1. Report Summary

A review of the Drugs and Homeless Initiative (DHI) resettlement and floating support services was conducted by Bath and North East Somerset Council Supporting People team.

The review found the services continue to be strategically relevant to B&NES Supporting People programme and Community Safety and Drug Partnership (CSDP),  priorities for service provision.

The floating support services presented good value for money and the service quality was assessed at level B in 5 of the 6 core objective under the QAF with the remaining core area at C.

Service users stated they had benefited from the services they received, and other stakeholders were positive about the contribution made by the services.

2. Introduction to Agency

DHI was formerly part of Bath Self Help Housing Association and achieved independence in 1999. It is a registered charity / non-profit making organisation and its main aims are:

•         to help people address and manage problematic drug and alcohol use
•         to help tackle the issues often associated with substance misuse, such as poor housing, offending and/or lack of life skills.

DHI offers a range of practical and emotional support services for people who are experiencing a combination of drug, alcohol, offending and housing problems. In addition to the resettlement and floating support services reviewed, DHI offer a range of services in B&NES including two accommodation based support services (SP funded);Structured Day Care services (DAT funded); Criminal Justice Services (DAT funded) and Resettlement services (Voluntary Grant funded). They provide additional services in Wiltshire and Somerset.

3. Brief History

DHI’s three floating support services were reviewed by the Supporting People Team between September 2004 and January 2005. They were found to be contributing to a number of local and national strategic agendas, and were validated as working at Level C under the QAF. 

The main outcomes and recommendations were as follows:

• The level of preparation and planning for the review was thorough and comprehensive and DHI had already produced a “Supporting People Action Plan” prior to review from their own evaluations. This level of preparation for review is exceptional in those undertaken to date and the service is commended for this.
• The review thoroughly validated all QAF objectives at Level C and found that the prospects for these to rise to a Level B were very good, with some areas already being partially met. It is a recommendation that the annual self assessment QAF be submitted in July 07 to evidence attainment of a level B across all six core objectives.
• In line with ODPM guidance, it is a recommendation that DHI identify 3 supplementary QAF objectives before Oct 05 that complement the ongoing service monitoring and evaluation and report progress on these in the annual self assessment.
• All staff interviewed showed they were well placed in terms of skills and experience to fulfil their roles. Although there was evidence of regular training there was a lack of any formal recording of this outside of supervision minutes. It is a recommendation that any future in-house training has a minimum of one aim and key objectives and that these sessions are evaluated by training participants.
• Feedback from staff and service users supports the argument for increasing capacity for floating support services in Bath and in the rural areas. The Supporting People 5 year strategy will take this information into consideration.      

With regard to partnership working DHI need to work more closely with RSL’s to ensure appropriate and timely referrals are made.

• It is recommended that DHI put in place a clear policy and procedure for managing services in the absence of the dedicated staff member.
• It is recommended that DHI be awarded a long term 3 year contract for the Specialist and Rural Floating Support Services. With regard to the Barton Buildings Floating Support Service it is recommended that DHI increase the capacity of the service from 15 to 20 units in line with the Specialist Floating Support Service as it has been identified that there is spare capacity in the service and that once this is agreed a long term contract can be issued.
• DHI must make this information available to service users.

  6. Service Capacity and Funding

7. Are the Services Strategically Relevant?

The review found that the services provided by DHI fit with the local and national context of strategic relevance. DHI services support users to develop their skills to live independently in their own accommodation. The review found that the services did not include the provision of general health, social or personal care.

DHI’s services continue to meet 3 of the Supporting People 5 Year Strategy 2005-2010 objectives including;

Objective 4 – Decrease levels of homelessness through the provision of preventative services.

Objective 6 – Providing services that help to promote the health, safety and well being of individuals and of the wider community.

Objective 8 – Improving the provision of services for people who may be hard to reach or who are socially excluded.

DHI services also continue to support the agenda of the DAT Housing Strategy October 2003 in that they support insecurely housed service users with problematic drug and alcohol use to maintain and sustain their accommodation.

The services also meet 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 safe, secure, and where necessary, supported accommodation, 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).

DHI services also fit within the national context, in the National Drug Strategy 2002, the key areas the strategy addresses includes;

• Reducing the harm that drugs cause to society – communities, individuals and their families.
• Preventing today’s young people from becoming tomorrow’s problematic drug users.
• 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.

All three floating support services meet this agenda.

In line with local and national agendas, the Community Safety and Drug Action Team , Supporting People programme and DHI are continuing to work in partnership through various planning and strategy groups including the Supporting People Core Strategy Group and the Housing and Drug Working Group to assess current provision, need and develop action plans to improve service user outcomes for the future.

  9. Consultation with Stakeholders

Service users, staff and other stakeholders  were consulted during the review.

9.1 Consultation with Service Users

Service user consultations

Four service users were consulted as part of the review. Interviews were conducted by telephone by Rebecca Potter.  Attempts were made to meet with service users face-to-face at DHI’s main offices but unfortunately this did not come to fruition and DHI reported that the users of the floating support services tended not to get involved in the service user events that they organise.  It is acknowledged that this area of service user involvement/consultation requires further development by both the Provider and the Supporting People Team.  Notwithstanding the above, feedback from service users was varied and included:

• Three service users were living in their own RSL tenancies, the fourth was moving between friends and Julian House night shelter having recently been evicted from an RSL tenancy.
• The service user who had recently been evicted reported that they were not referred by their landlord who was taking action through the courts to regain possession of the property, and it appears that the eviction process had reached the point of no return by the time the client accessed the service.
• Service users reported that they were referred by Green Park, (Bath Self Help Housing Association), and Bath Area Drugs Advisory Service, (BADAS). Two service user reported that they applied to DHI directly.
• There were no reported problems with waiting times.  Service users applications were assessed promptly and they were all quickly assigned a keyworker.
• Service users had been working with DHI’s floating support housing services for between two and eighteen months.
• Everyone had a keyworker assigned.  The client who had only been working with the service for two months was still undergoing needs and risks assessments and reported that they did not have a support plan in place at this stage. 
• The others had support plans which they said were useful and covered a range of practical areas including benefits, budgeting, sorting out their flats in terms of obtaining furniture, decorating etc, being a good neighbour, healthy living etc. In one case a service user reported that their keyworker supported them to obtain a housing transfer through Somer Community Housing Trust. Support plans are reviewed regularly and service users like the fact that they could track their progress in real terms through their improving CISS scores.
• Everyone reported that they had prearranged meetings with their keyworker on a weekly, fortnightly or monthly basis, and that meetings normally lasted around an hour, although in some cases they could be quite short, (half an hour or less). All service users began by meeting their keyworkers at DHI’s Milsom Street offices but after a short period they visited them at home.
• Two out of four service users felt that they would require continued low level support  although they were working towards becoming completely independent.  Another felt they would be fine once they had accessed settled accommodation, and another felt that they had achieved their aims and no longer required any housing related support.
• Some service users were uncomfortable about accessing support at Milsom Street because they felt it would bring them into contact with other people who were still using drugs and/or alcohol and that this could be detrimental to their own recovery. However, keyworkers were happy to make alternative arrangements including meeting the service users at home or at other venues locally.
• Keyworkers are available by phone at other times and everyone reported that the support was flexible and responsive to need.
• One service user reported that their keyworker had accompanied them to a ‘back to work meeting’ at the DWP and another said their keyworker had offered to attend 3 way meetings together with other professionals
• Only one out of the four service users interviewed were familiar with the service user produced newsletter, ‘Off the Wall’ and they were all unsure about whether there were any opportunities for being involved in service development or whether their views about this were sought.
• Everyone interviewed was happy with the service they received from DHI’s floating support services.  The three longer standing service users felt that positive outcomes of engaging with the services included increased self esteem, confidence, independence and community involvement; an improvement in their living conditions, (one person obtained a transfer and the others were enabled to settle into their accommodation and were supported  to access grants etc which they used for decorating/home improvement etc). In addition, service users were also supported to access other services as required.

9.2 Consultation with Staff

Interviews were conducted with two out of the three DHI staff providing the floating support services and with the service manager. Feedback/findings included:

• All staff appeared to have the appropriate skills and expertise to provide the service. Staff attended regular external and in-house training courses including.

• Staff were receiving supervision every four to six weeks and an appraisal system was in place.
• Staff were able to describe safe working practices and demonstrated knowledge of risk assessment and lone working procedures with a range of available control measures. An electronic logging system with had recently been introduced and staff reported that it worked well.
• Needs assessment procedures were clearly understood and well recorded in client files. All staff were completing support plans with service users and were conducting reviews. DHI have a clear monitoring process in place and staff were using this with the monitoring tool CISS, a tool which looks holistically at a service users situation on a quarterly basis.
• Staff had a clear understanding of ‘protection from abuse’ issues and were of the opinion that many of their service users are vulnerable adults. Some staff members had recently attended joint Social Services/PCT training in this area at St Martins Hospital.
• Formal arrangements have now been put in place to cover the services during planned staff absences. 
• Full time staff at the Barton Buildings and Bath services typically have a caseload of 20 and above.  Some of these will be new referrals waiting to be assessed and they may or may not engage. Service users are seen on a weekly or fortnightly basis for between one and two hours at a time.  Support workers also offer support via phone outside of these arranged contact times.
• The team leader reported that recently because of the increase in demand for housing related floating support, DHI has established a waiting list which is now full.  A drop in service is being offered for people unable to access the waiting list to give them basic advice and signposting.
• The length of time a user engages with the service is dependent on need.  Sometimes, a service user will require short term support in response to a crisis or particular event in their lives, (eg moving into a new home), and in other cases longer term support is required.  Staff are aware that the service is designed to be short term and all thought it was reasonable and likely that some users may engage with the service more than once.
• Staff reported that it is not unusual for new referrals to fail to take up the service and that two ‘no show’ appointments are tolerated before a service user’s place on the programme is ended and offered to someone else. These new referrals are currently been counted in the KPI and SPI monitoring, whether or not they engage.
• The majority of referrals come via Bath Area Drugs Advisory Service, (BADAS), which is predictable since this agency forms the first tier of drug and alcohol services in B&NES.  Support staff had recently visited RSLs in the area to promote the service.  They reported that they were well received; time will tell whether this will lead to appropriate referrals.
• Staff were in favour of raising the profile of DHI’s housing services.  Promotional literature had recently been sent out to a number of groups and agencies, including community groups and BME groups.

9.3 Consultation with other stakeholders

Feedback was obtained from a range of stakeholders including the Drugs and Alcohol Social Work Team,  the Probation Service, BADAS and the Community Drugs Advisory Service, (CDAS).  Feedback/findings included:

• There is a high demand for the services.  Many people with drug, alcohol issues or history of offending also have housing related support needs including the need to access stable accommodation or help to retain/maintain a tenancy.
• The referral system is straight forward and comprehensive and DHI responds quickly to referrals.
• There are good systems in place which enable users’ progress through all the DHI services to be effectively tracked.  Stakeholders found this useful.
• Referrers are not routinely copied in to letters offering interviews etc, and this would be useful as stakeholders could encourage the service user to attend the appointment.
• Potential service users are rarely turned down.  Each referral is considered on an individual basis.
• Joint meetings sometimes take place, particularly where there are problems with engagement.
• DHI staff have attended team meetings at the Probation Service.
• Information Sharing Protocols are in place and are working well.
• The services helps people move towards independence but sometimes this is a long process, especially where service users have chaotic life styles and there are historic barriers to resettlement, (eg rent arrears, past evictions, history of anti social behaviour etc).
• DHI is actively involved in the Housing and Drug Working Group.
• Some joint support planning takes place with the Probation Service, particularly where applicants are due to be released from custody. However, feedback indicated that there are opportunities to extend this and problems with capacity and time constraints could perhaps be overcome through the use of the video link which is available at the Avon and Somerset Probation Service.
• Some stakeholders were unclear about the extend of the support DHI floating support services could offer.  In one case, they were uncertain whether support could be offered to service users who are newly resettled.
• Milsom Street is not very accessible although floating support workers will meet service users at other venues.
• DHI are proactive in their approach to partnership working, and the range of services offered ensures a joined up/holistic approach.