Supporting People Service Review

Service: Owls (Our Way of Living Scheme). Service Address: 2 Manor Park, Writhlington, Radstock, Bath. Service ID Number: 203. Service Provider: Bath & NE Somerset Council. Service Provider Address: Adult Care & Commissioning, P O Box 3343, Bath, BA1 2ZH. National ID Number: 10008670. Date: Commenced April 2004, Concluded December 2004. Review Officer: Simon Dicker on behalf of Bath & N E Somerset Supporting People Team. 

2. Introduction to Agency

The “Our Way of Living Scheme” provides medium to high level supported living placements for 23 people with learning difficulties in and around the Writhlington/Radstock area of NE Somerset.

The scheme has an office at 2 Manor Park, Writhlington, which is adjacent to several Registered Social Landlord properties, including some of the higher support clients. This enables tenants to use the office as an identifiable point of contact if needed, and helps the assistant manager’s co-ordinate the tenants support without using their accommodation for excessive administration.

The scheme is well placed to access the nearby Connexions Day Centre without reliance on institutional transport.

2.1 Brief History

The origins of the service appear to have come from the closure of hostels and historic B&NES registered care homes no longer fit for purpose during the late 1990’s.

The service was developed through existing funding supplemented by transitional housing benefit claims resulting in the current jointly funded service, and fits well with the Modernisation of Social Services agenda outlined in the DoH White Paper ‘Valuing People’.

The service went through a period of instability during 2003 when the original manager departed and an interim locum manager appointed. One consequence of this appears to have been an over reliance on high cost agency cover due to covering sickness or vacancies.

However this has been improved since the appointment of the current, permanent manager, who joined the service in 2004. Revised staffing structures have been implemented, and the service has also achieved registration with the Commission for Social Care Improvement to provide domiciliary care.

The review does not find this incompatible with Supporting People funding, but the service will need to clearly demarcate its income and activities for providing care, from the housing related support element of the joint revenue funding covered by this contract.

2.2 Capacity

Units:   23           

2.3 Monitoring Information

The monitoring of the service is outstanding for the periods shown above; this is being addressed by the service manager. It is a recommendation of the review that at assistant managers attend training in order to learn how to submit SP monitoring.

2.4 Existing Funding

** - Increase of £128,906 from Adult Care and Commissioning to maintain existing funding confirmed by Social and Housing Services Finance Dept.

4. Legal / ODPM Guidance on group and type of service

There has been no specific guidance from ODPM on services for People with Learning Difficulties. The review sought to engage funding partners in social services and ensure that any variations in contract value recommended would be agreed via replacement funding. This was felt to be essential to ensure uninterrupted service to the client group that would inevitably follow any reductions in overall revenue.

‘Valuing People’ – “A new strategy for Learning Disability in the 21st Century” (March 2001) is a Department Of Health White Paper that sets out an evaluation of the current position for this client group, and an agenda for “Better Life Chances for People with Learning Disabilities”, with further guidance on delivering change. The review assumed this as the most recent and informative paper steering future provision for this client group.

The programme of change initiated by this White Paper was backed up by regional Valuing People Support Teams, charged with overseeing and supporting the implementation of necessary changes to Learning Disability Service provision.

The influence of this paper with regard to Housing for People with Learning Difficulties is summarised below:

• It is 30 years since such a government paper has been produced which gives firm direction for services for the years ahead.
• The attitudes, the aims and principles that should guide services are formally stated: inclusion, being part of the mainstream, promoting independence, enforceable civil rights, challenging discrimination.
• Housing has an important place in the guidance for the first time: improving choice, having a say in where and how you live, involving and supporting carers. It provides a good platform for raising standards.
• Every local Board has been asked to produce and implement a housing strategy for learning disability. This offers an opportunity for a strategic approach with enormous potential for change for the better.
• There is a commitment required of housing and social care and health organizations to work together on service development and improvement

In addition the following paper from “Housing Options” is derived from the aims of the White Paper includes the following reference to Supporting People:

Supporting People

“Supporting People is a new policy and funding framework for support services that was implemented in April 2003. It brings together resources from several existing programmes into a new grant to local authorities, which can be applied more flexibly to fund support services for people with learning disabilities and for other vulnerable people wherever they live. Local social services and housing authorities, working with other partners including the NHS, will be expected to establish joint arrangements for deciding how to apply the new grant and to integrate the planning and commissioning of support services with the planning and commissioning of housing, care, and health services

In practice this has been very helpful in promoting supported housing options for services but has also proved one of the sources of difficulty for both departments trying to reconcile different agendas.”

Source:  housing options website factsheet 21

The process for agreeing the funding changes at a strategic level is ultimately through the Supporting People Commissioning Body, but was also discussed and agreed as reasonable and pragmatic at a consultation meeting with the Valuing People Support Team represented by Steve Strong in December 2004.

It is a recommendation from this review that Supporting People contribute to the development of the Learning Difficulty Strategy with regard to housing options of People with Learning Difficulties.

In this respect the review recommends that the future focus should be Joint Commissioning between Social Services and Supporting People, rather than any previously regarded “pooled budgets”, in order to address the complexities of satisfying the separate agendas of the two allied funding streams.

6. Consultation with Service Users

A day was spent visiting three households in receipt of support from OWLS, which enabled consultation with five service users, around 25% of the client group. Consultation was carried out on a 1-1 basis or collectively with all household members, as some preferred.

6.1 Consultation Findings

There were no complaints raised by any service users. Many indicated there pleasure at having a home they could identify as their own, and everyone appeared to accept their living arrangements, including people sharing households, as their best available option. One service user expressed their preferences would have been to continue living with their family, but this had not been possible. When talking about the support they received service users spoke positively about their current provision, although this was generally in contrast with their previous care rather than any current alternative.

One service user who was consulted was working with an independent advocate in regard of financial issues which is to be commended.

It was apparent that awareness of tenancies and support plans was quite low amongst users and levels of participation in these processes were variable, sometime low. The review did not find fault with the Provider about this, as this is often the situation for people with learning difficulties who have high support needs, but the review recommends opportunities for Person Centred Planning and the use of Support Plans as a tool for support workers and service users to use together, in planning how support is delivered to reflect the aspirations of the service user.Relationships between service users and neighbouring households were described as positive or supportive, and the clients consulted all lived within manageable range of amenities.

7. Evidence and Risk Assessment

The review noted that all tenants consulted with had copies of support plans, although awareness of these was low in some clients.

Staff interviewed demonstrated a well informed approach both to the communication and support needs of the client group.

The review found that the bulk of support planning was carried out by assistant managers rather than support workers. The review recommends that support workers assume this responsibility, and that assistant managers provide access to any necessary training and development by continuing to provide effective supervision.

There was no evidence from the review of particularly high risks to the service. The manager has revised the staffing structure from a Deputy Manager to four assistant managers, and created more part time posts to give greater flexibility. This is essential given the amount of coverage the service provides, and to some extent helps provide contingencies in the event of sickness. It was noted that the service tries to avoid the use of agency staff wherever possible, although it is unlikely that this will cease completely.

In delivering high levels of floating support to tenants, the service is always at risk of staff sickness at short notice, and the review recognised the efforts put into responding to these instances during review.

There are no associated risks with the model of service delivery; the DRAFT B&NES Learning Difficulty Strategy recognises the future demand for supported living schemes and although residential care may still be offered to some service users, it is unlikely the to be the first choice of provision.

8. Value for Money

Regional Comparators

Of 470 similar regional services, the unit cost falls near the lower quartile of £149.21 and well within the upper quartile of £428.44

National Comparators

Of 4432 similar national services, the unit cost falls near the lower quartile of

£167.77 and well below the upper quartile of £471.46

(Excluding any SP inflationary uplifts for 05/06)

**Costs are mean averages and are calculated as an indicator only, service levels are varied in accordance with individual need).

9. Review Outcome / Recommendations and Impact

1. The review found the funding split between Supporting People and B&NES Adult Care and Commissioning to be inequitable. A reduction in contribution from Supporting People to 35% of total service cost was introduced via interim agreement from the Commissioning Body from 1/10/04. It is recommended that a further reduction to 20% contribution from Supporting People of total service cost is commenced from 1/4/05. This represents the final reduction and is made with reference to the cost savings for Adult Care that ensued with transfer through transitional housing benefit, reducing to a level appropriate for Supporting People to make a long term contribution. It is recommended that overall revenue be maintained as the service to clients would be destabilised without this.

2. Assistant Managers are recommended to attend Supporting People training in monitoring and review to assist the Manager in completion of monitoring returns and compilation of evidence via self assessment.

3. The service will need to demonstrate how it will account for its domiciliary care activities without prejudice to its existing service, therefore showing income separately and staffing hours employed over and above the revenue described in this contract. Where clients are in receipt of more than one service, joint support plans should reflect these arrangements.

4. The service should resubmit a QAF self assessment by October 2005 for validation in order to achieve an improved quality rating, and embrace a culture of continuous improvement, and service user involvement. After this time the service along with all other Supporting People services will provide annual QAF self assessments.

5. Support workers must develop Support plans and review Support Plans with service users. Work must be done with service users to raise awareness as much as possible about their support package and their tenancy rights and responsibilities.

6. The provider must make service users aware of the contents of the report and feedback service review recommendations for their service.

10. Action Plan (completed by the Provider) to address points 1 – 6 above