Circular SWSG7/94 5458 - Community Care - The Housing Dimention

SECTION 3 - PLANNING

3.1 This section discusses the following aspects of planning for housing and community care:

3.1.1 The general principles on which such planning should be based (paragraphs 3.3-3.4).

3.1.2 The structural arrangements for facilitating the involvement of housing agencies in community care (paragraphs 3.5-3.16).

3.1.3 Assessment of aggregate needs for housing for community care groups (paragraphs 3.17-3.26).

3.1.4 Monitoring (paragraphs 3.27-3.32).

3.1.5 Planning authorities (paragraph 3.33)

3.2 Contact with the local community over proposals for community care developments is an important aspect of planning; and practical guidance on this issue will be available in August.

PRINCIPLES

3.3 The aim of community care is to enable people to live in their own homes, or in a homely setting in the community, wherever possible, and to promote independence and choice. To be effective in achieving this aim, community care planning must:-

3.3.1 Be an equal partnership between social work, health and housing authorities;

3.3.2 Be based on identifying the needs of an area for care in the community - including housing - and deciding how these needs are to be met;

3.3.3 Give an integrated service to the user, including housing, health, and social work services as required;

3.3.4 Be based on formal agreement on objectives;

3.3.5 Lead to inter-agency planning agreements, including agreements on funding and targets, standards, and delivery of care;

3.3.6 Involve the private and voluntary sectors and take account of the strategic and enabling roles of statutory bodies;

3.3.7 Involve full participation by users of community care and carers.

In short, effective community care must be interagency care, related to the needs and wishes of users.

3.4 The above principles apply at all planning levels:-

3.4.1 Strategic: ie assessment of overall needs for a geographical area, and preparation of broad strategies for meeting them, including the commitment of resources, the setting of objectives and targets, and agreement on which body is responsible for each activity. Annex 4 summarises current guidance on preparation of housing and community care plans.

3.4.2 Programme or Project: ie planning of provision, within the parameters set by a strategic plan, for a particular programme or project.

3.4.3 Planning for individuals: ie day to day planning for the effective delivery of services to individuals and their carers, including allocation and management of housing or other accommodation.

JOINT PLANNING STRUCTURES

General

3.5 From the available information it appears that the involvement of housing bodies in the planning of community care is uneven across the country. While the position is improving, it still varies from being fully involved in some areas, to a very limited contribution in others. An effective housing input can be encouraged by:

3.5.1 A planning framework providing for a housing contribution at all planning levels including decision-making levels. The aim should be to ensure that housing bodies are involved in deciding on priorities, objectives and output targets, identification of needs, the determination of responsibilities, and the allocation and use of funds and other resources.

3.5.2 Housing bodies having a mechanism (eg a forum including both statutory, voluntary and private sector bodies) to facilitate their involvement within a geographical area.

3.6 These principles will apply equally to the contributions of other bodies to community care planning, including their contributions to housing plans. At the practical level, joint working will require the exchange of information, which in turn will have implications for information systems; and agreement on a common terminology between housing, health and social work bodies. Annex 3 has been prepared to assist with terminology. On Information Systems, see paragraphs 7.4-7.6.

Housing Forums

3.7 One useful device for promoting interagency co-operation in housing and community care, already adopted in many areas, is to set up a housing forum, which would be housing led, but include representation from the health and social work sectors. It should be concerned with strategic matters, including joint agreement on the needs of its area, broad

strategies for achieving them, and allocation of responsibilities for activities and the provision of resources by the strategic partners involved in the forum. Possible items for the forum remit, which may be modified to meet local circumstances, are:

- establishing a strategic, needs based, approach to the planning of housing for community care users. This will require agreement on common definitions, and on methods of measuring housing need;

- establishing levels of shortfalls or over provision, of types of housing provided for community care users, as compared with these needs;

- agreeing principles which will govern action by the various bodies involved in response to these shortfalls or over provision, and the related support needs of individuals;

- agreement of protocols for joint assessments involving housing at an operational level, including hospital discharge protocols;

- ensuring the allocation of capital and revenue by individual housing, health and social work bodies, to ensure that housing, and social care and health care, are supplied to users in an integrated way;

- ensuring that capital investment based upon agreed priorities is matched by the necessary revenue support enshrined in formal planning agreements;

- reconciliation of different timescales for capital and revenue funding.

3.8 Experience shows that if housing forums are to be effective they need to be decision making bodies, rather than talking shops. This implies that they should have a senior membership, and that they must be firmly linked to the decision making machinery in their respective organisations. This will be facilitated if community care plans, housing plans, and strategic agreements between local housing authorities and Scottish Homes include specific discussion of community care housing. The Scottish Office will look favourably on community care plans and housing plans which show clear evidence of an interagency approach, including clear allocations of the available capital and revenue resources in support of agreed targets (including resources in kind). As indicated in Circular Env 9/1994 of 31 March 1994 on Housing Plans, Annual Policy Statements and Housing Capital Programmes for 1994, Ministers have decided that community care should be one of the four national priorities for which local housing authorities should prepare strategies and set output targets. If this interlinking of community care and housing plans is to be successful, all services will need to be aware of each other's planning and decision making timetables; at the programme, project and operational as well as strategic levels.

3.9 Membership of housing forums is for local decision, but it is suggested that it should include at least the major strategic and enabling bodies responsible for aggregate assessment of need, strategic planning and enabling provision by other housing providers. It is also important that there should be an input from these other housing providers, including housing associations, the voluntary sector, and the private sector. While these providers may be in competition with each other for contracts from strategic and enabling bodies, and have limited management time to take part in meetings; this need not prevent them making their expertise and knowledge available at the strategic level and on general issues, perhaps via forum representatives acting in an advisory capacity. Consultations by correspondence as well as meetings may be useful.

3.10 The following checklist may be useful in considering arrangements for housing forums (including making optimum use of senior management time):

- Focused agendas that deal either with (a) strategic issues or (b) operational issues at a given meeting. This will affect the appropriate attendance.

- What detailed work, or investigations and studies, can be delegated to sub-groups or nominated individuals?

- What funding, accommodation and support staff is required to service the forum and sub-groups - supplied from one organisation, or shared between organisations?

- Establish geographical area for forum - this may vary according to whether strategic or operational issues being considered. Local sub forums to coordinate local action?

- Establish links with decision making machinery for community care and housing within organisations represented on the forum.

3.11 Health Boards and social work authorities have expressed concern about the number of housing bodies they have to deal with, and have sought on occasion to identify a single body or person who can represent the housing interests in an area as a whole. It may not be possible for one housing body to fulfil this role, but there should be occasions when the chair of the housing forum suggested above can offer a general view on behalf of the housing bodies. The establishment of housing forums linked to the general decision making machinery on community care may assist this process.

Planning Agreements and Finance

3.12 Action required by the different bodies, at all levels, for community care should be contained in planning agreements. These should set out the objectives, targets, and responsibilities of each body and the resources committed (including responsibilities for allocating these resources, and transfers of funds between bodies.) In some cases, contributions will be in kind, for example secondment of staff or provision of houses for conversion.

3.13 Such written commitments are a condition of bridging finance for programme and project plans relating to the transfer of patients or places from long-stay hospitals to the community. (See circular NHS MEL (1993) 67:14 May 1993, and also for housing, circular Env 15/1993 4 June 1993). The Scottish Office will give strong preference to other community care projects if they show an interagency approach.

Joint Commissioning

3.14 The aim of the community care arrangements is not to emphasise the distinctions between health and social care, but to encourage the development of imaginative and effective solutions to people's care needs. Through joint contracting and the pooling of resources, with the involvement of housing bodies, local social work authorities and health boards can develop feasible approaches to the provision of community care housing. Guidance on Commissioning and Purchasing of community care services, was issued by The Scottish Office in November 1991 (Circular SW19/91).

User Participation

3.15 Individuals are at the centre of the Government's community care reforms. Section 5A of the Social Work (Scotland) Act 1968, inserted by section 52 of the National Health Service and Community Care Act 1990, requires social work authorities to prepare and publish plans for the provision of community care services. The Act also requires local social work authorities to consult a range of other bodies, including organisations representing users and carers, in preparing their plans or carrying out any review. Similarly users should also be consulted on housing services. Users and others may also have an interest in their capacity as tenants or as local residents. Consultations with local residents was covered in a draft SWSG Circular on contact with the local community on community care accommodation. Subject to Ministerial consideration of a report on consultations on the draft circular, it is hoped to issue the final circular in August.

3.16 The user's viewpoint is an essential part of making an overall appraisal of community care facilities and services, and of whether they are succeeding in meeting their objectives; including the objective of providing an integrated service from the point of view of the user. Consultations with users and carers should not, therefore, be confined to the assessment of an individual's need for care. It is equally important that organisations representing users and carers are included in the planning processes and structures. This should include organisations representing ethnic minorities. The way in which this will be done will vary from authority to authority, but in any case community care plans should make clear how organisations representing users and carers can participate in the planning structures and processes.

ASSESSMENT OF AGGREGATE HOUSING NEEDS FOR COMMUNITY CARE GROUPS

General

3.17 The first stage in planning is to prepare an overall assessment of the need for housing for community care users. Such aggregate assessments support the preparation of strategic plans, and are distinct from those community care assessments which lead to recommendations on the housing needs of individual users and their carers, as well as their needs for health and social care. (Individual assessments are discussed in section 4.)

However the aggregation of individual assessments may produce important information on overall needs. The aggregate assessment should take account of the following general developments:

- the increase in the number of elderly people, particularly the over 85s

- the programme for the contraction of long stay hospitals, as it affects the geographical area covered by the assessment.

- the increasing emphasis on care in the home and the consequent need to provide appropriate housing for both the users of community care and their carers

- tenure changes, particularly the growth in owner occupation. It should not be assumed that community care users will, or wish, to live in the social rented sector (ie houses rented by local housing authorities, Scottish Homes, housing associations, and new town development corporations).

Responsibilities

3.18 Housing authorities are responsible for assessing overall housing needs in their area, including the housing needs of community care groups. This assessment must take account of housing provided by other housing providers, including housing associations and other voluntary providers and the private sector, as well as the public sector. This assessment will need to take account of existing specialist housing for community care client groups (though not all client groups will need specialist housing), whether it meets current requirements, and its location. (Advice on this is given in Circular Env 9/1994 on housing plans). Housing authorities will need an input from health boards and social work authorities on the likely numbers, dependency levels, and accommodation requirements of community care groups; including early information on patients expected to be discharged from long-stay hospitals, and the areas to which they will be discharged. Housing authorities should consider not only needs for "bricks and mortar", but what housing management services, and health and social care, will be required. Circular Env 23/1994 of 1 July 1994 on the preparation of housing management plans makes this point (see also section 5).

3.19 Conversely, social work authorities and health boards will need for their community care plans information on the size and shape of the existing housing stock, with gaps identified, and an indication of planned future housing provision for the area. They will also wish to be aware of arrangements for allocations, and referrals to and from housing managers (see section 5). The duty on social work authorities to obtain comments on plans includes both housing authorities and voluntary and other housing providers. Each has something to offer: but clearly the housing authority as the strategic authority, ought to be seen as the co-ordinator and therefore principal source of comments on housing issues.

3.20 Assessments of housing needs should pay attention not only to the bricks and mortar, but to the housing management, health and social care services needed to support their occupants, including those living in mainstream housing.

Community Care Groups

3.21 No list of community care client groups can be comprehensive but it should include at least the following main groups:-

elderly people

people with dementia

people with physical disabilities (including sensory impairments)

those with mental health problems

those with learning difficulties

drug misusers

alcohol misusers

HIV/AIDS sufferers

Since needs may differ within as well as between groups, sub-groups within these groups may require separate attention.

3.22 Traditionally, housing authorities have concentrated on the needs of the elderly and those with physical disabilities, but increasingly they are - and should be - securing provision for all community care groups, though not all will require specialist housing. Housing authorities have of course a statutory duty under section 1 of the Housing (Scotland) Act 1987 to assess the housing needs of their areas. Guidance on provision of housing for community care groups is given at Annex 1. In addition to permanent housing, it may be useful in some cases to include places for respite care.

Homelessness and Community Care

3.23 Homeless people as such should not be regarded as a community care group. However, some will require social or health care support. Conversely many people requiring care in the community are vulnerable and therefore more susceptible to homelessness. A housing authority or other relevant housing body must therefore have ready access to social and health care for people with community care needs who are either homeless, or at risk of becoming so without such support.

3.24 Housing, health and social work bodies should bear the following points in mind in this field:-

3.24.1 Hospital discharge protocols for patients, particularly from acute and long stay hospital services, should cover the need to ensure that accommodation and support services are in place before discharge (including furnishings if required). Patients should never be discharged to a homeless unit, though it is accepted that there are difficulties with patients who discharge themselves.

3.24.2 The same points apply to those leaving residential care, particularly young people leaving care. The difficulties which they can face are well recognised and were addressed in the White Paper "Scotland's Children: Proposals for Child Care Policy and Law" (Cm 2286). The White Paper proposes that the existing duty of local authorities to provide assistance to young people under the age of 18, if they had been in care immediately before school leaving age, should be extended. The aim is to bring forward legislation placing a duty on local authorities to assist such young people up to and including age 18 and providing a power for local authorities to assist such young people under the age of 21 who are eligible and in need.

3.24.3 Housing bodies should be alert in dealing with homeless people to the possibility that some will require community care or other support.

3.24.4 The health needs of many homeless people have given cause for concern. Therefore health boards were asked to assess the health needs of homeless people, and in October 1993 guidance was issued. The NHS Management Executive is following up this guidance as part of NHS accountability reviews, and the attention of housing and social work authorities has been drawn to these initiatives.

3.25 The Scottish Office issued separately on 12 May, for comment by 7 July, a consultation paper on reform of homelessness provision entitled "Tackling Homelessness". Comments on the consultation paper are now being considered, but the paper made it clear that The Scottish Office is fully aware of the needs of homeless people who need community care.

Types of Housing

3.26 Since the emphasis of care in the community is on enabling individual to receive care in their own home, all bodies should consider how to build flexibility into mainstream housing. This means wherever possible linking care and support services to housing to provide a comprehensive package; at the design stage for modernisation or new build taking account of barrier free standards; and, if specialised housing or accommodation is required, mirroring as much as possible both the design and service specifications associated with mainstream housing. There are a wide range of housing models available (See Annex 1), and all bodies should increasingly think in terms of the total accommodation and services, including housing management services, which an individual requires; rather than simply in terms of physical provision.

Monitoring

3.27 Monitoring and review of progress compared with housing and community care targets should be included in planning systems at all levels, with regular reports going back to housing forums and working groups, as well as to the different bodies involved. Review mechanisms are already built into housing authority plans and annual policy statements, community care plans, Scottish Homes Strategic Plans and individual care plans; they should also be included in arrangements at programme, project, and general service planning levels. The NHS Executive agrees objectives and target for health boards for the forthcoming financial year at annual accountability reviews.

3.28 Proposed national community care monitoring arrangements were discussed in circular SWS16/1993, which was sent to housing authorities and health boards as well as social work authorities. Monitoring will be carried out through examination of housing plans/annual policy statements, community care plans; joint meetings between The Scottish Office Environment Department, individual housing authorities, and Scottish Homes; and the work of the Social Work Services Inspectorate; in addition to monitoring of existing statistics and those being developed by the Standing Group on Community Care Information Requirements.

3.29 As part of this monitoring work, The Scottish Office will be examining progress on the following items using the approaches indicated below.

3.30 Housing involved in community care as an equal partner - by examining community care plans, housing plans and housing management plans, and Scottish Homes district plans; for adequacy of housing input to community care; monitoring where possible the progress of joint agreements, and monitoring housing's involvement in needs assessment.

3.31 The responsiveness of housing to community care, ie provision of choice for community care users through a range of housing and associated services, suited to their needs by monitoring, for example, by community care client groups the number of new houses provided by conversion or new build, monitoring where possible adaptations of houses in the public and private sectors, including care and repair, and monitoring community care coverage in housing management plans.

3.32 Is there a commitment to user involvement? - by looking at whether housing providers have developed policies and processes for participation in house design, and provision of housing services, by users and carers. This may involve policies for tenant/resident participation, feedback surveys etc.

Planning Authorities

3.33 The great majority of housing authorities are also district planning authorities, and some community care accommodation provided by health, social work and housing bodies will require planning consent. In terms of the Town and Country Planning (Use Classes) (Scotland) Order 1989 (UCO) the definition of a house, other than a flat, provides for its use by not more than 5 residents living together, including a household where care is provided for the residents. A development providing care for a larger number of residents is classed differently in terms of the UCO - as a residential institution rather than a house. The planning considerations may therefore be different and health and social work agencies should seek the early advice of the planning authorities, particularly where a planning application is likely to be contentious. Housing authorities will also be able to advise on such matters as licensing schemes, or other regulations, which would apply to community care housing which may be classed as housing in multiple occupation, and land use planning in general.