A better match
Supporting People and sheltered housing have often been at odds, but that needn't be the case, argue Imogen Parry and Sue Ramsden.
(as published in Inside Housing, March 23 2007)
The Supporting People programme has brought many challenges to sheltered housing providers since its inception four years ago. Many people argued that the programme was inappropriate for sheltered housing as the amounts of money per tenant were so small and the tenancy was for life unlike a temporary stay in a hostel or refuge. Around 25% of tenants pay for the service themselves without recourse to public funds. Many tenants and providers have complained bitterly about the increased bureaucracy, the costs of administration, insecure contracts and reduced contract prices.
But the benefits should not be ignored; Supporting People has brought a focus on improving quality and performance and in some local areas recognition of the value of the sheltered housing support service. There have been a wide range of positive outcomes in organisations through the introduction of needs and risk assessment and support planning. These outcomes include the identification of previously overlooked needs (such as under-claimed benefits, services or equipment). Lonely and isolated residents are more accurately assessed and a range of social and other solutions offered. Staff time is more focused and outcome orientated.
Older people in the community have benefited from Supporting People by the provision of flexible floating support services and there has been greater encouragement of the use of sheltered housing communal facilities by non-residents, promoting social inclusion and community cohesion.
However, a common problem for all providers however has been the difficulty of reconciling the views and choices of existing and future sheltered housing tenants with the wishes and strategies of Supporting People teams. These choices fall into four broad themes:
1. Choice of tenure. Many tenants have chosen to move to sheltered housing in advance of having tangible support needs, anticipating a time in the future when they will need the support of a warden or scheme manager. Indeed some of these fit and able tenants have been encouraged by lettings policies to move out of under-occupied council housing into sheltered housing or to fill hard-to-let voids. Yet the same local authority may simultaneously criticise the sheltered housing provider for accepting allocations for people with no or low support needs! There is a lack of political and managerial will by local authority Supporting People Commissioning Bodies to meet with allocations departments to address this inherent tension and to develop a lettings policy that reconciles need, choice, prevention and social inclusion.
2. Choice to live in a balanced community. Tenants prefer the retention of a balanced community and are fearful of the consequences of a move towards lettings only to those with moderate or high and complex support needs. They have not been consulted about this trend in many areas.
3. Choice of provider. Local authorities are now really taking hold of the programme and shaping it locally. The first three years was a period of transition with limited protection offered to existing service users. Providers were largely cushioned against having to tender for their own services. This has changed. What we see is all local authorities looking at the procurement process with a view to securing efficiency savings and challenging the way that services are delivered. Authorities are also obliged to meet EU requirements and secure best value for tax payers. Yet there is much room on how these obligations can be discharged and we see very different approaches from authority to authority.
Given that choice is such an important part of the government's wider agenda, it seems inconsistent that contracts are being re-tendered so that older people will not be able to choose between different providers and different service levels. Competitive tendering is starting to happen with no serious attempt to consult tenants in some local authorities. Tenants should be part of the procurement process not passive recipients of decisions made else where.
4. Choice to retain existing pattern of service delivery. Existing tenants of traditional sheltered housing services invariably stress the benefits of having a scheme specific warden or scheme manager service. These benefits include peace of mind and reassurance from knowing that someone is there. Sometimes, they value tasks that are not technically part of wardens' duties, some of which are done by some wardens in their own time (often against their managers' instructions), such as: collecting prescriptions, taking tenants to the doctor, organising parties and outings. Tenants have often come to see a long-standing resident warden as a friend and are uncomprehending of the reasons for a more professional, consistent and outcome based approach. It is hardly their fault if old-fashioned patterns of service delivery have been unchecked and unchallenged by managers for years. Where there is partnership with local authority commissioners, providers can inform tenants of the reasons for the move away from a traditional 'one-size-fits all' approach to support in sheltered housing (eg. five visits a week) to a more flexible and needs led approach which includes floating support outside schemes. Very poor practice occurs when tenants have services abruptly withdrawn, without any prior information or consultation.
No one would disagree with the fact that sheltered housing services need to be more flexible and responsive to need. But tenants in some sheltered housing schemes are angry or confused by having changes to their service, neighbours or provider forced on them without sufficient consultation.
Consultation on the remodelling of services and buildings requires time, patience and financial resources. It is very different process from closing a short stay service where people quickly move on.
Some local authorities are adopting an all or nothing approach and shifting away from sheltered housing in its traditional form. These authorities want to sever the link between housing and the extra support service that people receive. It is argued that people should not have to move into specialist housing in order to receive the support service or vice versa. If we were starting from a blank piece of paper, then this separation might seem sensible but if leaves the question of what happens to existing tenants? Must they go through an assessment? What if they pay for the service themselves and the price goes up? How can the new service cope with peaks and troughs of demand? An older person may need intensive support for a few weeks after returning from hospital but them this may tail off as confidence returns.
The move towards individual budgets may offer a counterbalance to insensitive decisions on service changes. An individual budget devolves decisions down to the service user and gives people the choice over who to pay and what service to buy. Though in their infancy, individual budgets are being pushed by all shades of political party as the way to achieve more responsive and targeted services and to give people control. This will add a new dynamic into the market and one that allows a more direct relationship between service users and providers.
The government and the Audit Commission place great emphasis on user led involvement and user led service improvements. The Supporting People programme is being implemented in many authorities with scant regard to the wishes of existing sheltered housing tenants and in a way that undermines choice for older people.
What is needed is a system that supports choice and acknowledges provider organisations and tenants as partners. Supporting People is about helping people to maintain independence. This might mean a support service, telecare or home care, but equally important are preventing loneliness and isolation and ensuring that someone's home is well maintained, accessible, affordable and warm. People do not loose their individuality as they become old and have a right to expect services that reflect their choice as well as needs.
