Tom McDonald John Taylor Alastair Mitchell-Baker Tricordant July London Borough of Hackney Supported Housing Commissioning Strategy

Transcription

1 London Borough of Hackney Supported Housing Commissioning Strategy Tom McDonald John Taylor Alastair Mitchell-Baker Tricordant July 2013 London Borough of Hackney Supported Housing Commissioning Strategy

2 Table of Contents Table of Contents... 2 Executive Summary The purpose of this strategy Promoting independence The case for multi-agency working Extending choice and innovation new models of support Helping service users to move to greater independence Effective measures of our success Taking forward the supported housing commissioning strategy Introduction Why a supported housing strategy? What is supported housing? Promoting independence Current provision Financial Benefits of Supported Housing The approach of this strategy Actions necessary to maximise the impact of commissioning decisions Consultation processes Context Supported housing provision for older people Current provision Need for supported housing for older people Projecting demand for older people s supported housing Our commissioning intentions for older people Financial implications Mental health Current provision Need for supported housing Commissioning intentions for people with mental health needs Financial implications Supported housing for people with learning disability London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 2

3 5.1. Current position Need for supported housing for people with learning disability Commissioning intentions for people with learning disability Financial implications Supported housing for single homeless people Current provision Need for supported housing for single homeless people Commissioning intentions for single homeless people Financial implications Other service users who receive supported housing Domestic Violence Substance Misuse Offenders Performance framework Actions necessary to support effective commissioning The role of accommodation panels Separation between Supporting People funding and Adult Social Care Funding Concept of move-on Access to mainstream housing Actions necessary to support effective commissioning Appendix 1 - Summary sheets of supported housing issues Older people Mental health Learning disability Single homelessness Appendix 2 - Predicting demand for older people s supported housing Appendix 3 - Research and Best Practice Review of Extra Care Housing Appendix 4 Summary of supporting strategic analysis Appendix 5: People and organisations interviewed and consulted during the development of the strategy London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 3

4 Executive Summary 1.1. The purpose of this strategy Supported housing is a vital service that enables vulnerable people to live independently in the community. It improves the quality of life of many people for whom some form of institutional care would be the only option without such services. This strategy sets out the key actions that the Council, working with its partners, will take over the next 5 years to develop further the provision of supported housing in the borough. It informs service users, providers of supported housing and other partners of the priorities for development so that we can work together to achieve the aims that are set out. The strategy focuses on four main groups, older people, people with mental health needs and learning disability and single homeless people. The main report makes specific recommendations in respect of each group but this summary will, in the main, focus on some key points that the strategy highlights Promoting independence Supported housing provides an opportunity for many people in different and sometimes difficult circumstances to achieve independence. This is a core aim of the Council and underpins all work with individuals within adult social care. 1 Thus, supported housing has a synergy with a key objective of the Council, enabling many people to live independently in the community. Without such support, they would be reliant on more intensive and costly interventions and would not have the same quality of life that independence brings them The case for multi-agency working Supported housing plays an important role within the over-arching strategies for housing developments within the borough as a key component of the range of living opportunities that we offer to residents. We will work to ensure that supported housing is central to the strategic developments for housing within the borough, working with strategists and planners, whose skills and knowledge can ensure that opportunities for new developments are grasped. The benefits of supported housing to the wider health and social care system have been well evidenced, particularly the benefits to the wider health system, and we will develop closer working relationships with commissioners of health services in order that we maximise the impact of supported housing for both individuals and the wider health and social care system. 1 Promoting Independence; Hackney Adult Social Care Services Commitment Statement London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 4

5 Some people in supported housing rely not only on the support of housing providers but also require the support of social care. Supported housing commissioners will work closely with adult social care commissioners to ensure that the plans developed for supported housing reflect the emerging needs of service users and that we also use our collective resources creatively to develop high quality, integrated models of support. Many of the people who need supported housing have complex needs; helping them retain their independence requires the engagement and support of a range of agencies and professionals to work collaboratively with residents and providers of supported housing. We know that all public services are under pressure but we also know of the preventative impact of supported housing. We have estimated, using national tools and good practice, that our current supported housing investment generates net savings for the Council and our partners of million per annum. Therefore, we will continue to work with a range of agencies so that providers of supported housing and their residents have access to other professionals when it is needed to ensure that they are able to continue to live in the community Extending choice and innovation new models of support There is now a strong body of evidence that demonstrates the effectiveness of supported housing and the contribution that it can make to people s lives. This includes the extra care model of housing for older people. We need to extend the choice that we offer to older people in the borough so that they can actively plan for their later years. The offer that is made must be high quality, with a range of tenure options and allows access to older people when they remain relatively fit and independent and not only when they have the need for greater support. We also know that the quality and attractiveness of supported housing accommodation can be enhanced by their design and we must build into all of our new developments learning from best practice that will enable and encourage older people to make a real choice about future living arrangements. Extra care housing We will commission extra care housing for older people It will offer choice and opportunities to plan for older age It will be to rent and to purchase It will conform to the highest design standards to attract older people At present, we are not able to offer older people such models and therefore they are unaware of the opportunities that such developments can offer. We also risk older people moving out of the borough to access a wider range of choice. We know that there is a need to release under-occupied housing, whether rented or owned, and extending the choice for older people will make an important contribution to improving the availability of housing, in general, within the borough. London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 5

6 The developments in supported housing have enabled many people to live independently in the community who would not otherwise have been able to do so. For many, it is an alternative to residential or other form of residential care. This is reflected in the reducing use of such facilities both within the borough and in other areas. However, many residents have very complex needs. There is not only the need to retain a multiagency focus but to ensure that we continue to provide supported housing that can provide the high level of support that many people need. We need, therefore, to extend our provision of high support accommodation, including integrated Integrated models of support We will commission models of care and support that recognise the complexity of some people s needs. It will meet individuals needs for both care and housing support. We will firstly commission such provision for people who are recovering from severe mental illness. models with health and social care, particularly for those people who are recovering from mental health problems and people with a range of needs which contribute to their homelessness Helping service users to move to greater independence The aim of supported housing is to enable people to move to greater independence. This requires people to move on from accommodation where they receive high levels of support to accommodation where they do not require any further support or a significantly reduced level of support. However, we also know that such are the nature of some service users difficulties, that they will require ongoing support if they are to remain independent in the community. We need, therefore, to do two things. First, Increase the number of people who move to independent living from supported housing. At present, this is a very low number and by increasing the number of people who move to independence, we would increase the availability of supported housing for others who need support. Flexible support contracts We will consult with providers on developing flexible contracts that incentivise providers to help individuals to maximum independence, whilst also allowing some individuals to continue to receive support, without which they would risk loss of their independence. Second, at the same, we need to develop flexible contracts with providers that allow them to offer different levels of support at different times, particularly during transition whilst also continuing to offer ongoing support to very vulnerable people who would be at high London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 6

7 risk of more intensive forms of support and intervention if supported housing was not available to them. We will consult, therefore, with providers on how we can devise flexible contracts that incentivises providers to help individuals to maximum independence releasing important supported housing resources, whilst also allowing some individuals to continue to receive support, without which they would risk loss of their independence. The overall housing shortage makes access to mainstream housing difficult and we value the arrangements within the Council that enables people in supported housing to have an opportunity to access their own accommodation. However, we will work with our Council colleagues to ensure that the processes supporting this initiative are as streamlined and accessible as possible Effective measures of our success As resources become more stretched, we need to ensure that they are used to best effect. We need, therefore, to understand the current and emerging needs of service users much better, the demand for supported housing, how it is used, where people go to from supported housing and the outcomes achieved for them. We will, therefore, have a more systematic approach to identifying need. In some service user groups, we need to build this into our performance framework for supported housing so that we have real-time information that enables the most efficient use of our scarce resource and which supports our planning for future developments. With such information, we will be better placed to take up opportunities for new developments and to work creatively with our partners to extend high quality, supported housing provision in the borough Taking forward the supported housing commissioning strategy In order to progress the Supported Housing Commissioning Strategy a Programme Board will be set up to implement its recommendations. It will make plans for activity for the next five years to ensure that a range of supported housing is available to vulnerable Hackney residents and that it is aligned with mainstream provision. Workstream groups will be established for the main client groups which will oversee the planning and development of new commissions, extending choice and innovative models that recognise the needs of vulnerable people. We have estimated Moving forward We will establish a supported housing programme board to take forward this strategy over the next five years. that the financial implications of this strategy for the key client groups are to reduce or We will embed supported housing provision within the core strategies of the Council. We will engage with key partners, particularly in the NHS, to establish a joint approach to commissioning supported housing. London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 7

8 constrain expenditure by circa 1.7 to 3.2M. These estimates will be refined and improved as business cases are developed. It will also ensure that the provision of supported housing and housing older people is embedded and aligned with the Borough s housing strategy as part of the Council s commitment to supporting the creation of mixed, balanced and inclusive communities. It will also work with Housing Needs and Options to ensure that there is a clear pathway out of supported housing into mainstream provision for people who are ready for independent living. London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 8

9 2. Introduction 2.1. Why a supported housing strategy? This strategy establishes a set of priorities for supported housing over the next 5 years in Hackney. Supported housing is a critical service that offers vulnerable people the opportunity to live independently. There is increasing evidence that supported housing services not only benefit the people who access such services but that it is a powerful preventative measure that reduces the need for health, social care and other interventions. These systems are increasingly under stress and will continue to be so over coming years. This will be compounded by further anticipated changes in housing and welfare benefits. Therefore, it is important there is a clear strategy for supported housing that safeguards its position as a key service for vulnerable people, whilst anticipating their changing needs. The strategy should facilitate partnership working between the different sectors which have a contribution to make to its success and sustainability What is supported housing? Supported housing is a generic description of support that is combined with the provision of accommodation for people who will normally require support in order to live independently. The objectives of supported housing are; To support independence for those who have a support need that cannot be met in ordinary housing. To enable those who need supported accommodation as part of a transition to more independent living to develop the skills and confidence to successfully make the shift. To play a role in diverting people away from other high dependence options. To ensure that those living in supported housing can exercise choice and control so that they can maintain their individuality and dignity, and retain their status as independent adults. To be flexible enough to meet changing needs. To prevent homelessness. To provide both long term and temporary housing Thus, supported housing can be a critical service to enable people with a range of needs, for example, older people who may become frailer or people with a learning disability or people recovering from a mental illness, who need additional support to enable them to remain living independently in the community. London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 9

10 Support is often provided by the landlord of the property but there are also models where support is provided by a different organisation. Funding for the support element of supported housing has usually been provided through Supporting People funding, a government grant administered through local authorities and now included in the formula grant. This funding, which was established in 2003 and rationalised and integrated a number of funding streams for the development of supported housing provision, has under-pinned many of the developments in supported housing in recent years. It is no longer ring-fenced for supported housing but many local authorities, as in the London Borough of Hackney, continue to fund such schemes in recognition of the vital role that they play in enabling vulnerable people to live independently. People living in supported housing may also, but not always, receive additional support through adult social care. However, a relatively small percentage of people living in supported housing do receive additional support through adult social care funding Promoting independence The provision of supported housing is consistent with a key aim of the Council, which is to promote and to maximise the independence of every individual and particularly those who may need additional support. 2 This is key outcome to be achieved through the provision of supported housing. Our aim is to utilise mainstream services, such as housing, leisure and learning opportunities to enrich and improve the quality of life of every citizen so that they can, as far as possible, live as independently as possible in the community. We know that many people in supported housing have a degree of vulnerability which would be exposed and compromised without the support inherent in the service. It remains, therefore, a cornerstone of our aspiration in the borough to promote and maximise independence Current provision National information about provision that allows benchmarking is not readily available. However, the table below includes information from some other London Boroughs that includes some with similar socio-demographic characteristics and overall population to Hackney. Older people Hackney London Borough 1 London Borough 2 London Borough 3 London Borough 4 SLS Promoting Independence; Hackney Adult Social Care Services Commitment Statement London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 10

11 SHwC Sheltered Learning Disability Mental Health Domestic Violence Offenders Single Homeless/Rough Sleepers Substance Misuse Young People/Teenage Parents The amount of supported housing available in each borough will reflect each borough s historical commitment and need for supported housing and which was consolidated in a streamlining of funding when the Supporting People programme was established in The table shows that despite the pressures on funding and, therefore, reductions in total availability, there remains relatively significant provision of supported housing in Hackney Financial Benefits of Supported Housing Nationally, the benefits of supported housing to councils and their partners especially across criminal justice, health and social care systems have been well evidenced. This is particularly the case for the benefits to the wider health system. Many of the people who need supported housing have complex needs; helping them retain their independence requires the engagement and support of a range of agencies and professionals to work collaboratively with residents and providers of supported housing. We know that all public services are under pressure but we also know of the preventative impact of supported housing. In 2011/12 we were able to spend 19.1M on our Supporting People programme. This included 17.5M on accommodation and floating support. We carried out a detailed analysis of the whole system impact of this spend across a range of care groups using a Department of Communities and Local Government tool 5. This analysed the likely costs of services across health, social care, housing, criminal justice system, transport etc which would be in place if Supporting People services were not in place. Our analysis showed the estimated total costs for the council and partners was 110.9M represents the total capacity within SHwC schemes but currently there are only 128 people who receive care support within these schemes. See section 2.2 on Supported Housing with Care and Supported Living schemes for how these schemes operate. 4 Sheltered tenants generally receive support from the Floating Support Services 5 See London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 11

12 including SP funding of 19.1M, but without SP the costs were estimated to be 130.1M. So there was an estimated net benefit of 19.2M across all partners. This did not include the benefits of our Telecare, Handyman and Home Improvement Services, all of which have a good evidence base. In 13/14 our forecast spend on SP has reduced to M as we have had to tailor budgets to reducing Government funding for local councils. We have ensured more efficient and effective use of the Supporting People budget and our updated analysis shows the expected net benefits of Supporting People programmes are 18.2M. Our Supporting People spend in 14/15 will have to reduce to 14.2M, as funding levels are further reduced. However by continuing to target our resources on care groups who show the best return on investment we anticipate maintaining net benefits of over 16.4M. We have estimated, using national evidence that our Handyman, Home Improvement and Telecare programmes save a further 6-8M p.a. for the Council and our partners. Thus, our planned Supporting People spend is estimated to generate benefits of 22-25M across Hackney. Our proposals will help to manage the growing demand for supported housing services within the diminishing resources available and are anticipated to generate further benefits. As part of the Implementation programme for this strategy, we will develop more detailed business cases for specific schemes, using the Department s Demand Model to analyse the impact on demand and costs for Adult Social care and potentially the DCLG tool to understand the wider system impacts. The overall effectiveness and efficiency of Supported Housing in the Borough will be enhanced and tracked through an enhanced performance framework The approach of this strategy This strategy focuses primarily on supported housing for four main client groups; older people, mental health service users, people with learning disability and people who are single and homeless. It is also recognised that many of the individuals who need supported housing will have a range of needs, for example, people who are single and homeless can also present with substance misuse or be subject to requirements of the criminal justice system. Thus, it is important to recognise these overlaps in commissioning supported housing services and related adult social care services. This report will identify common issues across all user groups whilst also focussing on issues in which are specific to client groups. London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 12

13 2.7. Actions necessary to maximise the impact of commissioning decisions This strategy focuses primarily on the Council s commissioning intentions in respect of supported housing. However, in order to ensure that the resources that are commissioned are used effectively, processes and systems for access and utilisation of those resources have also to be in place. In section 7 of this strategy, therefore, focuses on these supporting actions, particularly pathways and how different parts of the system interact, in order that commissioning intentions achieve their desired outcomes Consultation processes In devising this strategy there have been individual consultations with approximately 20 staff of London Borough of Hackney, partner organisations and providers [see appendix 5.] There have also been focus groups with the main providers for the four key client groups outlined in this strategy, older people, single homeless people and people with learning disability and mental health needs. The strategy also drew on learning from a survey of older people, conducted other older people trained as part of a review of supported housing conducted in the borough in Context The development of a supported housing strategy has to take into account the wider strategic context 6 including most obviously the current economic circumstances; Significant financial pressures on public sector funding, including health and social care. Limited public funds being made available for new build projects. Slow growth in the housing market that impacts upon all tenure types of housing. High demand for all forms of social housing. In January 2013, there were almost 20,000 on the waiting list for social housing in Hackney, of which over 9,000 were applying for one-bedroom accommodation, which is the category of accommodation virtually all those in temporary supported housing are applying for. Changes in welfare benefits which will impact upon those people in need of supported housing and attempting to move into mainstream housing. There are also specific pressures on Supporting People (SP) funds. Whilst no longer a ringfenced budget, many local authorities, as in Hackney, have continued to give priority to supported housing, even though the budget available, as with the majority of public spending, continues to face reductions. In April 2003, when SP was introduced, the budget for Hackney was almost 25m. In 2014/15, the budget will be 14.2m, a reduction from 6 See Appendix 4 for a strategic context summary. London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 13

14 18.2m in 2012/13. The reductions in budget have already seen a loss in the amount of supported housing and lower value contracts paid to providers. This is clearly a major risk in planning for the future. Finally, there is now a strong body of evidence which highlights the positive impact that supported housing has upon people s health and ability to remain independent. Multiagency working was a key principle supporting the operation of Supporting People. There is a view that, in more recent years, as changes have been brought to the programme that some of that multi-agency focus has been lost. In Hackney, there is a need to re-engage with health service commissioners because of the increasing evidence of the benefits to individuals physical and mental health that supported housing brings. A study commissioned by the Department for Communities and Local Government highlighted that the Supporting People programme delivered an additional 1.2 billion in national gains, many of which, have accrued to the health system. 7 There have also been other studies, for example, by the International Longevity Centre, 8 which showed significant benefits to both the health and social care system of extra care housing for older people; Compared to those living in the community, receiving domiciliary care, those in extra care housing are about half as likely to enter institutional accommodation. Around a quarter of residents who enter extra care with additional social care needs, later go on to experience an improvement in their health and leading to a decrease in social care needs. Extra care housing is associated with a lower likelihood of admission to a hospital overnight compared to a matched sample, living in the community. A well-funded, fully integrated system of care, support, health, housing and other services is essential, not just to provide high quality support for individuals, carers and families, but also to provide good value to the exchequer and the tax payer. 8 A lower than expected number of falls was recorded in a matched comparison group when compared to those living in the community. A recent Health Select Committee Report also advocated the need for a much more integrated approach across housing, care and health in order to deliver better outcomes for individuals as well as making better use of public resources. 9 It is important, therefore, that the Council works jointly with the City and Hackney Clinical Commissioning Group, which also faces significant challenges, as supported housing can 7 DCLG Research into the financial benefits of Supporting People Gap Gemini International Longevity Centre, UK, Establishing the extra in extra care; perspectives from three extra care housing providers, Dylan Keale, Sept Health Select Committee Report on Social Care, Fourteenth Report of Session 2012, Volume 1, 2012 London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 14

15 play an important role in delivering their priorities by diverting people away from hospital admissions and make less use of health resources. The following sections look specifically at provision, demand and need of supported housing for older people, people with learning disability, mental health service users and single homeless people. There is a summary sheet for each client group at appendix 1. London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 15

16 3. Supported housing provision for older people 3.1. Current provision Sheltered housing There is within Hackney extensive provision of sheltered accommodation for older people. Much of it was built in the 50s and 60s and consists primarily of one bedroom flats, some of them studios. In total, there are approximately 50 Sheltered Housing Schemes which provide 1052 units, where floating support is available. In addition, approximately, 617 units receive Supporting People funding, and all but 64 are within the Supported Living (SLS) and Supported Housing with Care (SHwC) schemes, described below. A significant portion of the current sheltered provision is the Borough s former stock, which is now managed by Hanover Housing Group, a national social landlord, who now manages approximately 60% of the current older people s sheltered accommodation in Hackney. Tenants have secure tenancies and usually have access to communal facilities. In some schemes where there is an estate manager, they will encourage and instigate, perhaps in partnership with a local voluntary organisation, social activities for residents. There is virtually no provision of private or owner-occupier schemes of supported housing for older people in the Borough. Anyone over the age of 55 years can apply to rent in a sheltered housing scheme. There is high demand for these properties which reflects the high demand for all types of accommodation in the borough. The pressures for one-bedroom accommodation may increase as benefit changes relating to unused bedrooms may cause more people to consider one-bedroom accommodation, wherever it might be available Supported Housing with Care and Supported Living Schemes A significant element of provision for older people within the borough is accommodation which has both housing support and care support available within it. These schemes have been known as Supported Living (SLS) and Supported Housing with Care (SHwC) schemes. Residents are tenants of the accommodation with the full tenancy rights. As a result of a recent review, these schemes are being integrated as one type of provision for those people who need additional support in order to remain living in the community. In order to access places in these schemes, an individual must require a minimum amount of social care support. In the case of SHwC, an individual must require a minimum of 10 hours personal care, as assessed by a care manager, although there are some people who have been living in these units prior to the introduction of social care eligibility criteria and still do London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 16

17 not require personal support. At the time of writing, there are 128 people are receiving care support in SHwC schemes in addition to housing support. There are potentially 401 places in SHwC and so there are a large number of people in these schemes who do not require social care support. Four of the units have 24 hour staffing. There are 7 SLS schemes, of which 2 are for older people with mental health needs. They provide a total of 152 places. As in SHwC, there is a partnership with 3 Registered Providers (RP) which provide the building, housing management and housing related support funded through Supporting People. Care is provided by the London Borough of Hackney. Access to SLS schemes is determined by an individual s need for social care support of a minimum of 18 hours. Thus, on admission, individuals are in need of a significant level of support. There are partnerships with a small number of social housing providers who act as landlords and the care support is provided directly by the Council s internal services. The total cost of SLS and SHwC schemes is approximately 6m of which 1 comes from Supporting People funding. As the schemes vary significantly in size, the costs are very different. The review of SLS and SHwC in 2012 estimated costs of individual schemes ranged from 249 to 610 per week, with one specialist unit for people with brain injury costing 741 per week. The costs of schemes have not been more recently reviewed Need for supported housing for older people Predicting the demand for supported housing for older people is complex. It is influenced by a number of factors; demographics, role of medical treatment that enable people to remain independent, the way that the NHS deals with conditions such as stroke and falls and, not least, by the availability of information and the prevalence of alternative and innovative models of supported housing. 10 Appendix 2 highlights these factors in more detail but the lack of extra care housing for older people in Hackney will inevitably affect demand and older people s perception and preferences, as many people will not be aware of such models. The Borough faces significant housing demand as many local authorities and particularly within London. It is the second most densely populated borough in the UK, after Islington, and its age profile is significantly younger than the UK average. 10 Understanding local demand from older people for housing, care and support, Institute for Public Care, Oxford Brookes University London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 17

18 In addition, 46% of the Hackney population has never married, compared to 23% nationally. Thus, these factors contribute to significant demand for housing, including one-bedroom accommodation, within the borough. Nevertheless, despite the relatively low numbers of older people compared to nationally, the population over the age of 85 in Hackney is projected to increase by 4% over the next 5 years at a significantly higher rate than the national average. This needs to be taken into account in determining the demand on services and the need for supported housing, particularly in the context of the role of extra care housing in maintaining people s independence. A major element of the strategy behind the development of SHwC and SLS has been to provide an alternative to residential care and, in this regard, the strategy has been very successful with Hackney having relatively low use of residential care. The Hackney model is based upon the extra care model of housing, which has been very successful in enabling older people to remain independent with improved outcomes and requiring less intensive interventions of health and social care. 11 However, a major difference between the normal model of extra care housing and the current model applied in the borough is the requirement that individuals need a minimum 11 International Longevity Centre, UK, Establishing the extra in extra care; perspectives from three extra care housing providers, Dylan Keale, Sept Improving housing with care choices for older people: an evaluation of extra care housing, Ann Netten, et al,, PSSRU, Dec 2011 London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 18

19 level of care and therefore are eligible for receipt of social care support. This is a very different model to the normal models of extra care housing, where the benefits of having a more varied range of needs from those who are very independent to those who need support, is shown to have beneficial outcomes for all residents. 12 The current model of older people s housing in the borough does not realise the benefits of extra care housing. Appendix 3 of this strategy summarises the research evidence about the benefits of extra care housing. As there is no other provision of supported housing in the borough, older people do not have the In the future, developments should be of housing suitable for option of making positive choices about where they older people rather than the more might live to enable them to age well and, if it is stigmatising older people s required at some point, they can also receive housing. It should be housing assistance. The option of supported housing is only which people look at and welcome with a wow rather than housing currently available when the need for care is where the underlying message is, significant and the range of choices is becoming far has it come to this? less to older people. People have to have Older people and Housing; Oxford Brookes University, 2013 deteriorated in order to access specialist provision in the borough, at present, and there is no pull factor to enable and encourage them to make a positive choice. The current model also requires that individuals rent their accommodation and there is no provision for people who might wish to buy or part own their property. A significant number of older people own their own home. In Hackney, according to the latest census data, published in February 2012, there are 4,600 people over the age of 65 who own their own homes. This is not an insignificant number of people who, were there options available, might find the option of buying or part-owning an extra care property an attractive proposition. It would enable them to actively plan for their later years and, at the same time, release family-sized housing into the market, of which there is a shortage in Hackney. Future developments of extra care housing for older people should not only consider the tenure of the accommodation but also the total size of the schemes. Most recent research on the benefits of extra care housing for older people focussed on schemes which, in the main, are significantly larger than those in Hackney. The largest SLS scheme in Hackney is 40 places, which is the smallest size of unit evaluated for the benefits, including cost benefits of extra care housing. Schemes of a lesser size are unlikely to provide the range of London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 19

20 opportunities and activities associated with extra care housing and will also struggle to run efficiently when there is a population with a range of needs for care. Older people s accommodation is generally onebedroom accommodation. When two-bedroom accommodation has been made available in Hackney, take-up of those units has been slow. This was the case in Century Court, a new development in 2011 for older people and people with learning disability. However, this scheme is only available for people with a minimum of care needs, which restricts the potential pool of applicants. There may also be potential for exploring whether ageing parents of people with learning disability would like Two-bed-room supported housing can provide support to ageing parents of adults with a learning disability whilst also being an important transition for the learning disabled person into greater independence and the time when the parent is no longer able to provide care and support. to move into such accommodation. In a later section, the importance is stressed of identifying families looking after adult children with learning disability and offering them the support to plan for when parents and family are no longer able to care. There are two major local schemes for older people which are coming on stream in 2014/2015. They will provide approximately 40 units in each. Discussions are taking place with the providers of the schemes, two major housing associations, to finalise the model of operation in the schemes. The discussions will draw on best practice and the experience of the providers in developing a wide-range of older people s accommodation to ensure that these schemes so that these schemes enable older people to make positive choices in planning for their later years and they maximise their independence through a sharp focus on promoting wellbeing. The development of genuine extra care housing provision requires that this is a priority within the Council s overall strategy for housing provision and requires a clear strategy across the Council to secure the sites, resources and partnership working to ensure the success of such developments. There is currently some potential capacity within SHwC which is currently being used as traditional sheltered accommodation. A review of this capacity with providers should be undertaken to identify potential developments of an extra care model of housing for older people. In developing new provision for older people, attention should be given to the standards set by the Housing our Ageing Population; Panel for Innovation (HAPPI) 13 which built on Lifetime Homes standards and which set out the importance of design for attracting older people who would not otherwise consider other provision. The report identified case 13 Commissioned by Homes and Communities Agency on behalf of the Department for Communities and Local Government and the Department of Health London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 20

21 studies which showed that a housing offer tuned to the priorities of older age can have real appeal, tempting empty nesters, and those prepared to plan for future care needs, to trade in homes that have often become a burden for something new. 3.3 Projecting demand for older people s supported housing There are a number of different models for estimating demand for supported housing for older people, based on population projections. A detailed approach is available in The Older Persons Housing Toolkit 14 and which projects need based on the population of over 75s. The chart below shows Hackney s current provision and the amount of supported housing that the model predicts is required in 2013 and This shows a predicted increase in total provision of circa 7.5% from 2103 to Form of provision Hackney current provision 16 Model requirement in 2013 Model requirement in 2020 Sheltered housing to rent Leasehold sheltered housing Enhanced sheltered Total sheltered provision Extra care for rent Extra care for sale Provision for dementia The model suggests a range of provision in sheltered housing, including opportunities for people to buy, which is not available in Hackney. One has to bear in mind that this model is focussed on older people, whilst within Hackney sheltered provision is available for people over the age of 55. Nonetheless, the total amount of provision of sheltered in the borough is in line with the model s projections but there is a lack of different forms of tenure which may prevent some older people from considering this option. In the above table, the Council s SLS provision has been listed as extra care for rent. However, there is no other form of extra care provision in Hackney and, if the assumptions 14 Appleton, N, in McCarthy and Stone (forthcoming). The Older Persons Housing Toolkit: Helping local authorities plan for specialist housing for older people 15 The population projections of people aged over 75, used in this table, is provided by the Greater London Authority and which the Council uses for planning services This does not include any projects currently being planned or in development London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 21

22 are correct in this model, there will be a shortfall in the total amount of extra care housing for older people, particularly approaching Thus, there is a need to consider not only the amount of provision available but different rental and ownership options. In 2014, there will be a unit opening in the borough for older people with dementia and this will provide approximately the amount of such provision that the model suggests for the present. However, there is a need to consider expanding such provision in order to meet the demand of a growing, very elderly population in the borough in just a few years time. Elsewhere in this strategy (see appendix 2), reference is made to how demand for any service is influenced by people s experience and knowledge of alternatives. As there is not a true extra care model for older people in the borough, people s knowledge of such provision 3.4 Our commissioning intentions for older people We will develop wider partnerships within the Council, with strategic housing colleagues, planning and procurement, to maximise the opportunities for developing new models of extra care housing for older people. We will identify with our social landlord partners, current sheltered accommodation which has potential for offering a wider choice to older people and which could be subject to proposals for redevelopment. New developments in extra care housing models for older people will offer wider choice to older people, should not be exclusively based on adult social care eligibility criteria and should offer opportunities for purchase, shared ownership and rent. New developments should incorporate the best design features, as proposed in Lifetime Homes standards and the Housing our Ageing Population; Panel for Innovation (HAPPI). Undertake a detailed review of all the processes and assumptions in the development of recent specialist housing for older people in Hackney with a view to incorporating learning into any new developments. is likely to be limited and there will not be a demand for it, unless it is stimulated. 3.5 Financial implications The anticipated increase in overall supported housing demand of circa 7.5% from 2013 to 2020 [as per section 3.3] for supported housing for older people in Hackney is likely to drive an increase in overall costs, estimated at circa M broadly based on a prorata increase if the current model operates. This will fall on the Council s Housing and Adult Social Care Directorates as well as local partners and individual residents. It is estimated that London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 22

23 changing the mix of provision as proposed, particularly towards an Extra Care model will help constrain this increase in costs for the Council by circa 0.5M compared to a no change in mix. London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 23

24 4. Mental health The importance of providing settled accommodation in aiding people with mental health needs to recover effectively is reflected in the national performance indicator that measures the percentage of people with mental health needs in settled accommodation. In this regard, the Council meets national targets reflecting its commitment to developing a range of provision through the Supporting People programme. In recent years, there has been growing emphasis on the recovery model within mental health. All our developments in supported housing should be designed to support this key objective Current provision In total there are 231 units of supported housing for people with mental health needs and the majority of the provision is through one provider. The units fall within the following levels of support; Level of support Number of units High 126 Medium 36 Low 69 The average cost per hour of support in mental health supported housing is similar to that in other client groups. The total budget available for mental health service users through Supporting People is 2.1m. The great majority of people with mental health needs living in supported housing do not receive adult social care support, emphasising the critical role that supported housing plays in maintaining vulnerable people in equilibrium. A recent survey within the borough estimated that by placement of individuals into supported housing, there was a cost avoidance saving of 500k to the adult social care budget in the financial year up to March Need for supported housing People placed in residential care for some time For several years, a key element of the supported housing strategy was to identify those people placed in residential care who could live more independently in supported housing. This strategy recognised that previous models of care within mental health services laid less emphasis on recovery and thus, there was much greater use made of residential care than is the case now. Analysis of the use of residential care for people with mental health needs shows that it has significantly reduced over recent years and in line with the greater emphasis on recovery. London Borough of Hackney, Supported Housing Commissioning Strategy, P a g e 24