Supporting People Service Review

Service: Sedgemoor Home Support Service. Service Address: 59 Sedgemoor Road, Foxhill, Bath BA2 5PL. Service ID Number: 10004. Service Provider:  Bath and NE Somerset Adult Care and Commissioning Services, Mental Health. Service Provider Address: Green Park Offices, C/O PO Box 3343, Bath BA1 2ZH. National ID Number: 10005309. Date: Commenced May 2004 Concluded Dec 2004. Review Officer: Simon Dicker, On behalf of Bath & NE Somerset Supporting People Team. 

2. Introduction to Agency

2.1 Brief History

Sedgemoor Home Support Service began in November 2002 It was developed to enable users of mental health support services to move from more acute services such as Residential Homes (e.g. Springfield, Kingsmoor) to a high support service linked to the “Core Units”. This was seen as a stepping stone to allow for a planned move (within 2 years) to “cluster” units with long term low level support. This allows service users to have their own tenancies where they live independently with support.

The provider operates from 59 Sedgemoor Road, a Council owned property, and 60 Sedgemoor Road (a Registered Social Landlord property) next door that houses the core units.

This means that the higher support is delivered to clients “next door” and enables efficient and fast responses to service users that may be adjusting to previous stays in more acute services, or experiencing episodes of mental ill health.

The cluster units are sourced from Registered Social Landlord properties, some in and around the Foxhill neighbourhood, but others towards the city centre. This gives a dispersed feel and avoids the “ghetto” that can sometimes be created through very dense single site provision in the community (e.g. Green Park). Support levels are routinely low, but within the total hours contracted there is room to increase short term provision to some people some of the time. This is an important feature of the service as staff can react quickly to individual needs, avoiding a “one size fits all“ approach.

2.2 Capacity

Units:   8 (4 Core and 4 Cluster)

Staff Hours:             1 x Team Leader (37.5)

                                    1 x Senior Home Link Worker

                                    2 x Home Link Workers (37.5)

                                    2 x Home Link Workers (18.75)     

(2,405 total hrs per qtr)

N.B. Above is the total staffing complement for Sedgemoor Home Support Service, and is deployed amongst a total of 27 units, not just the 8 funded through SP.

2.3 Monitoring Information

Not all information is available since going live, but staffing has consistently been above our warning level of 80% of contracted support hours.

Occupancy has an overall high value, which fits well with the overall picture of under supply for this service.

Availability of existing units has never been an issue since the service started; the service reports well about its housing management and have had no extended closure due to refurbishment or repair.

There are no concerns over the above figures, but following on from recommendations that both core and cluster units are costed separately, monitoring will also need to be separated for each service, with separate submissions for core and cluster services.

2.4 Existing Funding

Proposed SP funding of Sedgemoor Road core and cluster service

• Overall level of funding to the service should remain the same
• SP should fund the whole service (27 units rather than current 8)
• This comprises 4 core units and 23 cluster units
• Monitoring returns should be provided for all units
• Finance to separate budgets for core and cluster units according to scheme set out below

Rationale

• Core service is short term and cannot therefore be compared with LD services so this should be reflected in % SP contribution
• Core services is strategically relevant e.g. enabling hospital discharge
• Core service also allows for S117 discharge and should therefore be jointly funded with SS
• Cluster service is lower level support and clearly eligible for higher % SP funding
• Cluster service is also long term so should be jointly funded with Social Services

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

6. Consultation with Stakeholders

Consultation was undertaken through

•         3 separate 1:1 meetings with service users from Core Units
•         1 Group meeting between three people sharing one Cluster Unit

6.1 Consultation Findings

Tenant’s wishes in the cluster unit were for long term low level support, and there was a degree of anxiety displayed over what might happen if support was withdrawn, or time limited.

Other than this there were no critical issues raised by service users, and no evidence of unresolved complaints, or dissatisfaction with support levels.  Although the review reflects this, it should be noted that many tenants throughout all our mental health services would need support or advocacy to identify and articulate complaints that relate to a stated aim of the service. This is unlikely to be available, give that funding for appropriate adult advocacy  is not yet available at more critical times e.g. during arrest by the Police Force.

All tenants had histories of engagement with support services, many after periods of using acute services, and most described how they regarded their own recoveries. Some discussion was held around the anxieties involved in managing a tenancy for the first time and some people felt they would always need support, others were less sure, and for others it felt too soon for them to comment.

In terms of tangible benefits from support, the often quoted area was around the help individuals had received in acquiring and maintaining a tenancy; and for many people help and advice with levels of debt accumulated before engaging with the service, and restraint on committing to further debt.

Overall, the conclusion from consultation with service users is that they regard it as unrealistic to have to end support after two years as a rigid rule.  This is backed by evidence from other social agendas such as the National Service Framework for Mental Health; which indicates services should be sufficiently flexible to be able to be shaped to fit individual need.

7. Evidence and Risk Assessment

The service as it stands was assessed as low risk in terms of recommissioning, other than the minor concern over recruitment that will become necessary in the medium term.

Local Authorities internally provided services are exempt from accreditation therefore one has not been conducted.

There appears to be scope for developing this service if we were to choose to recommission all mental health services in the future; they would be well placed to support development of any peer support networks, which could help address the move on issues in this sector; and also may be well placed to provide short term fast response floating support in crisis interventions aiming to avert avoidable re-entry into Residential Care.

8. Value for Money

Core Service

Cost per unit (to Supporting People) per week:                                          £229.38

Regional Upper and Lower Quartile:                                           £78.31 - £215.02

National Upper and Lower Quartile:                                             £87.52 - £261.85

Sedgemoor Home Support Service falls slightly above the regional average, and just inside the high end of the National Average.

Cluster Service

Cost per unit (to Supporting People) per week:                                       £85.70

We have no information on equivalent services regionally or nationally.

9. Review Outcome / Recommendations and Impact

The outcomes for this specific service contract review are as follows:

1.   A clearer division of budgets should be put in place by the service managers to illustrate the core and cluster services separately from its Adult Care Budget funding. This is recommended to enable greater clarity of overheads for each service, and more accurate comparison with regional and national equivalents. These budgets should then be monitored against actual expenditure for each service, as the review could not prove that there was no cross-subsidy between the two.

2.   The service should be congratulated for its engagement with the QAF. It is a recommendation of the review that Sedgemoor Home Support Service resubmits its QAF self assessment for validation in Summer 2005 at Level B across all objectives.

3.   As a recommendation from review the service should identify what key action points from the Social Exclusion report it feels it contributes to, and how that contribution may be developed in 2005. This should then inform the choice of additional QAF objectives to be recommended by the provider and agree with the SP Team.

4.   Overall, the recommendation from review is to extend the interim contract by one year, but on the basis of all 27 units as indicated in Sec 2.4. This will mean monitoring returns in respect of the whole service.

5.   Financial reapportionment of costs to each service:

The maximum Supporting People contribution to Core Units is recommended at 40% of cost in line with draft eligibility matrices, the contribution to the Cluster Units is recommended at 60% of cost. The rationale behind this recommendation is that the core service enables hospital discharge, and also s117 discharge and should therefore be jointly funded with Social Services. The cluster units are long term services so should also be jointly funded with Social Services.

6.   Recommendation to classify the Core Service as Short term maximum 2 years duration, and the Cluster service as long term chargeable.

7.   The service managers should complete the following action plan to state how the above targets will be addressed.

10. Action Plan (completed by the Provider) to address points 1 – 5 above