Supporting People Service Review

 Carr-Gomm,  Duke House, 6-12 Tabard Street, London,SE1 4JU                                                                                                                          National ID No: 10000089                                                                             Date:Commenced September 04, May 05                                                                                                               Review Officer:  Simon Dicker (Commissioning Officer) For and on behalf of B&NES Supporting People Team   

2. Introduction to Agency

Carr-Gomm was established in 1965 in Bermondsey, South London, by Richard Carr-Gomm (OBE), who also founded the Abbeyfield Society.

The original aim of the charity was to offer a safe home and support to lonely and vulnerable people. Care was offered in shared houses and as demand grew, Carr-Gomm's services diversified. Presently these include self-contained accommodation, homeless projects, floating support for families and the development of an award-winning service user involvement programme. Today, Carr-Gomm has over 350 schemes and a number of other services, supporting 3,000 people a year, contracting with 87 different Local Authority Supporting People Teams or Social Services Departments.

Carr-Gomm is split into five regions across England. The Chief Executive, Gary Lashko (who is an ex service user), and the Directors of Service Delivery and Finance are responsible for overseeing all five regions and for reporting to the Board. The Board consists of 17 people - five of whom are Carr-Gomm service users.  Each region has a Regional Director, who is assisted by a team of Area Business Managers (ABMs). ABMs manage Local Service Managers, who in turn manage Project Workers, Support Assistants and local services. ABMs are responsible for developing new services and forming local partnerships. Some larger and more specialised projects have Project Managers, who directly manage Project Workers.

2.1 Brief History

Mulberry House is a large detached Victorian house set in large landscaped grounds in Weston Park, a secluded location lying between central Bath and Weston Village, it is in easy walking distance of services and amenities.

The support funded at Mulberry House is low to medium level across 10 units of accommodation.

Carr-Gomm bid successfully for Supported Housing Grant in order to carry out extensive refurbishment of the project including a new roof and conversion of the existing 10 bedrooms reduce to 8 bedrooms with ensuite in the main building, plus demolition of an adjacent single storey property and replacement with a new two storey building designed to offer 5 additional units as lower level supported move on options for people.

The refurbishment is due to commence in February 2005 and is expected to entail closure of the premises for 6-8 months.

Closure of the property for refurbishment explains why the occupancy figures reduce from July 2004, despite demand for services such as this exceeding supply.

Carr-Gomm had not secured decant accommodation at the earlier part of the review, however consultation with service users in May 05, proves this has been achieved. Service users have clearly stated they wish to remain in Bath during the refurbishment, and Carr-Gomm is offering to act as guarantor for temporary accommodation. They report that landlords so far have refused to discuss tenants that have support needs. 

Carr-Gomm had verbally stated they will pay for Bed and Breakfast if it is the only way the tenants can stay living in Bath. This was not necessary in the end.

2.2 Capacity

Units:   10

Staff Hours:            

Local Services Manager                  6.14 hrs per week   (17.5% of post)

Project Worker                                  21 hrs per week

Project Worker                                  14 hrs per week

Project Worker                                  7 hrs per week

Total                                                   48.14 hrs per week

2.3 Monitoring Information

** Carr-Gomm has been asked to clarify the monitoring information as it suggests voids being carried during full availability. This is inconsistent with the local pattern of demand and is thought to be an error in submission; clarification was requested from the Area Business Manager, on 20th January 2005. A written response confirmed that voids were being held because of the impending closure and decant. Monitoring submissions provided by Carr-Gomm identified that there are reporting inconsistencies which need to be addressed.

2.4 Existing Funding

There is no record of any additional monies being paid to this service via Social and Housing Services Finance Department.

4. Legal / ODPM Guidance on group and type of service

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 and 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)

The review did not identify any further ODPM specific steers for this client group under Supporting People, so recommendations have been drawn from above in reference to the role of Health and Social Care, and Getting the Basics right.

There is no national steer on legacy high support services for People with Mental Ill Health, yet in the main this group alongside Learning Disabilities represent much of the high cost individual long term expenditure for the Supporting People programme. Contracts can be renewed at the same level only when there is ample evidence they are high quality and represent value for money, though this must be within the overall limits imposed by the strategic direction for Supporting People that decides where housing related support fits as a funding stream and to what extent it will contribute.

7. Evidence and Risk Assessment 

Mulberry House represents an important resource in provision for people with mental ill health. The service’s capacity will increase, and the planning for refurbishment has been achieved in partnership with B&NES Housing and Supported Living Team. Carr-Gomm have liaised with Supporting People team and are committed to keeping service users in Bath as per their request. As the refurbishment works involve large capital expenditure and partnerships between contractors, Carr-Gomm have stated that the refurbishment will not be delayed.

As a service provider Carr-Gomm are the biggest, most established and have the widest geographical coverage of all the mental health agencies in B&NES.

The organisation is not perceived as presenting risk, and its contracts with 86 other Local Authorities evidence their fitness for partnership working.

8. Value for Money

Cost per unit (to Supporting People) per week:        £87.78

Cost per frontline support hour (to Supporting People): £10.58                                 

Regional Upper and Lower Quartile:          £78.31*          £215.02*      

(Drawn from 339 comparable services)

National Upper and Lower Quartile:           £87.52*          £261.85*                   

(Drawn from 2848 comparable services)

* - It should be noted that these comparators are interim contract values and not post review.

The unit cost falls at the lower end of both regional and national quartiles. The review found this appropriate for provision of housing related support.

9. Review Outcome / Recommendations and Impact

• The service will be operating at a reduced capacity during the refurbishment period. Rather than reduce payments to Carr-Gomm, who would then be faced with having to reduce support workers hours, it is a recommendation that Carr-Gomm are asked to support  additional units of floating support for other service users.
• Carr-Gomm are recommended to submit evidence as to how and where the service contributes to the objectives in the Mental Health and Social Exclusion Report, and to identify three supplementary objectives on the QAF to evidence at next review.
• Carr-Gomm are recommended to work towards and submit evidence for a level B in their annual self assessment submission to B&NES Supporting People Team.
• QAF Carr-Gomm is invited to submit detailed objectives covering move on expectations and costings for the new service to the Supporting People Team by Sept 2005.
• There will need to be some flexibility in expectations of move-on; to date there has been throughput from the service, but some clients remain there in excess of 2 years. It is a recommendation that Carr-Gomm is invited to submit move on targets for the total no of units and that the contract allows some units to be regarded as long term. This recommendation is made in light of the needs for services to be flexible to individual needs, rather than have service users constrained by inflexible service delivery.
• The refurbishment coincides with outline plans for Supporting People Team to re-commission Mental Health Services to a more structured specification. It is recommended that future consultation with service users is made after the Mulberry House reopening to ascertain realistic support levels.
• The service provides valuable capacity to the B&NES Supporting People programme and it would be recommended that the contract be renewed, however as all the Supporting People mental health provision in B&NES is being re-commissioned it is recommended (as to all mental health providers) that an extension to the interim contract by mutual agreement is awarded to Carr Gomm until April 06.

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