Reshaping Sheltered Housing Services in Suffolk Clare Smith, Head of Supporting People, Lead for Early Intervention & Prevention

Key Strategic Priority  Enabling older people to remain at home  SP Strategy in “Current data suggest that there remains an imbalance between the availability of housing related support tied to specific (often sheltered or supported) accommodation, and support which is not. This is particularly true of services for older people.”

MORI Social Research Institute  Findings from 3,500 Suffolk residents ( ) with particular emphasis on issues that Older People have indicated as being important in order to help keep them at home:-  More choice of services  Do not want to move to receive the appropriate services  Consistency of services

Why we needed to change SP reviewed all sheltered housing services (213 schemes & 28 providers) & found: –Lack of equity across the county –Variable costs –Variable quality –Variable staff / service user ratio –SP grant funding non housing related support services –As much as 70% of residents did not need HRS –Poor VFM

What do we want ?  A shared vision  Wider Choice  Equity  Better VFM  Improved links with other key commissioners  Seamless services  Consistency

VSH Residential Nursing Individualised Care NABS – long term Dementia Sheltered H.I.A./H.P. N|ABS – Short term Community Alarm Assistive technology Joint funded/ Preventative agenda SP & Partners ACS/Health SP/ACS A Vision of the Delivery of Care and Support for Older People KEY Green font = Jointly funded Purple font =SP funded Blue font = ACS/Health funded Orange font = ACS/SP funded

Achieving the Vision Set up the Older Persons Project Group (OPPG) in Feb 2007 to:-  Develop the Vision & how to progress  Decide on options for sheltered housing –Option 1 – no change – cannot achieve the Vision –Option 2 – establish a baseline service to reflect actual HRS being delivered –Option 3 –– set up NABS pilot to look at alternative support arrangements and evaluate effectiveness Reported to Commissioning Body in July 2009

Very Sheltered Housing  Recommended 2 hours average hourly rate of £ SP saving approximately £1m pa.  SP working with ACS on revised specification and funding model that incorporates Personalisation – aiming to complete by Sept 2011 when current contract ends

Non Accommodation Based Support (NABS) – Pilot service Established in July 2008 at a cost of £300,000pa and operated for 12 months to 499 Clients & concluded:-  There is demand for a service but older people need to be very well understood to get engagement  Support required is mostly short term  Services delivered are essentially the same as for existing HFS  Networking and links to other services is key

NABS Recommendation That a ‘tenure neutral’ NABS service is established Aim to have in place prior to funding for sheltered housing being removed – delayed by CSR announcement

HIA and Handyperson  County wide HIA and HP service successfully achieved in 2009  A new contract let at a competitive price

Dementia Recommendation That services are developed with ACS and Health in line with the Suffolk Dementia Strategy.

Assistive Technology Recommendation  SP contributes to the establishment of a 24/7 Human Response service that can react to ‘unplanned needs’  Service model is being developed – partners include ACS, IBC, PCT, Ambulance Trust  Aiming to be established summer 2011 – will be chargeable

Sheltered Housing Legacy Position:-  213 schemes with 5300 units (3500 SP funded)  Support ranges from 0.23 hrs to 27 hrs pw  Support costs range from £1.24 to £51.77 pw  Average hourly support costs £14.20  Annual SP contract value £3.3m  Current annual cost to SP £2.6m (75%)

Sheltered Housing Recommendation:-  Establish a baseline support service  Fixed cost per hour for all services  Use Fixed Capacity Contracts  Exceptions <10 small providers  Independently assessed service for intensive/crisis support delivered by a NABS service  Keep a sole Landlord / Housing Management / ‘baseline’ Support Provider

Negotiating with Sheltered Providers  Agreed a “baseline” service specification with OPPG  OPPG recommended 1 hour support per person – SP argued for 30 minutes  Hourly rate calculated by collecting evidence of current salaries from Suffolk providers = £12 per hour  Contacted providers and tenants to obtain views on our proposals; –Revised specification –Likely cost of £4 - £6 per person per week based on £12 per hour –Move to Fixed Capacity Contracts & reduce admin –Phased introduction from April 2011

Revised Specification for a Baseline Service Providers28 Responses79% (22/28) Accepted in principle95% (21/22)

Proposed pricing structure Accepted banding £4 - £629% ( 8/22) Proposed £ £7.0018% ( 5/22) Proposed £ £10.007% ( 2/22) Proposed >£10.014% ( 1/22) No Alternative Proposal21% ( 6/22)

Tenants Written3283 Responses3

CB meeting in Feb 2010  Advised that the service specification had been Equality Impact Assessed (EIA) and should be approved  That negotiations continue with individual service providers to achieve £6.00 per week (30 minutes support) To authorise the SP Team to negotiate a unit cost of up to £10.00 for small providers. That Fixed Capacity Contracts are used Phased implementation – 50% cut in 2011/12, full reduction in 2012/13.  SP to hold a provider meeting to consider tenant consultation

Current Position  All providers have agreed to the new service specification and price.  Large providers = £6 per week, small providers £10  SP have informed tenants of changes to funding and letters approved by providers in advance.  Tenants are informed that whilst SP can affect the funding it cannot affect the service model – that is for the provider to determine in consultation with them. Many providers are engaged in this process  FCC are being drawn up based on last 3 years evidence – will be a tolerance of 10%.

What has been Achieved?  Consistent service specification across the county  Consistent price across the county  Clarity about what support can be expected in a sheltered housing service  No sheltered service has been decommissioned and it remains an option of choice  Ability for the provider and service users to determine what they want in addition and how this will be paid for  Additional housing support services to be made available for those tenants that need it  Good VFM and released savings of just over 50% for SP

What remains?  CB will not approve new services being progressed until we know outcome of CSR  Affects floating support for OP but we have a contingency plan  24/7 Response service is going ahead as SP is only one funding partner  FCC contracts to be issued and signed.

What worked well  Establishing the OP Vision – a clearly understood message as to what we wanted to achieve  Clear message as to why sheltered had to change to achieve the Vision  Establishing the OPPG – very inclusive & they “owned” the solution of a baseline service and one price. Also helped with tenant engagement.  Some incentives – new services & less administration  Clear sign off from CB and communication at every stage

What did not work so well  Timescale was too long – OPPG established in 2007 & took 2 years to report

END SLIDE