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Supporting People Service Review Report

Service: Marlborough Lane. Service Address: 7 Marlborough Lane, Bath, BA1 7NQ. Service ID Number: 49. Service Provider: Places for People. Service Provider Address: 1-3 Surrey Street, Bristol, BS2 8PS. National ID Number: 10000076. Date: December 2006. Review Officer: Caroline Clark on behalf of Bath & NE Somerset Supporting People Team.

1. Report Summary

The Places for People scheme at 7 Marlborough Lane provides support and accommodation for people with Mental Ill health from BME communities. The service was reviewed by Caroline Clark on behalf of the Supporting People Team in December 2006.

The service achieved level B across all 6 QAF objectives and service users and other stakeholders report that they are pleased with the quality of the accommodation and service.

Since the last review the focus has been on helping service users to move to independent living within two years in line with the short term categorisation of the scheme. This appears to be successful with 2 service users moving from the scheme in the first two quarters of 2006/2007; the same number as moved throughout the whole of the previous 2 years. The service now needs to focus on identifying potential referral agencies to evidence demand for the service and reduce void times.

The scheme is managed from Bristol and although staff are able to evidence improved partnership working there is still further work to be done around communication with Bath based organisations and potential referral agencies.

The cost per support hour at the scheme continues to be above regional benchmarks. This cost could be reduced by delivering further support hours, probably through support to service users when they move on from the scheme. Places for People are to provide costings for increasing the number of hours going into the service by developing an element of floating support within the current contract value.

Service type and capacity:

Supported accommodation for people with Mental Ill Health

6 units

Annual Contract Value:

£23,249.05

2. Introduction to Agency

At the time of the last review the service was managed by Bristol Churches Housing Association (BCHA), part of the Places for People group. In May 2006 BCHA changed its name to Places for People and ownership and management of the property was transferred to Places for People Individual Support.

Places for People is one of the largest property management and development companies in the UK, with 2,500 employees and 58,625 homes either owned or managed in a mixture of different tenures.

Places for People Individual Support is a charitable Registered Social Landlord providing housing, care and support in over 5,000 homes. It provides a choice of housing and services for older people including purpose-built extra care facilities, tenancy support to people living in independent properties, supported homes for people with physical and learning disabilities, preventative and practical access to services for women at risk of domestic violence and supported housing for homeless people. Marlborough Lane continues to be managed by the same staff, from the same Bristol office.

7 Marlborough Lane is a large semi detached Victorian house, 5 minutes walk from Bath city centre. The scheme has been in operation since 1994 and its primary purpose is to provide low level housing related support to people with mental ill health to support them to achieve and maintain independence. It is the only service specifically for people from black and minority ethnic communities in Bath.

When the scheme first opened tenants were given assured tenancies, giving them long term security of tenure. However, since 2002 and the introduction of Supporting People the service aims and objectives have changed and the service now promotes recovery and independent living. There is however one tenant still on an assured tenancy who has been at the scheme for over 12 years and considers Marlborough Lane to be his home for life.

3. Brief History

Marlborough Lane was last reviewed by the Supporting People Team in May 2005. The main findings and recommendations were as follows:

The service achieved level B in 5 of the 6 QAF objectives and a level C in Protection from Abuse. Policies and procedures are well written and regularly reviewed and it was recommended that the service work towards achieving level B in Protection from Abuse.
Referrals to Marlborough Lane are assessed when there is a vacancy. With no waiting list it was not possible to demonstrate a clear indicator of demand for the service.
Support staff attend appointments and meetings with service users and other agencies as appropriate but there is limited contact with local agencies that current service users are not engaged with.
Marlborough Lane is described as a short term service although 5 out of 6 service users had lived at the scheme for over 3 years. It was recommended that the service focus on supporting service users to find suitable independent accommodation.
The service was found to provide good value for money in terms of unit cost although the cost per support hour was above regional and national comparators. It was recommended that more support hours are provided to reduce this cost.
The organisation should look at options for dealing with the long term tenant at the scheme. Possible options would be to either make the service for this tenant chargeable or to increase the capacity of the service to include 1 unit of floating support.

4. Monitoring Information

	2004/05	2005/06	2006/07
	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2
KPI2a	100	100	100	100	100	100	100	100	100	100
SPI1a	100	100	100	100	100	100	100	100	100	100
SPI2a	100	100	97.4	83.3	91.0	96.2	100	100	91.1	79.5
SPI3a	102.5	95.2	87.5	104.3	99.0	91.0	82.0	100	102.9	91.7
SPI4a	100	100	100	83.3	100	100	100	100	100	83.3

Key:

KPI 2a - % of service users who moved on in a planned way

SPI 1a - % Availability

SPI 2a - % Utilisation (housing)

SPI 3a - % Staffing Levels

SPI 4a - % Turnover / Throughput

Performance monitoring shows that in the first two quarters of 2006/07 2 people have moved out of the scheme; the same number as moved on throughout the whole of 2004 and 2005. SPI2a (utilisation) is currently low at 79.5% indicating the problem with filling vacancies at the scheme.

Destinations of users who stopped using the service

(April 2004 – March 2007)

Staying with friends
Staying with family members
Moved into bed and breakfast accommodation
Moved into supported housing
Moved into sheltered housing	1
Moved into a care home
Moved into accommodation as an owner occupier
Moved to take up an RSL tenancy (general needs)	3
Moved to take up a local authority tenancy (general needs)
Returned to previous home

In the three years from April 2004 to March 2007 a total of 4 service users stopped receiving the service. All were planned moves with 3 taking up general needs tenancies and 1 moving into sheltered housing.

5. Service capacity and funding

Service	Units	Support Staff	Management Staff	Funding
Total Hours	Support Hours	Total Hours	Support Hours
Marlborough Lane	6	12.05	10.2	3.29	2.47	£23,249.05

6. Strategic Relevance

Since the last review a mental health project group comprising officers from B&NES Social Services and Supporting People teams and representatives of Avon and Wiltshire Partnership Mental Health care Trust and B&NES Primary Care Trust has been convened. The role of this group has been to collate information on the current range of mental health accommodation and care/support provision including nursing and residential care, out of area placements, supported living arrangements and Supporting People services and to compare supply data to available information on local needs. The overall aim of this strategic review has been to align local commissioning activities, including the delivery of Supporting People services to a recovery based model of service delivery which promotes and encourages move on and independence.

A number of key themes have emerged from the review including the need to develop a broader range of supported living and supported accommodation options for people with higher level support needs as part of an overall spectrum of provision. In this context Marlborough Lane continues to be strategically relevant in that it provides low level supported accommodation which contributes to the delivery of a spectrum of provision.

Since the last review the scheme has focussed on moving those existing service users who were ready into independent accommodation to meet the aim of the short term service. Referral agencies such as the CMHT at Miles House, ACT Team at Hillview Lodge and the Community Recovery Team have been made aware of the aim to support people into independent accommodation within two years and this information is passed on to potential service users at the point of referral.

There continues to be an issue with the one service user who has an assured tenancy and considers Marlborough Lane to be his home for life. Places for People have expressed a desire to make this unit chargeable, but this needs to be looked at as part of the current review of mental health services.

6.1 Legal / ODPM Guidance for service user groups

Since the last review a number of national agendas which relate to the provision of service for people with mental health problems have emerged.

Sustainable Communities: settled homes, changing lives (Office of the Deputy Prime Minister, June 2005)

This document sets out ODPM (now known as the Department of Communities & Local Government) priorities for tackling homelessness. The overall aim of the document is to halve the number of homeless households living in insecure temporary accommodation by 2010. The strategy promises new resources for homelessness services and emphasises:

Homelessness prevention
Support for vulnerable people
Tackling the wider causes and symptoms of homelessness
Helping people move away fro rough sleeping
Provision of more settled homes

Our health, our care, our say: a new direction for community services (Department of Health, January 2006)

This document sets out the Government’s future direction of travel for health and social care services and has been driven by two consultation exercises carried out in 2005. Independence, Wellbeing and Choice, a Green Paper set out proposals for adult social care services, and Your health, your care, your say, sought views on desirable changes to health care services. The White Paper outlines outcomes for people’s lives that health and social care services will support:

Improved health and wellbeing
Improved quality of life
Making a positive contribution
Choice and control
Freedom from discrimination
Economic wellbeing
Personal dignity

A New Deal for Welfare: Empowering People to Work (Department of Work and Pensions, January 2006)

This paper sets out a number of key proposals relating to significant reform of the benefits system with the overall aim of helping disabled people back to work. Proposals include:

Employment and Support Allowance to replace Incapacity Benefit
Enhanced support for severely disabled people
Mandatory work focussed interviews
Revised medical assessments
Greater in work support
Financial incentives for Local Authorities to facilitate back to work schemes

Creating Sustainable Communities: Supporting Independence (Office of the Deputy Prime Minister, November 2005)

This consultation document on the future of the Supporting People programme poses a number of key questions to which Local Authorities have been asked to respond. The document identifies three broad types of need for Supporting People services and focuses attention on how such needs might be met in partnership with other stakeholders as follows:

Integration of planning, commissioning and delivery of services for people who need both care and support
Improvements in the quality, accessibility and flexibility of services for people who are able to live independently with support
Challenges associated with ensuring that there is proper focus on the needs of people who have experienced or who are at risk of social exclusion

7. Quality Assessment Framework (QAF) Outcomes

The objectives were assessed as follows:

QAF Objective	Self Assessed Score	Validated Score Sept ‘05	Validated Score Sept ‘06
C1.1	Needs & Risk Assessment	A	B	B
C1.2	Support Planning	A	B	B
C1.3	Security, Health & Safety	A	B	B
C1.4	Protection from Abuse	A	C	B
C1.5	Fair Access and Diversity	A	B	B
C1.6	Complaints	A	B	B

The service was self assessed at level A across all objectives and has been found to be working either at or above level B in all areas.

C1.1 Needs & Risk Assessment

The service was assessed as working at level B in this area with a comprehensive needs and risk assessment process which is appropriate to the service user group. It was not possible to validate this objective at level A as it is unclear whether service users are really involved in reviewing procedures and there is no documentary evidence that outcomes of reviews are used to inform service development.

C1.2 - Support Planning

The service was assessed as working at level B in this area. Service users understand their support plans and there is evidence of joint working with external agencies. Again it could not be validated at level A as there is insufficient evidence of service users being involved in reviewing policies and procedures or that outcomes of reviews are used to inform service development.

C1.3 - Health and Safety

Policies and procedures relating to health and safety are clear, concise and regularly updated and reviewed. Health and Safety issues are included on the agenda at house meetings, but it is unclear to what extent service users and third parties are involved in reviewing health and safety and security policies and procedures.

C1.4 - Protection from Abuse

At the last review the service was awarded level C in this area. Since then staff have updated their POVA training and the subject has been discussed at house meetings. Information is also provided for service users through leaflets and on notice boards. The service has now been awarded level B in this objective.

C1.5 – Fair Access, Diversity and Inclusion

Policies and procedures relating to equality and diversity are comprehensive and regularly updated. Information is available in a range of accessible formats and the organisation has developed a document detailing ‘Good Practice Initiatives Used In Areas And Businesses Across The Places For People Group’. Again the service was assessed at level B in this objective as there was not enough evidence of the involvement of service users and third parties in reviewing equality and diversity policies or the allocations procedures.

C1.6 - Complaints

The complaints policy is clearly set out and made available in a number of languages and accessible formats. Service users are encouraged to voice their concerns and, when asked, said that they felt their complaints would be listened to. The service achieved level B in this objective.

8. Consultation with Stakeholders

Consultation with Service Users

Service users are happy with the standard of accommodation at Marlborough Lane and the service provided by support staff. Maintenance and repair items are resolved quickly and complaints are resolved efficiently, usually without the need to go through the written complaints procedure.

Service users understand their support plans and confirm that support workers attend joint meetings with social workers and CPNs. The amount of support provided varies according to need and service users can contact support workers at other times if required.

Service users confirmed that staff help with the process of looking for move-on accommodation and explore all possible options.

Consultation with Staff

The Accommodation Based Scheme Manager and two Tenancy Support Officers were interviewed as part of the review. Staff are Bristol based and provide support to a number of schemes across the region but Marlborough Lane is the only one in Bath and North East Somerset. The three staff interviewed have been in post between 4 months and 12 years.

Staff are happy with the in house training provided by Places for People and they are encouraged to take up further training opportunities where relevant.

Staff spoke enthusiastically about the support planning and risk and needs assessment procedures and felt that service users were generally positive about the process. Support plans are clearly linked to the assessment process and there is evidence of joint working with CPNs and social workers.

Staff were able to demonstrate a good understanding of all key policies and procedures including Health and Safety, Protection from Abuse and Diversity and Inclusion.

Although support staff work closely with outside agencies when supporting service users there is still little evidence of contact with local agencies that current service users are not engaged with. Some work has been done in this area since the last review and there is documented evidence of meetings with Second Step and the Salvation Army to try to improve joint working. The organisation is encouraged to continue to promote the service to the wider community and attend local groups and meetings relevant to their service type.

Consultation with other stakeholders

Telephone interviews were carried out with a member of the Active Community Team (ACT), 2 members of the CMHT team and a CPN from the Community Recovery Team. The service is highly thought of as it offers support combined with a good standard of accommodation. They believe that there is a high demand generally for the service, not necessarily for a BME designated scheme. The scheme was described by the ACT team as a “really good project” and they have made a number of referrals over the last year.

The Team Leader from the homeseekers team was able to confirm that Places for People have been proactive in seeking move on options for service users and suggested that they should now work more closely with the Housing Advice team to develop a system for referrals.

9. Evidence and Risk Assessment

The review of Marlborough Lane did not identify any serious health and safety or financial risks to the service. Since the last review the Places for People group has been accredited by the B&NES Supporting People team.

The management team and Places for People group demonstrated clear and accountable leadership. Policies and procedures are clearly written and kept up-to-date and there is a clear process in place for staff training.

10. Value for Money

Weekly Unit Cost	SW Benchmark Costs	Number of Units	Annual Contract Value
Lower	Upper
£74.31	£110.90	£166.33	6	£23,249.05

Cost per Support Hour	SW Benchmark Costs	Total Support Hours
Lower	Upper
£35.03	£18.89	£24.91	12.71

The weekly unit cost falls well below the benchmarks for the South West Region. At £35.03 the cost per support hour however is significantly above the upper limit for comparable services in the south west. This cost could be reduced by delivering further support hours, probably in the form of floating support to service users moving from the scheme into independent living.

11. Review Outcome / Recommendations and Impact

1. The service is working at, or above, level B in all 6 core QAF objectives. Policies and procedures are well written, regularly reviewed and there is a clear process in place for staff training.

2. Unit costs fall below regional benchmarks, but the cost per support hour is high when compared to similar services across the region. It is recommended that this cost be reduced by delivering further support hours.

3. There is some capacity within the service to deliver further support hours by providing floating support to tenants moving on from the scheme. It is recommended that detailed costings are provided within 28 days to show how this could be provided within the current contract value.

4. Staff have clearly worked hard since the last review to identify opportunities for suitable accommodation to enable existing service users to live independently. Having improved throughput rates the service now needs to identify potential referrers and promote the scheme to the wider BME community.

5. In order to evidence demand Places for People have now developed a waiting list for the scheme. At present however the only person on the list is not yet considered ready to move into the scheme. This situation should change as further work is done with potential referral agencies.

6. Places for People have expressed a desire to make the long term unit in the scheme into a chargeable service. As there is currently a review of the whole mental health sector taking place this issue should be looked at as part of that review.

7. Staff at the scheme have been proactive in contacting local agencies to promote the service. They should be encouraged to continue to develop links with local agencies and participate in relevant groups and meetings.

8. Places for People have indicated that they would like to reassess the BME categorisation of the scheme as there have been long term problems identifying clients from that service user group. Marlborough Lane is the only BME scheme in B&NES and it is recommended that Places for People carry out a consultation exercise to examine the demand for the BME service.

The review recommends that the contract be renewed at the current contract value:

Supporting People Annual Contract Value £23,249.05

Because of the proposal to re-commission services in the mental health sector it is recommended that this renewal be an extension to the interim contract by mutual agreement with Places for People.

This report is a public document and will be placed on the Bath and

North East Somerset website. Places for People must share the review recommendations and outcomes with service users and complete an action plan in 28 days.

Bath & North East Somerset Council