Review of Care and Repair Projects

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APPENDIX SIX - REPORT ON STAKEHOLDER CONSULTATIONS

Introduction

The review of Care and Repair involved extensive consultation with stakeholders across Scotland - including email and telephone surveys and stakeholder events. This resulted in a vast body of views, experiences and opinions - all very varied and often conflicting. This chapter synthesises the key themes emerging from these discussions.

Strengths and Successes

Main Strengths

Care and Repair is seen as adhering to strong core values. Essentially, stakeholders believe it is a person centred, trusted, approachable and flexible service that works to meet the needs of its service users. Care and Repair was perceived as independent, confidential and non-judgemental. It is responsive to client needs on an individual basis, meaning that it is able to signpost to other suitable services, and fills the gaps where other services do not exist. It takes a holistic approach to meeting client needs, and is a service that listens to the needs of its customers.

"They tend to take a very holistic approach when seeing people we have referred and are willing to resolve often difficult issues."

(Partner - Local Authority Community Development Worker)

Care and Repair projects were seen as bringing a key source of expertise and specialist knowledge, with skilled, committed and motivated staff. Many Care and Repair projects felt that their organisational model was a strength - either because they had good relationships with managing agents, or were stand alone organisations.

Stakeholders felt that Care and Repair had high levels of customer satisfaction, and had a good reputation among partner organisations. Many mentioned that Care and Repair projects had good links to other services, and were good at partnership working. Finally Care and Repair was seen as bringing a big positive impact with relatively small levels of investment.

Successes and Key Achievements

We asked Care and Repair managers what they saw as the biggest achievements of their Care and Repair service over the past five years. Many pointed to the fact that their service was simply still in operation.

"The establishment (of Care and Repair), keeping it going and improving it is an achievement in itself."

(Care and Repair Manager)

Others mentioned that they had succeeded in introducing new activities, particularly small repairs and handyperson services. Often these had been piloted, and then mainstreamed into core activity. Others pointed to achievements including:

  • maintaining high customer satisfaction levels;
  • increasing activity levels - such as number of repairs;
  • expanding to cover a larger area; and
  • securing funding and support for clients.

"Securing a lot of charitable funding for individuals - one person got £26,000."

(Care and Repair Manager)

We also asked Care and Repair managers for any examples of particularly successful or innovative approaches to their work. Examples included:

  • New organisational or constitutional structures - some projects highlighted that they had or planned to set up a charitable trust or social enterprise. Another mentioned that being a stand-alone organisation was integral to its success.

"It allowed expansion, gives more flexibility and means we are more responsive to our clients."

(Care and Repair Manager)

  • New activities - many pointed to activities such as installing Telecare, minor adaptations, house MOTs, or providing financial advice.
  • New client groups - some projects mentioned that they had introduced activities for other vulnerable groups, such as people experiencing domestic abuse or with drug or alcohol dependencies.
  • Introducing efficiencies - two projects mentioned that they had worked to streamline or fast-track the grants application process.

Practice profiles, setting out interesting approaches adopted by eight Care and Repair projects across Scotland, are set out in Appendix Four.

Challenges

We asked all stakeholders for their views on the challenges - past, present and future - faced by Care and Repair.

Generally stakeholders felt that the profile of Care and Repair projects across the country worked well. But discussion with stakeholders identified that there was some interest in rationalising service provision across the country. For example, representatives from two local authorities mentioned that there may be potential either to combine Care and Repair projects within the one local authority area, or to create larger Care and Repair projects covering two or more local authority areas. It was suggested that this could create economies of scale, and could simplify service delivery for customers.

Funding

The issue most commonly raised by stakeholders - in the surveys and events - was that of funding. The level of revenue funding provided to Care and Repair projects to meet their operational costs was generally seen as reasonable. But some did mention that funding had been decreasing over recent years. Only one service indicated that it was offered more funding than it was able to spend, and had turned down funding from one source this year. Some said that although their operating costs increased each year, their funding levels had remained static for some time. This was causing pressures on resources and in some cases had resulted in reduced service delivery.

Although some did feel that they needed more resources to provide their services, the main challenges related to the annual nature of funding decisions. This impacted on service planning - and decisions were often made late and with no provision for carry over from the previous year. Even once decisions had been made, the funding often didn't come through to the Care and Repair service until after the beginning of the financial year. In this case, services with managing agents often had to ask them to provide cashflow support. But this was not the case across all services. Some found that their funding levels were easily negotiated, at an appropriate time of year, and that funding came through on time each year.

"Last year was difficult - the delay in funding being confirmed impacted on the service delivery."

(Care and Repair Manager)

"The annual funding round hampers long term strategic planning and development of the service."

(Care and Repair Managing Agent)

"This is amplified by the uncertainty of equipment and adaptations and repairs grant funding streams which are also annual."

(Care and Repair Managing Agent)

Most Care and Repair projects were unsure how decisions about funding were taken, and why their funding had increased or decreased over the years. There was a feeling that funding for Care and Repair - and adaptation and repair grants - had operated on a "boom and bust" basis over the past few years. This caused challenges for Care and Repair projects in managing client expectations, as the context could change very rapidly.

This problem was exacerbated because for many, there is a major reliance on the local authority as the main or only funding source. Many Care and Repair projects recognised that this was risky, but had experienced problems encouraging others to fund their activities.

"It is difficult getting other professionals to recognise the role of Care and Repair - the NHS in particular."

(Care and Repair Manager)

"My feeling is that housing takes the burden of the funding, whereas there are positive contributions to the NHS and social work but they are not obliged to provide any funding."

(Care and Repair Managing Agent)

All of this combined to result in a strong feeling of impermanence among Care and Repair projects. Many stakeholders felt that the decision to remove ring fencing of Private Sector Housing Grant in 2010/11 would have a negative impact on an already challenging funding context for Care and Repair. This concern was shared by Care and Repair managers, board members, managing agents and local authority sponsors. Many felt that Care and Repair was unlikely to be a priority for local authorities, in the context of difficult funding decisions about services across the whole Council. It was suggested that Care and Repair was not a high profile or political issue, like education or health provision. Many were also worried that in the environment of Council cut backs, Care and Repair may simply not be a priority.

"The removal of ring fencing from PSHG in 2010 will put real pressures on Council's ability to continue funding at the current level while trying to maintain the level of service."

(Local Authority Sponsor)

Others mentioned that in this context, it was likely that Care and Repair projects would become more varied and inconsistent across the country.

Future Planning

The issues relating to funding meant that many felt that future planning was a major challenge for Care and Repair. The organisations operated in an environment of uncertainty, and so only felt able to adopt a short term approach to planning. This had an impact on their ability to plan strategically, or aim to expand and introduce new services. Furthermore, it impacted on staff morale and job security and made it difficult to retain high quality staff.

There was a very clear view that three to five year funding would help substantially to create a more secure and sustainable model for Care and Repair projects across the country.

"Three year funding should be made available as we have more than proved our worth and the benefits of our services."

(Care and Repair Board Member)

Service Level Agreements and Tendering

Some local authorities had already begun to negotiate longer term agreements with Care and Repair projects. Our survey found that approximately one third of Care and Repair projects had Service Level Agreements in place with their funders. But often these did not specify outcomes or refer to funding arrangements.

A minority of local authorities had begun tendering for delivery of Care and Repair projects, and where this had occurred contractual agreements were in place. Many acknowledged that this could result in more stability for Care and Repair projects, and would offer more clarity over what was being funded. But there were also major concerns about tendering. Some simply did not feel it was appropriate to ask Care and Repair projects to tender to undertake activities, and were concerned that other organisations may win the tender process. Others were worried that a clear contract between the local authority and Care and Repair may result in the service becoming too output focused. And some wondered whether some managing agents may not want to put in the time and effort to tender to provide Care and Repair projects.

"The recent announcement that projects will require to be tendered will require detailed investigation from the Association's perspective as a managing agent."

(Care and Repair Managing Agent)

New Culture of Responsibility for Home Maintenance

Stakeholders also mentioned the potential challenges that could arise as a result of the introduction of the Housing (Scotland) Act 2006, placing responsibility for home maintenance clearly with owners. There were two main reasons that people felt that this new approach would be challenging.

Firstly, many stakeholders were very confused about how the new approach - particularly the Scheme of Assistance - was to be implemented. Care and Repair projects were generally not involved in strategic discussions about the Scheme of Assistance, and were worried that they may not be included in the resulting framework.

"There is uncertainty about the way ahead."

(Care and Repair Manager)

"The main challenge at the moment is dealing with the lack of information around the shape of the local authority Scheme of Assistance."

(Care and Repair Managing Agent)

Care and Repair projects were therefore very unsure about what their role would be in delivering the Scheme of Assistance. But they had varying views about the role that they should play. For example, one service highlighted that it had some concerns about expanding its client group due to the potential impact on its charitable status. On the other hand, some were worried that the role of Care and Repair could be diluted, as other organisations may take responsibility for service delivery.

Some stakeholders also mentioned that they felt that the changes were happening in an uncoordinated way. Some felt that it would have been useful to have completed the review of Care and Repair earlier, so that it was clear how it was expected to fit with the Scheme of Assistance.

The second key challenge faced with the changing context was simply persuading owners to take responsibility for maintaining their homes. Many mentioned that they were unsure of how this approach would work, particularly in the current economic climate. There was a feeling that people would be less likely to want to fund repairs and take out loans in this environment, and would also have some difficulties accessing credit. Some mentioned that older people in particular are less happy with being indebted, and may just choose to live in unsatisfactory conditions.

"There are concerns that Care and Repair projects may not be able to deliver the same levels of success under the Scheme of Assistance due to people's unwillingness to take out loans and that this may recreate the poor housing conditions of the past."

(Local Authority Sponsor)

Governance of Care and Repair projects

A number of challenges relating to the way in which their Care and Repair service was set up organisationally, managed and governed were raised. Over two-thirds (67%) felt that the arrangements for managing and governing the service could be improved.

Some of the services with managing agents saw both advantages and disadvantages of this approach. Many were very happy with their current structure, but a minority wished to change these arrangements.

Table A6.1: Advantages and Disadvantages of Managing Agent Model

Identified Advantages

Identified Disadvantages

Line management and strategic support

Strategic direction influenced by others

Contributing funding

Curtailing expansion

Sharing of overheads

Overheads and management fee

Cashflow when funding is late

Staff time dedicated to wider activities

Office facilities and functions - IT, finance, technical support, human resources

Conflicting business decisions

Wider policies and procedures

No legal status

Security at set up stage

Lacking in flexibility

Tap into strategic relationships - e.g. with the local authority

Potential lack of transparency in funding routes through agents

Economies of scale

Ten services (currently with managing agents) felt that they would like to move towards setting Care and Repair up as a separate organisation, with its own legal entity and clear governance arrangements. Eight of these felt that now was the time to do this. One said that this was something to consider further down the line. Another would be happy either with strengthened and improved managing agent arrangements, or becoming a stand-alone organisation. Some of those who would like to move towards setting up a stand-alone organisation mentioned that one option may be to become a subsidiary of their existing managing agent - in line with the Lochaber model. (For a profile of Lochaber's approach see Appendix Four).

Many of the services stressed that there was no animosity; it was simply that they felt they had reached the stage that they could be sustainable as an independent organisation. A minority were less happy with current arrangements, believing that there was a more immediate need for change.

"Care and Repair could have expanded and developed much more if the managing agent had allowed it."

(Care and Repair Manager)

"Ninety per cent of the time the arrangements with the managing agent work. Ten per cent there are difficulties and business clashes."

(Care and Repair Manager)

Some Care and Repair projects also mentioned that they felt that their Advisory or Steering Group should be strengthened, to provide more support and strategic direction.

"Support from partners has varied - the steering group used to meet regularly, but has reduced in number significantly."

(Care and Repair Manager)

"The steering group has disbanded and this has left a gap. It was largely due to a lack of attendance."

(Care and Repair Manager)

A small number of Care and Repair managers mentioned that it could be challenging to drive the strategic direction of the service themselves, at the same time as dealing with the day to day demands. And one stand alone Care and Repair service highlighted that it could be isolating without the support of others, and that a strong board was vital.

"The current arrangements work okay and staff have a great deal of autonomy. However a little more support would be helpful at times."

(Care and Repair Manager)

Another service echoed the importance of a strong board in stand alone organisations:

"Much depends on the attitude and quality of the Board members - this service has good ones."

(Care and Repair Manager)

Co-ordinating Service Provision

Challenges in co-ordinating service provision at a local and national level were also identified. Stakeholders felt that there were inconsistencies in the way in which Care and Repair projects had grown across the country. Services were keen to learn more from one another and share good practice. But they were concerned that local authority responsibility for designing the Scheme of Assistance would result in Care and Repair projects developing in very different ways in the future.

Stakeholders had very varied views about how to balance national consistency with local flexibility. Some suggested moving towards more commonality and consistency in services offered, but everyone recognised the need to have local flexibility too.

Some questioned whether it represented value for money to have 37 separate Care and Repair projects in Scotland. There were some suggestions that it may be useful to look at combining services - either within or across local authority areas.

Profile

Consultees also identified challenges in relation to the profile of Care and Repair. This was both in relation to customers and other organisations.

  • Customers - There were challenges in raising awareness of the services, without creating demand which could not be met. Many services are not advertising their activities. This may mean that they are missing the most vulnerable clients. Although there is high satisfaction among current clients, some were concerned that they were not prioritising and targeting effectively to make sure they are working with those most in need.

"Our client base is expanding. The service needs to further prioritise, to find different means of providing assistance and to develop to meet the needs of our clients."

(Care and Repair Board Member)

  • Organisations - Some Care and Repair projects have found it hard to make sure that other organisations - including local authorities, elected members, and key partners like the NHS - understand the benefits of their activities. It was felt that there was a lack of local political and professional support in some areas.

"We often dig Social Work out of their own problems. This should be recognised more."

(Care and Repair Manager)

"Recognition depends on individuals. We constantly need to build new relationships if people leave."

(Care and Repair Manager)

Demonstrating outcomes

Care and Repair projects - and other stakeholders - also felt that it was very difficult to demonstrate the impact of their activity. The environment is changing quickly, and services are having to consider how they link to the Single Outcome Agreement, the Scheme of Assistance, and other policies and strategies.

Many felt that the current national indicators for Care and Repair are not clear and meaningful, and don't allow comparison between services. The absence of any audit process, peer assessment or benchmarking was also seen as a weakness.

"I am quite concerned about how Care and Repair projects are monitored at a national level. The indicators don't go far enough, and they are sometimes inappropriately used."

(Care and Repair Manager)

National Support

Those responding to the survey and attending the events raised issues about the way in which Care and Repair projects are supported at a national level. There was a feeling that the way in which the Care and Repair Forum operated could be improved, to better support Care and Repair projects in addressing the above challenges. The main issues identified were:

  • membership structure - many felt that the individual membership model was inappropriate;
  • inclusiveness - there should be national support for all stakeholders - including managing agents, boards and advisory groups;
  • resources - the Forum simply doesn't have the capacity to address these challenges due to staffing levels; and
  • strategic links - Care and Repair projects need support linking to and influencing the Scottish Government in a constructive, positive and mutually supportive way.

"We could get more support from the Care and Repair Forum. The structure and function of the Forum should be reviewed. Each Care and Repair project should be a member and there should be more support with training and publicity."

(Care and Repair Manager)

Current Contribution to Local and National Priorities

Contribution to National Priorities

Stakeholders were asked for their views on how the activities of their service contribute to national Scottish Government priorities. Most felt that Care and Repair directly contributed to national priorities, including:

  • improving health;
  • supporting independence;
  • building safe and strong communities;
  • promoting empowerment and inclusion;
  • improving housing quality and encouraging owners to take responsibility;
  • improving community safety; and
  • building skills and employment opportunities.

"(Care and Repair) ticks all the boxes in terms of health and social care."

(Care and Repair Manager)

This resulted in outcomes for individuals, who were:

  • safer - for example through reducing risks and hazards, preventing falls, and making people more secure in their homes;
  • healthier - they are warmer, less stressed and have a reduced risk of injury;
  • more independent - they are able to stay in their own homes for longer, and are more settled, reassured, more confident and have more dignity;
  • wealthier - they receive value for money from a trusted brand, and have greater access to benefits and more energy efficient homes; and
  • in their own communities - they are able to stay at home close to family and friends. This was seen as particularly important in island and rural communities, where people may otherwise have to leave to access support.

Housing related investment was seen as leading to a consequential benefit in health, independence and improving the quality of life for customers. Few pointed to improving housing quality as an outcome in itself.

"Our customers are full of praise for this service. It makes them feel safe, independent and confident that they are being provided with a reliable, safe service."

(Partner - Pensions Service)

"It enables service users and their carers to be more independent and safer and contributes to their wellbeing. Frequently without the Project, service users would no longer be able to remain in their homes."

(Partner - Local Authority Occupational Therapist)

"To summarise, Care and Repair's intervention can result in the client being safer, healthier (less stress, less damp, less cold) and better off - they make a difference!"

(Partner - National Charitable Organisation)

A small number of stakeholders also mentioned the impact that Care and Repair can have on families and carers.

"The service supports and makes life easier for local carers."

(Care and Repair Manager)

A minority of managers mentioned that they did not feel that Care and Repair had a role in contributing to national outcomes, or did not know how their activities linked to national priorities.

"We don't really try to link with either national or local priorities. We just respond to requests from owners and do what is needed."

(Care and Repair Manager)

Others felt that through linking to local priorities - particularly through the priorities set out in the Single Outcome Agreement - this would ensure that there were clear linkages from Care and Repair's activity through to national priorities. These varied views demonstrate the different approaches of Care and Repair projects across the country, which are all at very different stages of development.

Contribution to Local Priorities

Care and Repair managers strongly believe that their services contribute directly to a substantial number of local priorities, and impact directly on other organisations operating in the health, housing and community care field.

"The Council, NHS and Community Planning Partnership all look to Care and Repair for solutions to supporting older and disabled people locally."

(Care and Repair Manager)

Care and Repair managers highlighted a number of key areas:

  • preventing hospital admissions, bed blocking and delayed discharge;
  • reducing pressure on care homes, supported housing and social housing;
  • improving the quality of private sector housing;
  • reducing local crime and contributing to community safety; and
  • reducing fires and improving home safety.

Overall, managers strongly felt that Care and Repair saves other organisations time and resources - particularly social and health care services.

"The service takes the pressure and problems away from other services."

(Care and Repair Manager)

Again, the impact on health and social care was mentioned more often than the impact on the housing stock, although this did remain an important factor for some.

"It helps to provide them with a warmer, safer, habitable environment that is better placed to cope with the external elements. It also helps to keep our housing stock in a better state of repair which can only be a good thing for future generations."

(Partner - Local Authority Building Standards)

Local authorities and other organisations working in partnership with Care and Repair were also asked for their views on how Care and Repair impacted on their work and contributed to their priorities. Local authority funders felt that Care and Repair contributed to a number of objectives, closely linked to those identified by Care and Repair managers. These included:

  • promoting independent living;
  • maintaining private sector housing stock; and
  • reducing hospital admissions and contributing to health and social care objectives.

Many other partner organisations mentioned that Care and Repair was effective at reducing the time that local authority Occupational Therapists spend on dealing with adaptations. (Note: The following quotes come from different survey responses.)

"(The main impact on our work is) reducing time to support clients through the process for the Occupational Therapists."

(Partner, Local Authority Occupational Therapist)

"Since Care and Repair have been around, they take care of much of the time consuming work involved around producing plans and obtaining funding and quotes."

(Partner, Local Authority Occupational Therapist)

A minority of partners mentioned the wider impact in terms of keeping people in their own homes and reducing the need for affordable social and supported housing.

"Were the service not in place, individuals would be vulnerable and in some cases would require re-housing. This is problematic as there is a general shortage of social and affordable housing in this island community."

(Partner, Local Authority Occupational Therapist)

"Helping people to stay in their own home is very important due to limited and decreasing numbers of care home spaces locally."

(Care and Repair Manager)

Partners also mentioned that they had high levels of trust in Care and Repair, which meant that they felt confident that they could ask Care and Repair projects to deal with these important issues.

"It is a reassuring dependable service we work closely with."

(Partner - Police Service)

Argyll and Bute Care and Repair: Evaluating the Impact on Health

Argyll and Bute Care and Repair commissioned consultants to review the wider health and community care benefits of their work. The aim was to provide evidence about the impact their activities had on the health and community care network in the area.

This research found that Argyll and Bute Care and Repair could result in savings to the NHS and other public agencies through reducing falls and accidents in the home; providing opportunities for people to live safely (and warmly) at home longer; and reducing delayed hospital discharge. In talking to people who had received support from Care and Repair, the research identified that they were less anxious, felt more independent, felt less likely to have an accident in the home and felt warmer as a result of the initiative. The report estimated that the NHS and other public services 'saved' at least £600,000 each year as a result of the Care and Repair scheme - which cost public agencies a little over £200,000 a year 21.

There was some feeling - particularly from Care and Repair Managers - that Care and Repair often does what others want done, rather than being involved in strategic decisions about service delivery across the local area.

"We deliver what is needed. We were approached to deliver Telecare, so did this."

(Care and Repair Manager)

"The service helps address important issues - like bed blocking in the NHS. But it is very reactive - responding to the needs and demands placed on it."

(Care and Repair Manager)

This did differ substantially across different Care and Repair projects, with some very connected to the strategic decisions that took place locally.

It is worth noting that although most partners, including local authorities, were very positive about the contribution that Care and Repair makes to local priorities, one local authority sponsor felt that the service it funded did not offer value for money.

"Generally we feel that the existing Care and Repair service does not represent value for money, and we do not feel that we get the level of outputs which we would expect from the level of investment in the service. This service would benefit from a review of service delivery, which would include varying levels of support depending on client needs, a review of management arrangements and location of service, and a review of client needs versus services delivered."

(Local Authority Sponsor)

Evidence of Contribution to Local and National Priorities

Almost everyone agreed that it was very difficult to provide clear evidence of the impact of Care and Repair. Care and Repair managers consistently felt that a key challenge was getting partners to recognise the contribution that they make. And although many partners are happy to say that Care and Repair makes a difference, they are less happy to commit resources to the service.

"We prevent hospital admissions, but this is not recognised by the NHS."

(Care and Repair Manager)

The survey of Care and Repair managers asked whether services gathered any evidence or information about the impact of their activities.

  • 40% of Care and Repair projects had assessed local needs, or the need for their service.
  • 87% had assessed customer satisfaction.
  • 36% had assessed the input or outcomes from their service.

Fourteen Care and Repair projects provided copies of this information - contained in business plans, progress reports, evaluations and customer satisfaction reports. Much of the information provided related to monitoring the process of Care and Repair delivery - the number of grants processed, the time people had to wait and so on. There was very little information about the impact of services. Examples of interesting findings from assessing impact are outlined below.

Edinburgh Home From Hospital Project

In Edinburgh, Care and Repair gathered clear evidence from the Royal Victoria Hospital that their initiative to install keysafes was making a real difference:

"Recent changes regarding keysafes at Care and Repair have made a huge difference to the speed at which keysafes can be supplied and fitted. This is particularly important where a keysafe is essential to enable a discharge to go ahead."

Renfrewshire Customer Survey

Care and Repair Renfrewshire included questions about impact in its customer satisfaction survey. It found that:

  • 33% of customers would not have gone ahead with the work if they hadn't received assistance from Care and Repair
  • 10% of customers would have had to move home if the work was not carried out
  • 83% of customers thought that the completed work made a substantial difference to their comfort.

Angus Doorstoppers Programme

Angus Care and Repair evaluates its 'Doorstoppers' programme on a regular basis. This aims to tackle uninvited callers and make people feel safer in their own homes. Recently, 62 people were surveyed to assess the impact of the service. This found that the service resulted in a:

  • 17% reduction in fear of crime
  • 36% reduction in fear of opening door
  • 54% increase in feeling of support in own home

For more information about how Angus Care and Repair assessed impact see Appendix Four - Practice Profiles.

Care and Repair managers felt that generally they were able to demonstrate the importance of their service through excellent case studies, testimonials and satisfaction surveys.

"I can't emphasise enough how popular the service is, especially the small repair."

(Care and Repair Manager)

"The satisfaction survey shows 99 per cent satisfaction."

(Care and Repair Manager)

But there tended to be a focus on exploring customer satisfaction, rather than assessing the impact or difference that Care and Repair made. Some Care and Repair projects found it difficult to distinguish between satisfaction and impact. Many mentioned that as Care and Repair contributes to such a wide range of potential outcomes, it is difficult to accurately assess the difference it is making.

Views on the Future - The Role of Care and Repair

What Activities Should Care and Repair Undertake?

Within the broad roles for Care and Repair, stakeholders also had a vast range of views on the activities that should or could be undertaken. Consultation at the stakeholder events generated significant discussion about the types of activities that Care and Repair should undertake. Some participants felt that Care and Repair should continue to increase the range of activities undertaken, for example expanding into maintenance planning, proactive home visits, welfare rights, assistive technology, energy advice, and so on - as many services are already doing. Other options mentioned were to employ Occupational Therapists to streamline the adaptations process or undertake medium sized repairs (as well as small repairs).

"A greater combination of advice on building, grants or funding. Heating, insulation and energy efficiency could all come under one roof and would be of considerable benefit to the client."

(Care and Repair Managing Agent)

In one discussion group at one of the events, some stakeholders felt that Care and Repair should expand to provide any service that supports older and disabled people to be independent in their own homes - so all types of home support and even care. But there were very strong views against this, with many insisting Care and Repair should keep its focus and signpost to other appropriate services.

Many cautioned that Care and Repair should be careful about its identity, and should not drift too far from what it is already good at. Stakeholders also felt that any service expansion needs to be strongly based on local context and need - as there may be organisations already providing some of these services locally.

Some consultees stressed that any expansion into new areas needs to be undertaken with a clear understanding of the skills that staff have currently, and what new skills would need to be developed.

"The new Scheme of Assistance may need appropriate Care and Repair officers to have appropriate financial training and qualifications to maintain the level of service that they currently provide."

(Local Authority Sponsor)

The Concept of Core Activities

As many people had very varied views about what Care and Repair should be doing, many stakeholders felt that the concept of core Care and Repair activities would be useful. It was suggested that core activities could be defined at a national level, setting out the basic or central activities that every Care and Repair service undertakes.

Stakeholders felt that this could be linked to updated standards for service delivery. Many felt that assuring the quality of service provision was essential, particularly if Care and Repair projects will require to tender to provide services in the future. Options such as quality assurance frameworks, peer review, audit and accreditation were all suggested.

"There should be a nationally recognised accreditation scheme and professional qualification for all Care and Repair staff and Care and Repair Projects."

(Local Authority Sponsor)

Linked to this, some suggested that it would also be useful to have the same charging structure across the country. At the moment there are lots of different approaches - for example some services are completely free, some charge for materials only and others ask for donations.

Stakeholders felt that this framework could allow for a degree of consistency across Scotland, but with opportunities for local flexibility as required.

"Having Care and Repair projects that are so diverse is a great strength - it allows them to be locally responsive. But it can be a weakness as well. It does not allow a national identity to develop, which could raise awareness of the service. Continuity at a national level would be a great benefit - some core services could be consistently provided."

(Care and Repair Manager)

What Client Group Should Care and Repair Work With?

Traditionally, Care and Repair has focused its activities on older and disabled people who own their homes. Stakeholders had varied views on whether Care and Repair should retain this focus, or expand the client group it works with.

Some consultees felt that there could be benefits in expanding to assist more vulnerable people outwith the current client group. Some Care and Repair projects emphasised that they were already doing this, through working with victims of domestic abuse, and vulnerable families. A minority felt that Care and Repair could expand to work with all home owners.

"Advice and assistance to all home owners regardless of age or disability."

(Care and Repair Board Member)

Others felt that there were opportunities to expand the housing tenure covered. Many Care and Repair projects felt that they could usefully provide services to people in social rented accommodation - provided they did not infringe on landlord responsibilities.

"We could work with housing associations in assisting older and disabled tenants with small repairs which are not the responsibility of the landlord."

(Care and Repair Managing Agent)

Others felt that Care and Repair should retain its focus of working with older and disabled people. This was partly due to ethos - some felt that expanding the client group may dilute Care and Repair's focus and approach.

"We wouldn't want to lose the ability to do that extra bit for clients."

(Care and Repair Manager)

And it was partly due to concerns about ability to meet demand. Many mentioned that even now, Care and Repair can't provide services to all older and disabled people who need the service. Some pointed to the changing demographics in Scotland, meaning that the older and disabled population - and the Care and Repair client group - is increasing naturally.

"The elderly population is increasing, and this means that the workload for Care and Repair is increasing."

(Care and Repair Manager)

Much of the discussion at the stakeholder events focused around how to prioritise and target the people most in need of Care and Repair projects. It was recognised that age limits were not always a good way of assessing vulnerability, and other criteria may be needed.

There was also some discussion around whether Care and Repair could expand its client group through offering chargeable services. Some Care and Repair projects have already begun to think about this - for example in Lomond and Clyde (see Appendix Four - Practice Profiles). This would provide an opportunity to assist more people, but also potentially to generate income which could be reinvested in providing services to vulnerable clients.

How Could Care and Repair Contribute to the Scheme of Assistance?

Care and Repair managers were asked what role Care and Repair should play in the future.

Table A6.2: The Future Role of Care and Repair

Could Care and Repair play a bigger role in...

Yes

No

Don't Know

No.

%

No.

%

No.

%

Supporting owners to take responsibility

35

95%

2

5%

-

Delivering Scheme of Assistance

34

92%

1

2%

2

5%

Advice on housing options

32

86%

4

11%

1

2%

Supporting disabled people to make adaptations

31

84%

5

14%

1

2%

Supporting private landlords/ tenants to maintain property

31

84%

5

14%

1

2%

Providing housing support services

27

73%

8

22%

2

5%

Generally, managers felt that Care and Repair could play a role in most of these activities. Many felt that services were very well positioned to assist with supporting owners to take responsibility, for example through maintenance plans, home health checks and trusted trader schemes. Managers mentioned that Care and Repair does already have skills and experience of supporting people to undertake repair, maintenance or adaptation work when there is a shortfall of grant funding. This will be important with the reduced levels of grant funding available in the future.

"Care and Repair is best placed to expand considerably to take on many of these roles."

(Care and Repair Manager)

Some Care and Repair managers were confident that they could be the lead organisation in delivering the Scheme of Assistance.

"Care and Repair could come into its own in delivering the Scheme of Assistance. We already work to support clients where funding is lacking, and have pioneered 'problem solving' approaches to organising help."

(Care and Repair Manager)

But most felt that they should play a considerable role, but continue to focus strongly on repairs, maintenance and adaptations for older and disabled (or at least vulnerable) people. They felt they could play a key role in linking and signposting, but didn't want to dilute the focus of Care and Repair. Others cautioned that any expansion of Care and Repair had to be coupled with the resources to support this. Some were much less happy and confident about taking on this type of role.

"I don't think that we could or should provide advice on loans."

(Care and Repair Manager)

Many felt that the Scheme of Assistance was both a threat and an opportunity for Care and Repair. If Care and Repair projects are included in these Schemes, it will help services to position themselves and establish a clear role. But there is always the danger that other organisations, possibly local authorities themselves, will take on responsibility for providing these services.

Continuing to support disabled people to make adaptations was also seen as a key activity, given the grant funding which will continue to be available in this area. Many Care and Repair projects felt that they already did a lot in this area, and couldn't enhance their activities further. But some felt that there were some changes that could be made to make the process of obtaining adaptations more efficient. For example, some Care and Repair projects were interested in building on practice elsewhere through exploring the potential for Occupational Therapists (or Assistants) to be based in Care and Repair, allowing quicker assessment of need.

There were mixed views about whether Care and Repair could play more of a role in supporting repairs, maintenance and adaptations in private rented properties. And most managers were less keen on the concept of Care and Repair expanding into wider housing support and personal care services.

Overall, Care and Repair projects said that they were open to what they were required to do. Many were relatively passive, and not really involved in strategic discussions about the role that they could play locally. Some were much more strategic, and actively involved in discussions about - for example - the Scheme of Assistance.

Board members, managing agents, local authority sponsors and partner organisations were also asked about the future role of Care and Repair. Although board members and managing agents had very similar views to those of Care and Repair managers, local authority sponsors had slightly different opinions. Although they felt that Care and Repair could play a role in supporting owners to maintain their homes, only 70 per cent felt that they had a role in the Scheme of Assistance.

"Care and Repair currently do not have sufficient resources to deal with existing service demand, and we feel they would be better concentrating their resources on tackling their current demands rather than expanding into other areas."

(Local Authority Sponsor)

Views on the Future - Funding and Delivering Care and Repair

How Should Care and Repair Activity Be Funded?

To date, Care and Repair funding has generally been annual and resulted in a feeling of impermanence. The strongest and most consistent message emerging from this review was the need for sustainable funding for Care and Repair, to allow for effective business planning over a three to five year cycle.

"Care and Repair should be put on a solid basis, with regular funding."

(Care and Repair Manager)

Although there was agreement about this aim, there were different views about how it should be done. Some Care and Repair managers strongly felt that there should be direct national funding from the Scottish Government to Care and Repair projects. Some suggested that it may be appropriate for the Scottish Government to fund core services, that it expects to see in every area. Local authorities (and other potential funders) could then negotiate with Care and Repair to establish any additional services required.

Others felt that the route for funding Care and Repair should stay with local authorities. Some suggested that the Scottish Government should delay (or reverse) the decision to abolish ring fencing of the Private Sector Housing Grant. There were concerns that Care and Repair would be a low priority in the resulting decisions that local authorities have to make about their budgets. Others suggested that local authorities should put in place 'effective ring fencing', so that there remained a clear budget for funding Care and Repair, and grants for repairs and adaptations.

Almost all stakeholders agreed that Care and Repair projects could get much better at demonstrating their impact to funders.

How Should Care and Repair Activity Be Delivered?

Currently, Care and Repair projects are delivered locally in different ways. Some arrangements are working very well, others have organisational difficulties. There are some Care and Repair projects which strongly believe that having a stand alone structure is highly beneficial. And some are unhappy with their current model, and wish to move to a stand alone structure. But many of the services with managing agents are content with this arrangement, and keen to continue in this way.

Partners and local authority sponsors did not have any strong views on the issue of how Care and Repair projects were structured. Some expressed surprise that some Care and Repair projects wanted to become stand alone organisations, given the potential benefits and security from a managing agent. One local authority sponsor felt that the current Care and Repair model in their area (a stand alone organisation) was inefficient.

A number of stakeholders pointed to the need for clear governance arrangements, and the value of Advisory or Steering Groups in bringing together key partners to help to drive the strategic direction of Care and Repair.

Views on the Future - Co-ordinating and Supporting Care and Repair

How Should Care and Repair Activity Be Co-ordinated Locally?

Most Care and Repair projects are operating on an annual basis and, as such, many don't have much capacity to engage in strategic discussions about services across the local authority area. But many were keen to strengthen their relationships with key organisations - particularly ensuring linkages to Community Planning Single Outcome Agreements, local authority strategies (including the Scheme of Assistance) and NHS priorities.

Stakeholders were also keen for Care and Repair to build relationships with similar services in the area, and focus on complimenting activities. Although many Care and Repair projects do have strong links to other similar services, some do not. The scoping exercise undertaken as part of this review demonstrated that most Care and Repair projects are not fully aware of the range of similar services operating in their area.

"There are, no doubt, areas where we could provide the same work offered by Care and Repair but, in our view, this is not a competition. It is about providing a service to this community and ensuring that the services on offer can reach all who are in need of it."

(Care and Repair Type Service)

How Should Care and Repair Activity Be Co-ordinated Nationally?

Stakeholders felt that in the future there were opportunities for strengthened support and co-ordination for Care and Repair projects at a national level. Stakeholders would like to see:

  • improved national monitoring of the impact of Care and Repair;
  • strengthened strategic linkages and policy influence;
  • more sharing of good practice;
  • support for piloting new approaches; and
  • publicity and awareness raising activity.

How Could the Scottish Government Support Care and Repair?

It was felt that the Scottish Government had a key role in supporting the development and sustenance of Care and Repair. Stakeholders would like to see:

  • A high level policy statement to acknowledge and guide role and contribution of Care and Repair
  • Care and Repair projects made mandatory for every local authority area
  • Direct funding from the Scottish Government - or a ring fenced budget provided to local authorities
  • Core services and performance indicators or standards.

All of this would help to lead to sustainable Care and Repair projects in the longer term.

Views on the Future - Demonstrating Contribution to Local and National Priorities

There was a consistent view that Care and Repair should get better at understanding and demonstrating the impact that it has. A number of suggestions were made in relation to understanding impact:

  • Assessing impact on clients - understanding which clients access the service, whether any vulnerable groups are being missed, and what real difference it makes on people's lives.
  • Assessing impact on partner organisations - understanding what difference Care and Repair makes and how it contributes to partner objectives. Stakeholders were particularly keen to see research and evidence relating to the Care and Repair's contribution to health and social care objectives.

Stakeholders felt that some of this work could be done by improving monitoring and evaluation at a local level, and some could be achieved through national evaluations and research on specific topics.

Once this evidence has been gathered, stakeholders also felt that it was vital to promote this to others, to demonstrate that Care and Repair has a real impact. Suggestions included:

  • National branding to enhance identity and raise awareness
  • Promoting and celebrating achievements - both in terms of quantitative and qualitative information, such as case study examples
  • Raising awareness among key individuals - such as Councillors, MSPs and other key agencies.

Many did caution that it was important to balance any promotion activity with ability to meet demand from customers.