Supporting People Service Review

Services: (1) Henrietta Street, (2) Burlington Street. Service Address: (1) 7 Henrietta Street, Bath BA2 6LL. (2) 1 - 4 Burlington Street, Bath BA1 2SA. Service ID Number: (1) 21 (2) 50. Service Provider: Bath Solo. Service Provider Address: Stoke Tyning, Limpley Stoke, Bath, BA2 7GJ. National ID Number: 10007267. Date: October 2006. Review Officer: Caroline Clark on behalf of Bath & NE Somerset Supporting People Team.

3.         Brief History

The services were reviewed by the Supporting People Team in July 2005.  The main findings and recommendations were as follows:

• Bath Solo provides highly cost effective, low level support to a range of vulnerable tenants.  The organisation is encouraged to clarify it’s stance on move on and to more actively support current tenants, where appropriate, to consider move on options
• Both services deliver low levels of support and one meal a day which allows the majority of tenants to live busy, involved lives in the community away from the schemes
• Service users whose support needs are identified as long term should be financially assessed, where appropriate, in line with ODPM and Fairer Charging guidelines
• Unit costs across both schemes should be re-structured to reflect the same level of service received by users at each and to reflect the hidden costs at Henrietta Street that have not previously been allowed for.  The review recommends a standard unit cost of £70 per week
• It is clear from validation visits and from interviews with staff that there is further work to be done to raise QAF standards to the minimum level C across all objectives
• Within the next six to twelve months Bath Solo should review, revise and update risk assessment policies and procedures in relation to individual tenants, in relation to health and safety issues and in relation to the organisation as a whole.
• Staff are highly motivated and are clearly providing a much valued service.  The organisation now needs to develop, implement and monitor a formal staff induction, training, appraisal and development plan.
• The process for referrals seems to be working effectively and there is evidence of good co-operative working between the organisation and other stakeholders.  Bath Solo must ensure that they operate to a set of clear referral criteria and that they are able to show a more proactive approach to diversity and inclusion
• Specifically, the procedure for service user needs assessment, outcome focussed support planning and review could be enhanced and given a higher profile within the organisation

5.         Service Capacity and Funding

6.         Strategic Relevance – local and national  

Since the last review a mental health project group comprising officers from B&NES Social Services and Supporting People teams and representatives of Avon and Wiltshire Partnership Mental Health care Trust and B&NES Primary Care Trust has been convened.  The role of this group has been to collate information on the current range of mental health accommodation and care/support provision including nursing and residential care, out of area placements, supported living arrangements and Supporting People services and to compare supply data to available information on local needs.  The over all aim of this strategic review has been to align local commissioning activities, including the delivery of Supporting People services to a recovery based model of service delivery which promotes and encourages move on and independence. 

A number of key themes have emerged from the review including the need to develop a broader range of supported living and supported accommodation options for people with higher level support needs as part of an overall spectrum of provision.  In this context Bath Solo services continue to be strategically relevant in that they provide low level supported accommodation which contributes to the delivery of a spectrum of provision however the provider should continue to ensure that services are aligned with the principles of a recovery based model.

Also in this time a joint commissioning strategy for people with learning difficulties has been developed between B&NES Council and the Primary Care Trust. 

There are a number of messages that are key indicators of the underpinning philosophy of the commissioning strategy:

• Achieving social inclusion requires a fundamental shift in the relationship between the person with learning difficulties and those agencies providing services, and the culture in which services are provided.  At the heart of this culture shift is the notion of Support versus Care.
• Specialist services for people with learning difficulties must recognise that their role is one of support, rather than care, where the balance of power rests with the individual, rather than with the service.
• The strategy aims to develop a different approach to care management and commissioning – one which will be more inclusive of people with learning difficulties and families and carers at all levels.
• Increasingly people will be supported to look to a range of services and solutions outside of the traditional learning difficulties provision, and may play a vital role in helping to break down barriers that have in the past led to social exclusion for large numbers of people with learning difficulties.

Again within this context Bath Solo should continue to ensure that service area aligned with these principles.

6.1  Legal / ODPM Guidance for service user groups

Since the last review a number of national agendas which relate to the provision of service for people with mental health problems and people with learning difficulties have emerged.

Sustainable Communities: settled homes, changing lives (Office of the Deputy Prime Minister, June 2005)

This document sets out ODPM (now known as the Department of Communities & Local Government) priorities for tackling homelessness.  The overall aim of the document is to halve the number of homeless households living in insecure temporary accommodation by 2010.  The strategy promises new resources for homelessness services and emphasises:

•      Homelessness prevention
•      Support for vulnerable people
•      Tackling the wider causes and symptoms of homelessness
•      Helping people move away fro rough sleeping
•      Provision of more settled homes

Our health, our care, our say:  a new direction for community services (Department of Health, January 2006)

This document sets out the Government’s future direction of travel for health and social care services and has been driven by two consultation exercises carried out in 2005.  Independence, Wellbeing and Choice, a Green Paper set out proposals for adult social care services, and Your health, your care, your say, sought views on desirable changes to health care services.  The White Paper outlines outcomes for people’s lives that health and social care services will support:

•      Improved health and wellbeing
•      Improved quality of life
•      Making a positive contribution
•      Choice and control
•      Freedom from discrimination
•      Economic wellbeing
•      Personal dignity

A New Deal for Welfare: Empowering People to Work (Department of Work and Pensions, January 2006)

This paper sets out a number of key proposals relating to significant reform of the benefits system with the overall aim of helping disabled people back to work.  Proposals include:

•      Employment and Support Allowance to replace Incapacity Benefit
•      Enhanced support for severely disabled people
•      Mandatory work focussed interviews
•      Revised medical assessments
•      Greater in work support
•      Financial incentives for Local Authorities to facilitate back to work schemes

Creating Sustainable Communities: Supporting Independence (Office of the Deputy Prime Minister, November 2005)

This consultation document on the future of the Supporting People programme poses a number of key questions to which Local Authorities have been asked to respond.  The document identifies three broad types of need for Supporting People services and focuses attention on how such needs might be met in partnership with other stakeholders as follows:

•      Integration of planning, commissioning and delivery of services for people who need both care and support
•      Improvements in the quality, accessibility and flexibility of services for people who are able to live independently with support
•      Challenges associated with ensuring that there is proper focus on the needs of people who have experienced or who are at risk of social exclusion

8.         Consultation with stakeholders

Consultation with Service Users

Two service users, one each from Henrietta Street and Burlington Street, were interviewed as part of the review.

One of the service users had been at Burlington Street for more than 15 years and could not see a time when he would be ready to move on.  The service user at Henrietta Street had moved in approximately 18 months ago and was hoping to move on within the next 12 months.

Both service users were very happy with the standard of accommodation and the support staff, and both said that they felt very safe and secure.  It was felt that the local community offered a good range of shops and services and that both schemes were well integrated locally.

Both service users felt that rules and regulations were kept to a minimum which helped to promote the homely atmosphere they valued.  Both felt able to complain and the majority of problems are dealt with as they arise, meaning that formal complaints procedures rarely had to be followed.

Service users liked the informal approach to support planning although both were unclear about the process.  One stated that he didn’t like having things written about him.  They were however both clear about the sort of support they could expect and thought that staff were very good at providing help when it was needed. 

Consultation with Staff

Consultations took place with two members of staff and the service manager. 

All staff interviewed had been in post when the last review was carried out.   Both housekeepers have completed the Certificate in Community Mental Health Care in the last year.   

Staff are very positive about the risk assessment and support planning process and the new support plans are outcome focussed and provide a clearer link to the risk assessment process.   Both risk assessments and support plans are reviewed regularly.  Support staff attend care plan meetings when required and keep in regular contact with social workers and CPNs.

Staff were clear about health and safety processes and were able to describe the new lone workers policy. 

All support staff have recently attended Vulnerable Adults training and were able to demonstrate a thorough understanding of the subject.  This is backed up by a new Protection of Vulnerable Adults policy which has been introduced along with a whistle blowing policy.

Although staff have not had any formal training in fair access, diversity and inclusion they were able to describe ways in which the Association considers diversity issues when delivering services.  Compatibility of applicants with existing tenants remains the singular most important factor for acceptance.

Staff are well motivated and were very positive about the services they offer to tenants at both Henrietta Street and Burlington Street.

9.         Evidence and Risk Assessment

There was no evidence of financial risk and effective leadership is provided by the management board.

Policies and procedures have been updated in line with current legislation and staff have received further training in key areas e.g. protection of vulnerable adults from abuse.

The services now meet the required minimum standards of the QAF across all key objectives.

10.       Value for Money

Following the recommendation of the last review unit costs across the two schemes have been restructured to reflect the level of service provided to service users.   These costs still fall well below the expected range for similar services both regionally and nationally and represent excellent value for money. 

11.       Review Outcomes / Recommendations and Impact

• Bath Solo has clearly worked hard since the last review to update and revise many of its policies and procedures.  In particular new risk assessment and support planning procedures have been implemented.  Staff in both schemes have completed the Certificate in Community Mental Health Care which covers subjects such as care planning and managing risk. 
• Validation visits and interviews with staff and service users showed that the service has improved sufficiently to have achieved the minimum QAF level across all objectives.
• Staff have also received Vulnerable Adults training giving them a good understanding of the subject. New policies and procedures have been implemented which raise the QAF score in this area to level B.
• The Association should now work towards achieving level B across all key objectives.

• Bath Solo’s aims and objectives and referral criteria have been amended to highlight the focus on supporting tenants “for the period of time necessary to recover from a crisis or to develop appropriate skills”.   There is still a balance to keep between encourage a tenant to move towards independence without putting them under pressure to move if they do not feel ready.  The Association is encouraged to continue to support current tenants to consider move on options.
• Performance returns indicate that it is taking longer than average to fill vacancies, particularly at Burlington Street.  The Association needs to streamline it’s process for filling vacancies to ensure that utilisation rates remain above 90%
• A formal induction process has been introduced for new staff which covers all the key areas.  Further work still needs to be done to develop a full staff appraisal and development plan.          

The review recommends contract renewal at the following value:

Supporting People Annual Contract Value                                    £67,506.75

12.       Action Plan (completed by the Provider) to address points above