Delivering supported accommodationChallenges, considerations and cuts

Angie Boyle, Policy AdviserMental Health Providers Forum

Supported accommodation – Challenges,considerations and cuts

Angela Boyle MHPF

Me

Email A.boyle@mhpf.org.uk Angela.boyle@nhs.net

• Policy Advisor MHPF

• Head of ProgrammesCoalition for Collaborative Care NHSE

• TLAP

• Associate In Control

We lead a strategic

collaboration of “not for

profit Mental Health

organisations”

Linking strategically with

the Department of Health,

NHS England and Public

Health England aimed at

benefiting the strategic

development of the “not

for profit mental health

sector”.

“Minister I want a life, not a service….”

Gavin Croft 2014 to Norman Lamb Minister of State for Care Services

People with disability and long term conditions:Cuts to Personal income to support independenceCuts to housing benefitsCuts to social care

“Angie…what is social care?” “It’s the front line prevention service of the welfare state”

Localism?

•Hooray

•Boo

•Social care is the main activity of local government

Complex system?

•What actually is social care? – the best kept secret?

•Time for a new narrative - ??

•It’s the NHS who provide my care isn’t it?

Social Justice diminishing by the day?

•People in need just feel ‘lucky’ to have anything

•Most people pay for their own social care

•We are not a poor country, we choose to spend our money on other things.

Social services leaders commit to four-year campaign to secure funding Association of Directors of Adult Social Services calls for social movement to build public support for a better deal

social care as a social movement

Harold BodmerFormer President ADASS

Care Act 2014

Parity of access.

Suitability of accommodation central to wellbeing

5YFV 2014

5YFV mental Health 2016

10 year journey

Among other things decent place to live, job

and relationships

Integrated

Personalised

Commissioning

18 sites

2015-

Housing White Paper

2017

Transforming Care including

housing programme

Sustainability and

Transformation Plans

44 STPs main vehicle for transforming health and

care services

Public Health

Framework

Positive ……………….Policy framework

Strengthening the case for

supported housing:

the cost consequences

Resourced, Appropriate Accommodation

Quality – investment in both Psychologically Informed environments

Co-production – adoption of co-production with people and other expert advisors

Staff recruitment and training – investment in the recruitment and development of staff

Policy Informed Practice

Basic Ingredients for successful supported accommodation

Mental health and Housing report 2016

What exactly do we mean by supported accommodation?

Although residential and nursing care may be coming back, the reality is it’s never really gone away.

Cost and savings

“Very broadly, the evidence for people with mental health problems indicates that either individual or shared supported housing options are lower cost than residential care homes (Jarbrink et al, 2001; Beecham et al, 2004; Priebe et al, 2009; Knapp et al, 2014; Killaspy et al, 2016). For people with a learning disability, the picture is less clear; some studies have suggested that individual or shared supported housing options can be higher cost than residential or nursing homes (Hallam et al, 2006; Roe, 2011a; Roe, 2011b) while others provide examples of supported housing options costing less than residential care (Department of Health, 2009; Association for Supported Living, 2011, McConkey et al, 2016).”

NDTI Housing Discussion Paper 1 2017

Between the rhetoric and what our members and overall sector are telling us and experiencing….

Reduced stock

• Social housing Right to Buy

• Housing subsidy grant disappearing

Income challenges

• Introduction of Universal Credit

• 1% rent reduction

Impact on vulnerable people and

prevention services

• Paralysis in development

• Local Housing Allowance Cap

And a key enabler to sustained wellbeing .... Social Housing

Impact for people in need of social housing…

LHA issues are resolved via a

ring fenced fund

We think it’s problematic since no agreements about how this will pan out locally

and impact on particular groups.

HCA ramping up focus on VFM

No issue in principle but

must bust the myth of great

affluence

Universal Credit having negative

impact on people

Less Hostile -Opportunities to

build more houses and

increase borrowing BUT 1% rent cut still

in place until 2020 when new rent decisions will be made

People with mental health problems - most live in private sector provision with little protection. And also live in their own homes

National living wage

Sleep in payments

Increased

Regulation fees

Apprenticeship levy

Reduction of fees from statutory

funders – less than care costs

People:Reduction in supportIncreased threshold

for eligibilityReduced income Reduction in life

chances

And the current approach to dealing with all this …

Radical change needed

Entrenched paternalism

Rationing

We cannotAfford the currentWay of being so a 21st century approachneeded

The state isResistant to Choice and Control and Letting go

Rationing is the primaryApproach in most areasAnd increased control

Health and social care integration at a system level…

Another form of structural or financial re

engineering?

The key to greater efficiency?

Improved system for people? Less handoffs, less complex funding,

easier to navigate?Service providers given

greater flexibility?

Integrated Personal Commissioning• Sites so far……Stockton, Luton, Cheshire, Gloucester, Hampshire, Lincolnshire, NEW Devon, Portsmouth,

Somerset, Torbay, Tower Hamlets, Birmingham, Herfordshire, Islington, Notts City, Sheffield.

Integrated Personal Commissioning will be the main model of care for 5% of a local system’s population, including people with multiple long term conditions, people with severe and enduring mental health problems, and children and adults with complex learning disabilities and autism (NHSE IPC)

…Personal Health Budgets

‘No society has the money to buy, at market prices, what it takes toraise children, make a neighbourhood safe……The only way the world is going to address social issues is by enlisting the very people who are now classified as ‘clients’...and converting them into co-workers, partners and rebuilders of the core economy.’ Edgar Cahn

“The introduction of new models of care that deliver better health and wellbeing outcomes for people and a better experience when they access services, depends significantly on the commitment, understanding and ambition of local leaders, all health and care providers, the voluntary and charitable sector and communities themselves. “ Personalised health and care 2020 – a framework for action. Gov.uk

INNOVATION ON OUR DOORSTEP..…..

Woodsend Court IAS Trafford Housing12 Apartments – 6 for people with additional Needs6 for good neighbours

Accommodation centred support for Improved mental health

Organisation Timebank

New technologies the new frontier and the panacea?

Will transform tasks, enhance lives…. But not at the cost of human interaction...

acknowledgements

• InControl

• Simon Duffy Centre for Welfare reform

• MHPF members and associates

• IAS, Dimensions, Certitude, PSS

• NHSE IPC programme, C4CC

• Chris Hatton University of Lancaster