Homelessness is reduced through the promotion of independent living skills.

Objective 6 – Providing services which help to promote the health, safety and well being of individuals and of the wider community. Through key-working, the staff team at Barnabas House seek to address issues around mental and physical health, offending and/or anti-social behaviour. This has a direct impact on the clients themselves and the wider community, as issues around criminal behaviour are reduced as a consequence of improved health.

Objective 8 – Improving the provision of services for people who may be hard to reach or who are socially excluded.   Barnabas House offers accommodation and support to people who have a history of insecure housing and rough sleeping. This group are known to be hard to reach and are socially excluded.

Crime and Disorder Strategy. (Priorities-Tackling Persistent Offending, reducing crime related to alcohol and drug misuse, providing support for vulnerable communities). Barnabas House provides accommodation-based support to clients with histories of offending behaviour, drugs and alcohol misuse and helps them in accessing support services that reduce the need to commit crime or be involved in nuisance in the community. In addition, many residents are vulnerable, socially isolated and at risk of crime. By helping people to sustain their accommodation, develop independence skills and secure permanent housing, Barnabas House provides the stability to enable clients to maintain contact with support services, thereby avoiding risks to themselves.

The service also meets the agendas of B&NES Corporate Plan Framework 2003-2007 and B&NES Community Safety and Drugs Partnership Strategy 2005-2008 through the provision of support in accommodation that is safe and secure. This is essential to achieving the Council’s objectives of building a healthier and safer community, reducing the fear of crime and improving the urban public realm (liveability).

The Community Safety & Drugs Strategy for Bath & North East Somerset 2005-2008 contains the following aims relevant to the work carried out at Barnabas House:

• reducing and treating those perpetrating alcohol related crime
• reducing anti-social behaviour
• building community confidence
• increasing awareness and intervention in domestic violence
• reducing and treating drug misuse
• increasing awareness and intervention in hate crime
• reducing volume crime
• reducing the number of young people committing crime and support those who crime is committed against 

Barnabas House also fits within the national context, in the National Drug Strategy 2002. The key areas the strategy addresses relevant to Barnabas House include;

• Reducing the harm that drugs cause to society, communities, individuals and their families.
• Reducing the supply of illegal drugs
• Reducing drug-related crime and its impact on communities
• Reducing drug use and drug-related offending through treatment and support
• Reducing drug related death through harm minimisation.  

Barnabas House addresses the following priorities within the Homelessness Strategy for Bath & North East Somerset 2003-2005:

•        Preventing homelessness.  Barnabas House seeks to prevent homelessness by providing supported accommodation to clients to enable them to move into and sustain permanent accommodation.
•        Information and monitoring of homelessness. The service provides information to the Housing & Supported Living team within the Council to inform its homelessness strategy.
•        Partnership working to prevent homelessness. Barnabas House enables clients to access services and works in partnership with other agencies to prevent repeat homelessness

The B&NES Mental Health Services Improvement Plan (2003/04) identifies a need to “develop a full range of supported accommodation options” for people with mental health problems. As current estimates by the Social Exclusion Unit suggest that 50% of homeless clients have mental health issues, it is clear that Barnabas House has an ongoing role to play in the delivery of this objective. Residents are supported in accessing services for those with mental health issues, obtaining diagnoses, assisting with monitoring individual progress and intervening to prevent crises.

In Spring 2003, The Prime Minister and Deputy Prime Minister asked the Social Exclusion Unit to consider what more could be done to reduce exclusion among adults with mental health problems. The project focused on people of working age, and asked two questions:

What more can be done to help adults with mental health problems to enter and retain work?

How can adults with mental health problems secure the same opportunities for social participation and access to services as the general population?

The report sets out a 27 point action plan to bring together the work of Government departments and other organisations in a concerted effort to challenge attitudes, enable people to fulfil their aspirations, and significantly improve outcomes and opportunities for this excluded group. Action falls into six categories:

Stigma and Discrimination – A sustained programme to try to challenge negative attitudes and promote awareness of peoples rights

The role of Health and Social Care in tackling social exclusion – implementing evidence based practice in vocational services and enabling reintegration into the community.

Employment – Giving people with mental health problems a real chance of sustained paid work reflecting their skills and experiences.

Supporting Families and Community Participation – enabling people to lead fulfilling lives the way they choose.

Getting the basics right – access to decent homes, financial advice and affordable transport.

Making it Happen – Clear arrangements for leading this programme and maintaining momentum.

(Mental Health and Social Exclusion, SEU Report Summary, June 2004)

Barnabas House contributes to these areas by providing stable accommodation and support to people who have mental health issues and making sure support from specialist agencies is available.

The service will also contribute to the B&NES Primary Care Trust and Social Services Local Delivery Plan and the B&NES Mental Health Services Strategy. 

In addition the service will contribute more generally to the delivery of the National Service Framework (1999) objectives for people with mental health problems by further developing and promoting a wellness and recovery model of service delivery.

7. Consultation with Stakeholders

• 5 service users and 1 ex-service user were interviewed as a group. Two were female. They had stayed at Barnabas House for between a month and 3 years.
• Tony Pettit, BADAS Drug Worker
• Peter Brown & Amanda Taylor, Housing Advice Team, Bath & North East Somerset Council
• The Client Services Manager, Team Leader and Support Worker at Barnabas House

7.1 Consultation Findings

Service Users

The feedback was generally good. All stated that the support they received was useful and that they had regular key working sessions.

The location was described as ‘perfect’, being in the city-centre and near all amenities. However, the downside to this is that visitors also find the location handy and call late at night, often ringing the wrong bell and waking people up. Several residents mentioned problems caused by visitors. There have been a number of occasions when the Police have been called due to noise and threats.

There were mixed views on safety and security. Initially, all the residents stated that they felt safe and secure at Barnabas House. However, some went on to give examples of incidents that made them feel less so. One person mentioned seeing someone climbing over the back garden wall at night, noise from others in the building being a cause of friction and visitors pushing their way past into the building when they had answered the door. These concerns seemed to be shared by several people. Evening security cover and a second inner door were suggested to tackle these problems. Despite staff reporting that the Beat Officer visited monthly, one resident stated that they’d seen him very rarely and not at all for some months. There did seem to be some level of acceptance that not all of these factors are under the team’s control. When asked if they felt able to influence the house rules, all said they did and cited a recent series of incidents with visitors. This was brought under control after residents complaints led to a change in  rules around times when visitors could call. All residents stated that once these were agreed at a house meeting and put in place, problems within the house reduced dramatically.

The building itself was rated as 1 (good) to 2 (satisfactory). Improvements suggested included keeping the kitchen clean (seen as everyone’s responsibility) and installing a bath. The only maintenance problem mentioned was a broken shower that had taken 3 weeks to repair.

All residents said they were happy with the level of support received, the frequency of sessions and the outcomes gained through key working. Having their support plans shared with drug-workers was popular. However, there did seem to be a concern that staff were over-burdened with paperwork and under pressure to deal with administrative tasks. (Tony Pettit, BADAS worker, expressed a similar view. See below.) One resident said that he often feels embarrassed to ask for help because he would be interrupting. Two residents stated that they would like counselling from a professional who had had similar life-experiences to them in terms of drug and alcohol problems.

Tony Pettit, BADAS

Tony acts as a referral point and support provider for Barnabas House residents. His feedback was generally very positive, stating that he was happy to refer clients to Barnabas House as residents receive good support. The referral process works well, with Barnabas House staff keeping him up-to-date on progress of applicants through regular meetings. Tony has seen 10 service users move through Barnabas House to independent living, which they would not have been able to do without the team’s input. He cited an example of how the service is able to respond flexibly to individual needs: one of his clients was having difficulty sustaining his tenancy due to the behaviour of his visitors. Once the visitor ban was in place problems for other residents reduced and an eviction was averted. He felt the staff were willing to persevere with the resident, working to make the house rules flexible enough to avert his eviction without compromising the needs of other residents.

As with service users, Tony has noticed that staff seem to have an increased workload in terms of administrative tasks which means they have less time to spend with residents. He suggested that this may be a direct impact of planning for Supporting People inspection and so may only be temporary, but was keen to see a re-focus of staff-time.

Examples given of good practice were:

• Regularity of contact between Barnabas House and Tony was very good. The team are ‘good at keeping people informed’.
• There is a pro-active approach to service-delivery
• Staff make good efforts to ensure residents are involved in decisions and the running of the project
• The staff are aware of unmet need and try to highlight this.

Peter Brown & Amanda Taylor, Housing Advice Team, Bath & North East Somerset Council

Peter is the key contact and referrer between the Housing Advice team and Barnabas House. Amanda has recently moved from the Homeseekers team to work as Housing Advisory Officer. Their general feedback was that Barnabas House provided a good service. The staff team are excellent advocates for residents and are committed to providing a good quality service. Support planning appeared to work well, as residents nominated under AMOS seem very well-prepared to move on. 

At the time of the interview, a new procedure had recently been put in place within the Housing Advice team to monitor referrals. All referrals are now being made in writing, rather than by phone. If a referral is refused, an appeal is lodged. This was put in place because the team were not happy with how referrals were being handled. Previously, referrals were made by telephone. Frequently, they would have a conversation with staff at Barnabas House who would take basic details (name, date of birth and brief history) and then ring Julian House or one of the other services the person had had contact with to ask about their suitability for Barnabas House. Applicants were being refused without interview, based on conversations between agencies. Peter and Amanda were also concerned that staff were asking the Housing Advice team for ‘sensitive lets’, usually people without any drug or alcohol problems, when they felt they needed to balance out the number of residents with a drug or alcohol problem. Whilst recognising that staff need to ensure a balance within the house, both felt that, combined with the lack of a formal referral and interview, this could have the effect of excluding applicants unfairly. They felt that staff were not able to make an informed judgement on an applicants suitability without a written application and interview.

Debate has been going on in several partnership groups and internal housing teams around making the best use of existing housing stock and making the private rented sector more accessible. Projects funded through the Supporting People programme have an important part to play in this. Peter and Amanda stated that some residents were staying longer than 2 years at Barnabas House and that this might be alleviated by use of the private rented sector. This would only be a solution for the less vulnerable residents but could be a valuable resource, giving an element of choice over areas, reducing move-on times and pressure on the RSL stock. As far as they are able to tell, Barnabas House residents are not encouraged to consider the private rented sector. When this was raised at the QAF validation visit, the Client Services Manager stated that the private rented sector would be considered only for less vulnerable residents. Peter also said that he felt that residents were not being encouraged to respond to all Homeseekers bulletins received, which was also affecting their length of stay at Barnabas House.

Amanda raised the issue of appeals against needs assessments (prior to a decision on eligibility) She had referred an applicant to Barnabas House and was subsequently contacted by the Team Leader, who advised her that the application had been turned down. The Team Leader stated that he had made a decision to accept the applicant as eligible, but that his decision had been overturned by the Client Services Manager. A letter formally giving this decision was received, followed by one from the Client Services Manager, stating the reasons for refusal. Amanda wrote asking for a review of the decision by someone not involved in the original decision. The appeal letter upholding the decision came from the Client Services Manager.

It should be noted that both the team leader and Client Services Manager state the decision and appeal were handled within the correct procedure when the issue was raised during the review.

In terms of good practice, both stated that the team are very good at identifying residents who are ready to move on.

11.      Action Plan

The Client Services Manager at BCHA submitted the following update on action taken in response to draft recommendations:

The principal action from the Supporting People review report for Barnabas House related to unit costs. The current weekly unit cost at Barnabas House is £192:12 pence compared with a regional upper limit of £168:14 pence and a national upper limit of £175:18pence. Having reviewed the Barnabas House unit cost in line with these benchmarks I would offer a revised weekly unit cost that would bring about a £22:02 pence reduction. This saving would produce revised weekly unit costs of £172:10 pence at Barnabas House. The saving has been made by reducing the staffing levels to 0.3wte manager post 1wte team-leader post and 1.5wte project worker posts.