Modernising Community Care - The Housing Contribution: Page 4

Modernising Community Care - The Housing Contribution

4.0 IMPLEMENTATION

Introduction

4.1 Translating the agreed objectives, priorities and targets set out in community care plans into practice represents a formidable challenge that requires effective arrangements for joint working and funding.

General

4.2 Within community care, implementation frequently requires co-operative working between Departments within the local authority (most obviously housing and social work) and across agencies (most often between the local authority, Scottish Homes and the health board or NHS Trust).

4.3 "Modernising Community Care" suggests many ways to achieve better results through improved inter-agency working. It also suggests that agencies have significant powers to work together; but asks whether there may be value in extending these powers to cover specifically: -

lead commissioning, in which a single agency manages a community care service on behalf of all the agencies in a partnership, using funding transferred from the other agencies;
giving each of those leading in the respective services a compatible set of targets and budgets which are then managed by them as a team;
making one person responsible for a single joint budget.

Lead Commissioning

4.4 Lead commissioning in the service wide context referred to here is still being developed, but the principles are being applied to a more local, project level. Lead commissioning is already used in a number of projects that are relatively easy to implement, with agencies other than the lead commissioner acting mainly as suppliers of funding and services. It allows for quicker and more direct access to those with commissioning responsibilities (for example a care provider will deal with a single agency so the support needs of an individual should be met within a shorter timescale). It is therefore important that the lead commissioner takes sufficient account of the needs and views of other agencies in the partnership and is accountable for the use made of their resources. Where lead commissioning is relevant all agencies involved should agree on: -

aims, objectives and timetable for the project or service, and what each agency should contribute to it;
arrangements for monitoring and reporting on progress to all agencies involved;
arrangements for dealing with any variations or funding required during the life of the project.

Supported Living Project in North Lanarkshire

North Lanarkshire Council and Lanarkshire Health Board have set up a project to develop and evaluate new ways of commissioning and providing services for people with learning disabilities, poor mental health and for older people.

Social work takes the lead in commissioning support services but it works closely with other agencies, in particular housing, to meet the needs of people in the community.

Key features of the project are:-

effective joint working arrangements between social work and housing;

a person centred plan (essential lifestyle plan);
a joint social work and housing assessment;
security of tenure through an individual tenancy or home ownership;
flexible support from a dedicated support team tailored to the individual's need;
active care management and review procedures;

joint funding of housing provision and staff working in the supported living project.

For the individual this means:-

access to the same range of housing options available to other citizens;
the choice of support staff and how the support is provided to meet particular needs;
the choice of location and who the person lives with (if anyone).

Contact: Annmarie Palmer; North Lanarkshire Council, 01236 812523

Grouped Budgets and Joint Commissioning

4.5 A more developed form of interagency co-operation is the establishment of grouped budgets and joint commissioning. Instead of there being different "pots" of funds managed by different agencies, a single grouped budget can be used to fund all aspects of a project. The grouped budget would be managed by a joint team drawn from housing, health, social work and other agencies as required which, within the strategic planning framework would determine the needs to be met, objectives and targets, allocate resources, supervise their implementation, and monitor the results. This approach requires substantial delegation of decision making powers within partner agencies to their team members, particularly to commit resources, which in turn requires agreement on strategic aims and objectives between sponsoring agencies, at either the council wide area or local areas.

4.6 Within the existing framework there are many good examples of innovative and effective joint working.

Jointly Funded Posts and Joint Commissioning

Accommodation Broker in Grampian: - This post was jointly funded for two years by Aberdeen City Housing Department and Grampian Health Board to address the housing needs of people who are being resettled in the community through the various hospital resettlement projects. The housing department managed it, and at the end of the two years has become part of the mainstream housing department staff complement.

An individual project or brief is developed by the resettlement co-ordinator and an occupational therapist and this is then considered by the accommodating broker to ascertain the best housing solution amongst the range of local authority, housing association and private sector options.

Technical Services section ensures that the necessary technical design and building issues are addressed. This provides the basis for a feasibility study that is presented to the key funders and which also forms the basis for discussions with the local Registration and Inspection Unit.

Once a house or property has been identified, the accommodation broker will liaise with the social work department to ensure that any particular local issues, such as the location or mix of special needs housing developments, is appropriate.

A Housing Procurement Group has been established, with representatives from all of the statutory agencies involved, to provide a strategic overview of the profile of needs assessments that are emerging and the resultant housing requirements that need to be addressed.

Contact; Mike Scott, Aberdeen City Council, 01224 522000

Home Link in Glasgow and East Dunbartonshire is a joint initiative to procure houses for people leaving long-stay learning disability and psychiatric hospitals. The project has two co-ordinators, one based in Glasgow Council and the other in East Dunbartonshire. The project received a capital budget of £2.1m from Greater Glasgow Health Board in 1997/98 to fund the co-ordinators posts and to: -

meet housing providers start-up costs;
cover property upgrading and adaptation;
develop projects in conjunction with Scottish Homes.

Home Link works closely with a range of housing providers, including locally based housing associations and the Glasgow City Housing Department. It also operates a house purchase programme. Home Link works with the commissioning teams involved in the hospital re-provision process, in which housing and care arrangements are separate. The project works closely with care providers to ensure that the appropriate housing and any adaptations required is suitable.

Achievements to date have been impressive with around 180 people discharged from Lennox Castle being rehoused over the past two years and assistance also provided to the mental health commissioning team.

The project has not been formally evaluated but the success appears to result partly from the particular backgrounds and skills of the co-ordinators, and partly from the funding and support framework put in place by the statutory agencies; the dedicated staff resources are seen as particularly important.

Contact: Stewart Gibb, Project Co-ordinator, 0141 287 4833

Accountability

4.7 Delegating responsibility and powers is a key theme of "Modernising Community Care". However, there may be concerns that, when delegating powers, the teams might over commit the sponsoring agencies in terms of funds or other resources, or take policy decisions which create unwelcome precedents. A clear accountability framework, agreed between sponsor agencies to overcome this concern, is required. It should include: -

agreed objectives and targets, in terms of outcomes to reduce the need to involve senior staff on operational issues;
an agreed policy framework, making it clear which policy decisions have to be referred back to sponsor agencies. (Preparing this framework may have also the advantage of drawing attention to any unsuspected inconsistencies between sponsor agencies' policies);
agreement on the frequency and format of monitoring reports, including exception reports if there are large deviations from targets or unexpected events between regular reports;
an agreed timetable for action;
an agreed budget or budgets with associated delegated spending limit by the joint teams and a clear agreement about the scope for switching of resources between budget heads;
the exchange of information between health, social work and housing agencies and feedback from each other's meetings, for example, through regular interagency team meetings.

Trusts

4.8 One possible approach being developed in some areas is the formation of new service delivery vehicles, jointly created by the planning partners. This in effect pools budgets under a single agency. The legal structure of these organisations varies, although they are usually formed, as companies limited by guarantee, sometimes known as a trust. The benefits of this approach are:

the new body will be independent of each of the existing organisations but will still contribute to achieving shared objectives;
it can fill gaps in local service provision and can have a broad range of objectives;
it can attract private sector finance;
it can access different sources of granting funding, such as Scottish Homes Special Needs Capital Grant;
it can readily address partners' accountability issues through commissioning procedures to purchase services from the new organisation, and account for expenditure.

Community Care Trusts

Angus Community Care Charitable Trust (ACCCT). ACCCT is a joint initiative by Angus Council and Tayside Health Board and has the active support of Scottish Homes, Angus NHS Trust and other local organisations.

ACCCT aims to support the development of community care services in Angus by developing appropriate independent living, supported accommodation and other elements of the infrastructure, such as resource centres. ACCCT will be able to develop innovative approaches to providing services through partnership funding.

ACCCT is a company limited by guarantee with charitable status: - board members are drawn from elected members, interest groups involved in the community care planning process and individuals with relevant skills and experience.

Contact: David Sim, Assistant Principal Officer, Social Work, 01307 473183

Grampian Community Care Charitable Trust (GCCCT). This is also a joint initiative in this case involving the local Councils, Scottish Homes and local housing associations. Its main aim is to provide the housing element for those people being discharged from long stay hospitals. Grampian Health Board has provided funding for two years to co-ordinate and commission projects on behalf of the Trust.

The Trust was formally constituted in 1996 as a company limited by guarantee. A number of projects have now been commissioned accessing significant levels of private funding levered in by funding from Scottish Homes and the Health Board. Unlike ACCCT, the Grampian Trust focuses solely on developing housing.

Contact: Gordon Kyle, Chairman, GCCCT, 01224 625822

4.9 To date these organisations have been designed to be independent from the council and the other planning partners. In considering this approach, councils should take into account the Code of Guidance on Funding External Bodies and Following the Public Pound, published by the Accounts Commission in 1996 which seeks to ensure proper accountability of public funds.

Projects

General Approach

4.10 Community care housing projects should integrate the provision of the housing itself, with the housing, social care, and community and primary care health services required to support residents, taking account of their expected dependency levels. This will allow cost-effective provision to be made across all sectors. For example, the inclusion of certain design features can enable people with physical disabilities to live more independently, thus reducing the need for support services and the strain on carers. Barrier free housing, which caters for a wide range of impairments, can make a substantial contribution in this respect, and is now the preferred design standard for housing in general.

4.11 Scottish Homes has produced new housing design guidance for all types of housing for vulnerable people. Entitled "Housing for Varying Needs" and published in 2 parts, the guidance incorporates barrier free standards. This means that all new housing funded by Scottish Homes is expected to be built to barrier free standards unless there are good reasons to the contrary, such as site difficulties. It is also recommended for local authorities and the private sector.

4.12 Barrier free standards have clear advantages. They avoid or reduce the need for expensive adaptations at a later date and the movement of people to specialist housing, sometimes away from family, friends and their community. They also cater for people who are temporarily disabled, and have other advantages for the wider population such as better circulation spaces e.g. ability to manoeuvre prams. However, it is recognised that houses built to barrier free standards may not always meet the needs of all community care users, particularly wheelchair users.

4.13 Housing for community care users should be integrated with general housing developments to facilitate integration in the community and promote social inclusion. It may also be useful to combine housing for different community care users, and houses with other facilities such as day or respite care facilities serving the area. This multi-facility approach may be particularly useful in sparsely populated areas that do not have the population to support single client group facilities.

Development Brief

4.14 Development or project briefs can be used to co-ordinate interagency action where purpose built housing is required. The development brief should set out the requirements that have to be met by the architect and service providers. These include the expected needs of residents in terms of special housing design features, housing, social work and health support services, and any communal or other facilities (including staff accommodation) required to deliver these services. The development brief can also be a useful tool for consulting potential residents (or if these are not known, bodies representing relevant users and carers) in non technical terms; and also in obtaining agreement to the project and funding from the agencies involved.

Funding and Development Agreements

4.15 Public sector organisations may face difficulties in making long term revenue funding commitments linked to community care housing projects. It can take 2 or 3 years from the initial approval to occupancy by the first residents. Normally there are also a number of funders and providers involved, and it may be difficult to provide definitive information at the early stages on capital and revenue funding contributions. Accordingly, a funding and development agreement could be used to cover: -

a full description of the project, including the type of service, client group, selection process, registration status and arrangements for the tenancy and the care provider;
a list of all the partners (likely to include the commissioners and funders of the service as well as the housing and care provider), and details of their level of involvement and commitment at various stages of the project.

4.16 The Standing Forum of Supported Accommodation (SFOSA), an informal group of statutory and voluntary housing, social work and health interests, has produced a model development agreement that can be tailored to individual circumstances. This is set out at Appendix 2, along with 2 examples of typical agreements.

4.17 In preparing the development agreement, partners should also take into account the following: -

timetables for different activities e.g. building, assessment of potential residents, recruitment and training of staff, including dates by which funding decisions have to be taken by different agencies taking account of their differing decision making cycles;
the need for clarity on who is responsible for taking decisions, and when, in each agency. Delegation of decision making (to localities) as suggested earlier will be helpful in speeding up decision making, as will flexibility in allocating resources between this and other projects within organisations;
which agency has responsibility for allocating places in the housing, and providing support services;

expected income and expenditure levels for different activities within the project, linked to individual partners' budgets as well as the overall project budget;
how financial and other relevant information has to be presented to different partners preferably through a jointly agreed common budget form;
monitoring progress on the project, including related activities such as assessment of long stay patients who will be accommodated in the housing, so that the implications of delays or faster than expected progress can be considered in good time. This in turn requires clear reporting links, both within and between partners, and agreement on what information should be provided, preferably in common reporting forms or formats;
an evaluation of the project once in use, the results of which should inform future housing and support service design as well as immediate action on any problems;
involving housing and support service providers as well as funders in these activities, including monitoring.

4.18 The greatest difficulty in implementing development agreements is variations from the originally agreed buildings, activities, and funding due to: -

building or other work proceeding more slowly or quickly than expected. This is not a new problem, and can be dealt with by funding agencies switching resources between projects proceeding at different rates;
differences between estimated and actual capital and revenue costs, particularly longer term revenue costs;
funders may run into unexpected problems resulting in some or all of the funds allocated to the project no longer being available;
changes in the number or type of residents expected. Good co-operation between agencies on the development brief should help to minimise changes in the short term.

4.19 Some variations during the life of a project are almost inevitable, and may make funding agencies reluctant to enter into binding legal agreements with providers. The solution may be to include in a development agreement a variation clause allowing the agreement to be renegotiated to take account of such changes, while leaving the main agreement, and the stability and reassurance it gives to both housing and support providers, and private lenders, in place. Naturally, it has to be recognised that large variations may still cause problems. Variation clauses should be agreed by all partners.

4.20 It may be convenient for the initial development agreement to cover the development phase together with a section that refers to the need to negotiate a management or service agreement covering revenue funding, provision of services and selection of residents when the housing comes into operation.

4.21 However, the preferred approach is for development agreements to take account of the following 3 stages: -

the initial development or building phase of 2 or 3 years (or more), during which capital funding is provided;
the medium term period covering the first 3 years of the project operation, and its revenue funding;
the long term, say 10 years, after the project comes into operation, or the period required to pay off a private loan. While this is rather speculative, on the best information available, partners should ensure at the design stage that the project is financially viable in the longer term or that the property can have an alternative use in the future (perhaps by other community care or general needs groups).