Supporting People Service Review

Services: Barton Buildings Floating Support (1), Specialist Floating Support Service, Bath (2), Rural Floating Support Service, NE Somerset (3). Service Address: 15-16 Milsom Street, Bath, BA1 1DE. Service ID Number: 224 (1), 233 (2), 232 (3). Service Provider: Drugs & Homeless Initiative. Service Provider Address: 15-16 Milsom Street, Bath, BA1 1DE. National ID Number: 10000902. Date: Commenced September 2004, concluded December 2004. Review Officer: Simon Dicker on behalf of Bath & NE Somerset Supporting People Team. 

3. 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. DHI demonstrated that with their support service users achieved independence. The review found that the services did not include the provision of general health, social or personal care.

In the forthcoming Supporting People 5 Year Strategy 2005-2010, it states that additional investment is needed in drug and alcohol services as our current investment is relatively small although this must be seen in the context of the overall level of investment in services for single homeless people.  Given this we propose to invest in community based preventative support services for people with complex needs including drug and/or alcohol abuse.

DHI’s services meet 3 of the forthcoming 5 year strategy 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.

As the services meet these objectives they clearly providing relevant supporting people services.

DHI services also support the agenda of the DAT Housing Strategy October 2003. The DAT recognises that it is essential that people who are being treated for drug and alcohol problems have access to secure housing, but that this needs to be balanced with the need to tackle anti social behaviour relating to drug and alcohol use and the DAT Housing Strategy has been written in the context of the overall Housing Strategy and Homelessness Strategy for the area. The strategy states that around 30% of people seeking support for problem drug use are homeless or insecurely housed and amongst single homeless people, well over 50% have either drug or alcohol problems or a combination of both.

DHI services 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.

6. Consultation with Staff and Service Users

DHI staff were interviewed about the services they provided and service users were consulted with about the service they received. As part of undertaking a joint review, service users for Bath and Wiltshire schemes were interviewed at DHI by Simon Dicker (B&NES SP Team), Nigel Lambert (Wiltshire SP Team) and Ian Keasey (formerly  Joint Commissioning Officer for B&NES DAT).

6.1 Consultation with Service Users

• Service users were pleased with the services they received and did not report any complaints about DHI services.
• A minority of service users voiced their feelings that the initial induction to DHI was too long and time consuming, however this feedback has to be balanced against the responsibility DHI have to new service users.
• A consistent message from service users was that they believed there remained a high level of unmet need amongst their friends or acquaintances and they advocated that more funding should be identified to enable services to address this.
• One service user described how he himself had benefited from DHI support, as had his daughter, and illustrated the added value this had meant in terms of improved family relationships and communication.

6.2 Consultation with Staff

Interviews were conducted with two out of the three DHI staff providing the floating support services and with the service manager. One of the support workers was on annual leave at the time of the review.

• All staff appeared to have the appropriate skills and expertise to provide the service. Staff attended regular external and in-house training courses including crack cocaine, anger management, health and safety (including lone working) and one worker was funded to take a professional housing qualification.
• Staff were receiving supervision every six weeks and an appraisal system was in place.
• One staff member reported that on average 20% of the working week was spent on administration, in addition to this an hour was spent after each session with a service user writing up notes and doing session follow up work. This  particular worker saw three service users a day on average.

The Ex Offenders Floating Support service had weekly contact with two thirds (10) of the service users on the caseload (15), therefore seeing on average 2 service users per working day. Each session was reported to be approximately an hour long, with subsequent time spent on administration, phone calls, action points from meetings, and writing supportive statements for housing applications.

• 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.
• 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.
• The DHI referral form had recently been reviewed and circulated to referral agencies, however there was felt to be some issues around late referrals for example, referrals were often made after anti social behaviour orders had been made, and one worker reported that there was a need to “educate” RSL’s around referrals.
• Staff had a clear understanding of ‘protection from abuse’ issues and gave examples of how physical and financial abuse or intimidation could be addressed between service users.
• Staff stated that they worked with service users wanting to make changes to their drug/alcohol use and in the event of working with service users that lacked motivation to reduce their drug/alcohol intake, their use of DHI Support would be questioned.
• One support worker felt that it was realistic for support to last up to 1 ½ or 2 years and that this time was needed for the service user to develop an independent lifestyle. Service evaluation and exit questionnaires were completed by service users on exit and service users were made aware that the  “door was always open” in the event of relapse.
• Staff felt that there were adequate resources available for the post, but that there was an argument for a second floating support post in Bath and additional capacity needed in rural areas.
• Staff reported that during periods of annual leave or absence there was no formal arrangements on place to cover the services, however they reported that other members of the staff team did support service users who needed crisis support in their absence. Service users were invited to ‘drop in’ to DHI if the need presented during this period of staff absence.

9. Review Outcome / Recommendations and Impact

1.         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.

2.         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 submit in July 06 to evidence attainment of a level B across all six core objectives.

3.         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.

4.         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.

5.         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. 

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

7.         It is recommended that DHI put in place a clear policy and procedure for managing services in the absence of the dedicated staff member.

8.         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.

9.         DHI must make this information available to service users.

10. Action Plan to Address Report Recommendations (Providers to complete)