Supporting People Service Review

Service: Rethink Floating Support Service - Service Address: 74-80 City Road, St. Pauls, Bristol, BS2 8UH - Service ID Number: 10154 - Service Provider: Rethink - Service Provider Address: 28 Castle Street, Kingston Upon Thames, Surrey, KT1 1SS - National ID No: 10000502 - Date: 1st April 2008 - Review Officer: Lisa Matthews, on behalf of Bath & NE Somerset Supporting People Team - Date to Commissioning Body: 20th May 2008

7 - Strategic Relevance

The review found that the service fits with the local and national context of strategic relevance and that it supports the aim of enabling service users to develop the skills to live independently in their own accommodation.

The Supporting People Five Year Strategy

The service contributes to five of the Supporting People 5 Year Strategy 2005-2010 objectives including:

Objective 1 – Partnership working to ensure that the programme makes a significant contribution to community planning and social inclusion.

Rethink contributes to this contribution through its effective partnership working with RSL’s, the community mental health team and Bath racial equality council.

Objective 2 – Taking an active role in linking the programme into other strategic agendas and initiatives.

Rethink was specifically commissioned to provide a short term floating support service, contributing to the local authority agenda to provide a recovery rather than maintenance model of support services for people with mental health problems; as identified in The Mental Health Commissioning Strategy 2008-2012:

‘The services will support and enable people who experience mental health problems to recover and lead personally satisfying, physically safe and socially meaningful lives as valued members of our local communities.’

Objective 3 – working towards the provision of wider choice and a range of high quality services.

Rethink contributes to this objective by providing services which are needs led and reflect the diversity of our local population, for example, by offering a service across all tenure and in the wider community.

Objective 6 – providing services which help to promote the health safety and well being of individuals and of the wider community.

Rethink contributes to this objective by providing opportunities for their service users to develop and maintain their independence, through the support they deliver and to have a greater community presence through the mapping resource they have developed for use in the service they provide.

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

Rethink contributes to this objective by providing a service that supports service users to live independently in their own homes, as part of the community and by supporting service users to engage in meaningful activity within their local communities. Rethink has also forged links with Bath racial equality council to promote their service to service users who may be hard to reach.

The service fits with some of the national priorities set out in the Governments’ white paper ‘Our Health, Our Care Our Say’. For example, by offering services that shift the system towards prevention.There is also a growing evidence base showing that preventative measures involving a range of local authority services can achieve significant improvements in well-being. Rethink contributes to this model of support.

The review found eivdence that the service also fits with some of the objectives set out in the National Service Frameworks, mental health, executive summary 1999, for example:

The paper set out that people with mental health problems should be able to expect that services

• Involve service users and their carers in planning and delivery
• Be well suited to those who use them and be non-discriminatory
• Be accessible so that help can be obtained when and where it is needed
• Promote their safety and that of their carers, staff and the wider public
• Offer choice which promotes independence
• Be well co-ordinated between all staff and agencies
• Empower and support their staff

The review found evidence that Rethink also contributes to standard one of the mental health promotion of the national standards and service models:

Mental health promotion -  standard one

Health and social services should:

• Promote mental health for all, working with individuals and communities
• Combat discrimination against individuals and groups with mental health problems, and promote their social  inclusion.

Social Exclusion Unit Report Summary - June 2004

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 issues. The project focused on people of working age, and asked two questions:

• What more can be done to help adults with mental health issues to enter and retain work?
• How can adults with mental health issues secure the same opportunities for social participation and access to services as the general population?

The report sets out an action plan intended to challenge attitudes, enable people to fulfil their aspirations, and significantly improve outcomes and opportunities for this excluded group. Action falls into the following 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 issues 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.

The review found evidence that Rethink has an important part to play in local delivery of all of the above national and local agendas.

9 - Consultation

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

Consultation with Service Users

Four service users were consulted with during the review process in a group setting supported by their support workers. Service users were given the opportunity of being interview alone, however, this was declined. Service users were given the opportunity of giving feedback in a group setting for the last 15 minutes of the session without the support workers present and this was taken up.

All service users have been receiving a support service from Rethink for just over one year, since the service was commissioned in February 2007. Two service users had been previously receiving a support service in their current accommodation through New Era and Sedgemoor since 1996 and the other two since 2001. Three service users have moved on through the New Era accommodation from Armes court, which are shared Bed-sits to Norfolk Crescent and Terrace Walk, which are individual flats. The other service user lives at Armes Court. Service users felt that they have a ‘home for life’, not viewing the service as short term. Move on had not been considered, with one service user strongly stating that her mental illness is stable; move on would be detrimental to the support network she had built up since living there. In terms of her overall mental health, felt that receiving a low level support service prevents her from having to be re-admitted to hospital. Service users reported that they did not have to wait long before being offered accommodation and support, and felt that their tenancies were secure.

Most service users had not had to complain since living in their accommodation, one service user had been supported to make a complaint about another tenant, this was prior to Rethink taking over the contract.

Service users were generally aware of protection from abuse policies and one service user confirmed this area was covered in her support plan.

One service user commented that further information and clarity on the responsibility split between the landlord and Rethink would be useful.

One service user reported that he was able to be involved in service planning by being included on the interview panel for a further resident, he also identified that he had been supported by his support worker throughout this process.

All service users could identify with their support plan and reported that they had been involved initially and ongoing in the support plan and needs and risk assessment process. All service users commented that they had received a copy of the complaints leaflet and a pack of policies and procedures.

Service users identified that they receive a weekly visit for around two hours, they felt that this was adequate; they also felt that they would be able to request greater support at other times if needed. Service users all stated that whilst their support worker is away, their support is covered by another known support worker. One service user identified that Rethink responds better to support needs than the previous support provider. Service users felt that they were likely to require the same level of support in the future in order to maintain their independence and their tenancies.

Service users were able to confirm that they received a review of their support plan, that they were given notice of when this would be; and that they could request a review at any time should the need arise. Service users felt confident that through their support plans the provider could meet their needs; even if they were not those of the mainstream.

Service users identified that they had received help from their support worker in the following ways:

Budgeting and debt management

• Support to complete utility forms
• Support to structure week, meaningful occupation and college courses
• Emotional reassurance
• Support with mental health problems

One service user identified a requirement for support at weekends or evenings and this was not available directly through the support worker; relying heavily at times, on family and friends. It was also identified that help with attending activities on a weekend or evening was not available and help with arranging and attending social activities would be beneficial.

All service users felt that the staff were good at their jobs, were generally helpful, approachable and friendly. All service users felt that the support charge represented good value for money in terms of the level of support they receive per week and the quality of the support.

Service users commented that they thought Rethink as an organisation was good, with a good reputation.

One service user identified that they used to have residents meetings (Landlord) but that these had broken down and no longer happened. One service user commented that they were not given any notice for the landlord to carry out safety checks and identified an issue over security; as the landlord had given out keys to access the accommodation without the knowledge of the service user.

On service user commented that a Rethink office in Bath would be beneficial.

Staff Consultation

Two community mental health workers (support workers) were consulted with during the review process; these two members of staff are responsible for delivery of the support service.

Both members of staff had a clear understanding of their roles and responsibilities and have been recruited from relevant backgrounds and experience. All staff have been subject to an enhanced criminal records bureau check and the provider induction programme. One community mental health worker has been in post since July 2007, whilst the other has been in post since Rethink took over the contract in February 2007. The latter member of staff previously worked for Sedgmoor and Dimensions and has supported service users in this accommodation for 6-7 years.

The review identified that the staff at Rethink have a good skill base both through the training they have received so far from the provider; and from their previous roles. Both community mental health workers are part way through the provider induction programme and reported that they receive regular supervision meetings with their line manager. Staff confirmed they have received training in basic health and safety, mental health awareness and equality and diversity. Both members of staff have received Protection of Vulnerable adults training with their previous employers; which will be re-enforced through the Rethink induction programme later on in the year.

Both members of staff confirmed that staff training is an agenda item in their supervision meetings, as is health & safety and risk assessment. Training needs can be raised in supervision meetings and staff confirmed they are able to request relevant training through their supervision meetings and their performance reviews.

Staff indicated a good awareness of Health & Safety issues and were able to describe a recent Health & Safety incident and how it had been dealt with.

Staff were able to describe fully the needs and risk assessment and support planning process and showed a good level of understanding in these areas and how they are affiliated to outcomes. Staff also identified the importance of service user involvement and engagement in these areas. One member of staff commented that some service users are difficult to engage in these processes, mainly due to them having accessed the service for a long time.

Both members of staff were readily able to identify with the lone working policy and the procedures they follow in practice. Both understood the importance of the policy, particularly in this service user group, and were fully committed to adhering to the policies and procedures that are in place for the service.

Staff consultation identified that they are able to ensure that diversity issues are considered through the needs and risk assessment process, the support planning process and through the service mapping folders, both identifying that this is a valuable resource that enables them to effectively signpost service users and meet their support planning needs.

Both staff members were strong in their knowledge of the complaints policy, the leaflet, actions to take and timescales to respond to service users. Staff identified that there hadn’t been any complaints as yet, but showed a sound understanding of the processes. They knew where the complaints log was kept and indicated they would support service users or signpost them to an advocate should they feel the need to complain. Both members of staff identified the two advocacy services that Rethink have partnered with to enable service users to access an independent advocacy service. One member of staff showed a good understanding of the areas of the policy that may inhibit service users to complain, and felt that the advocacy service was a positive alliance for service users.

Both members of staff identified that they spend one hundred per cent of their time on support and/or related tasks.

Both members of staff felt that they offer a good service, and they felt that service users were satisfied and happy with the service they receive. One member of staff felt proud to work for Rethink and felt supported to do the job well. The other staff member advised that Rethink offers a flexible needs led service, feeling that the only improvement could be an office in Bath, enabling service users to be able to drop in to a local office.

Stakeholder Consultation

Two stakeholders were interviewed during the review process.

1)     Supported Housing Services Manager – Futures at Knightstone

2)     Housing Services Officer - Dimensions

Both stakeholders identified a high demand for the service, although one stakeholder identified that it can be challenging to match Armes Court accommodation to the service user as its shared accommodation.

Both stakeholders were clear about the referral process and identified that it is well established. One stakeholder felt that there is good joint working practise between themselves as the landlord and the provider; to make referrals. The other stakeholder identified that it is an emerging working relationship but felt that the referral process was good so far.

Both providers felt that the needs and risk assessment process worked well and gave different perspectives to aid fair access to the service.

One provider felt that Rethink could do more to identify move on options for service users and felt the provider could make better use of their AMOS places.  It was also felt that Rethink could communicate to the landlord how the service user is getting on in the service. The landlord identified that this is something he would strive to work towards in the future.

Both stakeholders felt that Rethink helps to enable service users to move towards independent living, neither stakeholder identified any problems with exclusions or evictions and there were no problems identified with the length of time a service user would wait for a service.

One stakeholder identified as an area of good practice that Rethink works actively to seek the views of service users and had recently engaged a service user in interviews for accommodation, the stakeholder felt this was very genuine and worked extremely well.

One stakeholder felt that not all service users were fully engaging with the service, however, these issues were identified as being inherited and historical.

Stakeholders felt that the provider has a good knowledge of other services available locally and would be able to signpost service users effectively.