Supporting People Service Review

Service: Bath & NE Somerset Floating Support Service. Service Address: Various. Service ID Number: 10034. Service Provider: Second Step. Service Provider Address: 9 Brunswick Square, Bristol, BS2 8PE. National ID Number: 10000544. Date: May 2007. Review Officer: Sarah Shatwell for and on behalf of Bath & NE Somerset Supporting People Team.   

3. Brief History

Second Step was commissioned in April 2006 to deliver a low to medium level floating support service in B&NES and was not operational in the area before that time.  Although the organisation has been reviewed by other local authority SP Teams in the area this is the first review of the service to be carried out in B&NES.

4. Monitoring Information

B&NES Floating Support Service

Explanatory note

This is a new floating support service, funded from April 2006. The service provides time limited support to clients with mental health support needs.  The service currently provides two levels of support.  Low need clients receive on average, a total of 3 hours of support per week and medium need clients receive a total of 6 hours support per week.  The capacity of the service is the equivalent of 28 low support clients. As the service will be supporting both low and medium support clients it is unlikely to ever be seen to reach the capacity measured in the workbook.

KPI 1 – Service users who have been supported to establish independent living as % of all users in the quarter – In Q1 11 service users joined the service, in Q2 the figure rose to 20 and then again to 22 in Q3 and to 24 in Q4.  In each period there was a mixture of low and medium need clients.

SPI 2 - Percentage utilisation – The service was newly set up in Q1 and by the end of the period the service was supporting 3 low need and 8 medium need clients.  In Q2 and Q3 the ratio changed to 12:8 and 13:9 respectively and at the end of the first year of operation this figure was 14:10.  These figures show that there is significant demand for the service with current utilisation levels running at 12:13

SPI 3 - Percentage staffing levels – The service was newly set up in Q1 and recruitment took place during this period.  The following quarters show that a full staff team was in place by the end of the quarter and staffing levels continued at acceptable levels in the subsequent quarters.

SPI 4 - Percentage throughput – Service users were joining the service in Q1 and Q2 and it is only during Q3 that service users started to leave the service (see below for destinations).  In single tier services any movement of service users will show as throughput figures of > 100% however in this two tier service it is unlikely that the 100% would be exceeded

5. Destinations of users who stopped using the services 2006/07 Q1- Q4

In Q3, 4 service users ended their contact with the service.  One service user did not fully engage with the programme of support offered and was given notice, and three service users completed a limited programme of support before disengaging with the service.

8. Quality Assessment Framework (QAF) Outcomes

The objectives were assessed as follows:

Examples of good practice:

Needs and risk assessments

•       Referral criteria state that applicants must be willing to accept Second Step’s Equal Opportunities Policy

Support planning

•       SMART targets enable progress and outcomes to be monitored

Security, health and safety

•       All service users have a ‘crisis plan’ included in their support plan

Fair access, diversity, and inclusion

•       Resource Handbooks are centrally available, providing information and contact details of BME, cultural, religious and other resources.
•       Second Step has recently joined the Mindful Employer Initiative which shows their commitment to supporting and enabling staff who experience mental health issues.

Service user involvement/empowerment

•       Service users are provided with comprehensive handbooks, they receive regular newsletters and are involved in nearly every aspect of the organisation via reference groups focussing on specific issues, recruitment panels and user involvement groups such as the Stepping Forward Group.

9. Consultation with Stakeholders

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

9.1 Consultation with Service Users

Service user consultations

Six service users were consulted as part of the review which represents 25% of all service users currently in receipt of the service. Face to face interviews were conducted in service user’s homes, Second Step offices or in an alternative venue of the service user’s choice.  Feedback from service users was consistently positive.

Several service users expressed the view that Second Step would be their provider of choice based on experience of a range of statutory and voluntary sector services.  One service user was experiencing a particularly fragile period of mental health at the time of the review and was able to confirm that the support they received from Second Step had contributed significantly to keeping them out of hospital.

All service users interviewed had been in receipt of the service for between six and twelve months.  They had been referred from a variety of sources including Community Mental Health Teams, other mental health service providers, drug and alcohol service providers and homeless hostel providers.

Service users confirmed that they had received support with a range of practical and housing related tasks such as managing finances, ‘paperwork’, shopping, cleaning etc.  In addition all service users stated that they benefited from the social and emotional support provided by Second Step for example going for a coffee, having a chat, going swimming.

Service users were aware of having a support plan and stated when asked that a copy of this was included in the service user handbook.  Most described the support plan as a flexible tool that was sometimes referred to and that at other times the activities that happened when support workers visited was on a more spontaneous basis. 

Most service users had contact with their support worker on a weekly basis, usually for around an hour to an hour and a half at a time.  A number of individuals had received visits more frequently during times of stress or poorer mental health and two individuals received support from two workers.  All service users felt that the level of contact they received was enough for them and added that they could ask for more if they needed it on a flexible, needs led basis.

No one consulted had made a complaint about Second Step though all felt they would know what to do should they need to.  Most service users stated that they could discuss any problem they might encounter with their support worker or with the senior support worker.

All service users gave consistently positive feedback in relation to the skills and personal qualities of support workers with descriptions such as ‘a life saver’, ‘doesn’t judge’, ‘supportive, friendly, approachable and helpful’ being common feedback.  One service user stated in particular that the service had a ‘good feel’ about it and that they felt the organisation was ‘fresh’ and ‘outward looking’.  All service users consulted expressed concern about the limited length of time they would be able to receive support for and that they would prefer the support to be available on a long term basis.  None of the service users consulted felt that they could see a time when they would not need the service anymore.

9.2 Consultation with Staff

Interviews were conducted with three support workers, the senior support worker and the team manager. 

All staff interviewed were clear about their roles and responsibilities and showed a clear commitment to the organisation.  The majority of staff had worked for Second Step for a number of years and commented that their loyalty to the organisation was a reflection of their satisfaction with how they had been treated and the training opportunities they had been afforded.  One member of staff was keen to increase their hours but understood that this was not possible within the current contract value.

Staff had a diversity of previous experience including relevant experience of working with vulnerable adults in supported housing and floating support settings.  All staff were able to evidence that they had received appropriate and comprehensive training in relation to a range of skills and issues and that they were due to undergo training on the protection of vulnerable adults in the near future.

Staff had a good understanding of needs and risk assessment and support planning and gave generally positive feedback about the new process for support planning that had been introduced, although it was noted that completing paperwork could sometimes be a bit arduous.  Staff reported that service users had a copy of their support plans in their handbooks.

All staff were able to describe the key features of Second Step’s health and safety policies and procedures and knew where to look for further information in the extensive policy and procedure files held at the Bath office.  Staff were able to describe potential health and safety risks in relation to lone working in service users’ homes and to explain processes for managing and mitigating risks, for example the safe reporting procedure.  Several staff members described how they supported service users to plan for potential ‘emergencies’ or out of hours crises, with the help of the crisis plan which is completed with all service users as part of the support planning process.

All staff had an excellent and sensitive understanding of the possible issue covered under the term ‘protection from abuse’ despite the fact that some individuals were waiting to undergo training in this area.  Staff were able to demonstrate at interview the ways in which they would support and empower service users to tackle ‘low level’ exploitation such as being pressured to lend money or having ‘unwanted guests’ overnight, and were clear about the procedures for involving statutory agencies where appropriate in more serious abuse incidents.  Staff had a good understanding of the confidentiality policy and when it would not be appropriate to adhere to it.

Staff were aware that referrals came from a range of sources and stated that the service was widely advertised.  Staff were aware of and sensitive to individual service user needs in relation to diversity, fair access and inclusion.  Positive examples of this included one staff member being aware of ‘manners’ when working with an older person, being aware of how interests might differ between staff and service users, being aware of a service users weight might affect their self esteem and ability to interact socially and always working from the perspective that having a ‘mental health’ label might automatically subject service users to discrimination.

The complaints procedure was known about and understood by all staff and they were confident that service users would know how to complain if the need arose.  Staff generally felt that complaints or concerns were dealt with at an informal level and could not remember an incident when the formal procedure had been invoked.

Staff were able to describe positive outcomes for service users such as one individual being supported to move to more appropriate accommodation, others engaging in college courses or health promoting activities and a recognition that for some a good outcome was to actually engage with the service on a regular basis.

Overall staff reported that they felt part of a ‘great team’ and part of a respected and professional organisation.  Staff felt that that were valued and respected by senior and line managers, that they were ‘well taken care of and supported’ and that this contributed to their sense of loyalty to Second Step.  When asked how they viewed the service staff reported that they felt it was of high quality, it afforded excellent opportunities for participation by service users and that Second Steps commitment to promoting mental health was directed at both service users and staff alike.  When questioned about potential improvements the service could make one member of staff stated that they would find it valuable to have greater flexibility to work more intensively with service users when they first joined the service in response to short term needs.[1]

9.3 Consultation with other stakeholders

Telephone interviews were carried out and feedback was obtained from five individuals from a range of stakeholder organisations including Community Mental Health Teams, other statutory services and Supporting People service providers.

Stakeholder feedback was generally positive with the majority of stakeholders stating that there was a demand for this type of service.  The referral process was felt to be swift, open and flexible though one stakeholder stated that they were surprised not to have been asked for more information as part of the referral and assessment process, though this does not reflect standard policy of requesting two references.  All stakeholders who had made a referral had been kept informed about the progress and outcome of the process.  One stakeholder stated that they had expected the service to be more widely known about and had expected Second Step to do ‘more networking’ and to have ‘more of a presence’ in the area.

No agency consulted had had a referral refused by Second Step and two stakeholders reported that they had been successful in securing the service for ‘more challenging’ service users, and that the provider’s approach to managing risk and offering a flexible service to such individuals should be praised.  There was general agreement amongst stakeholders that referring agencies were kept informed of service users’ progress and some evidence that joint working and support planning and attendance at ICPA meetings was not uncommon.

One provider was impressed that the service was able to accept people with autism as this was felt to be a significant gap in provision and also noted that the service provided a ‘valuable safety net’ for those who did not fall within ICPA criteria. 

Common feedback was that the service works well with individuals in relation to maximising independence, though it was recognised that service users’ level of functioning might vary and that Second Step were sensitive and realistic in terms of their expectations of what could be achieved.  One stakeholder questioned the amount of flexibility the service was able to offer in relation to providing higher levels of support initially that tailed off over time, possibly reflecting a lack of clarity amongst some stakeholders in relation to what the service is able to offer.

Some less positive feedback was received by a minority of stakeholders, two of which expressed some concern in relation to overlaps with other services (statutory and voluntary sector) and how this affected demand for Second Step’s service, and whether indeed there was sufficient demand for the service.  Another observation that was made was that the service seemed to focus on providing social support for service users rather than focussing on practical, housing related tasks.  One stakeholder in particular felt that the service should be encouraging service users to engage in mainstream social activities and focus more intensively on supporting individuals to develop skills relating to budgeting, cooking, cleaning and independent living and managing their home.  There was some concern expressed that engaging service users in social activities might create dependency rather than foster a culture of recovery.

Overall the service was rated highly by stakeholders with flexibility, responsiveness and a person centred approach being key themes.

10. Value for Money  

The cost of the service to Supporting People compares favourably with the   regional quartile information for similar services, however it must be noted that this quartile information is still based on contract prices prior to service reviews.  The unit cost falls below the national lower quartile for similar services although again it must be noted that these are pre-contract review values.  It should also be noted that both regional and national quartile data are for similar rather than ‘like’ services and may not be comparable to the service under review in terms of contact hours with service users etc.  The information contained in the table above was provided by ODPM (now DCLG) in the first year of the SP programme and should be referred to as a guide only.

The hourly costs and unit weekly costs fall below the lower SW Regional benchmark limits for floating support services which have been produced by Mark Goldup.  The figures for hours of contact time and number of first tier management time are within the SW regional benchmarks (figure in brackets includes first tier management support hours).

The cost per support hour per week falls between the local benchmarks for mental health floating support services. 

[1] Since the review senior management have confirmed that the service does offer a flexible approach and that this has been communicated to all staff