NDTi Response to Government Supported Housing Consultation
NDTi believe in people having choice and control over where they live and the support that they receive. Through our work across the UK with older people, people with learning disabilities and people with mental health problems it has become clear that despite the range of housing options that exists for people with support needs, there is still an over reliance on traditional forms of housing and support such as residential or nursing care.
Although current health and social care policy and legislation emphasises person-centred approaches and use of community based options (e.g. the Care Act 2014), and discourages residential settings which are segregated from family and communities, this does not appear to be having a significant impact on current patterns. Indeed, it appears that we are currently seeing a shift away from options that offer choice and control, towards more traditional residential care – with these developments being implemented on the rationale that residential care is lower cost.
The housing and support model on its own cannot lead to or block people’s inclusion in the community, as that is also significantly influenced by the staff and management practice of the support provider. However, the model can influence the possibility of community inclusion being achieved. The extent to which a person’s housing is part of the community, appearing physically and visually to be no different to that of other citizens, will impact on how the person is seen by other community members and thus the potential for them being accepted as an equal community member. Transport links and local employment opportunities also need to be taken into account.
There are indications that alternative housing and support options which, we argue, offer greater levels of social and community inclusion, choice and control can be provided at comparable or lower cost than residential care, but the evidence is both minimal and limited in quality.
We therefore welcome this paper, which sets expectations for local authorities and commissioners and offers certainty for investors and providers which will stimulate the market.
We welcome the proposal that local authorities work with other agencies to identify local need and set a strategic plan stating how they will meet the identified need. We agree that this should link with other plans that involve tenants of supported housing, including social care, health, education and employment. We also welcome the suggestion that plans should take a collaborative approach and include a range of organisations, tenants, families and communities.
We believe that the following recommendations will support the effective implementation of the ambitions in the supported housing consultation.
- Addressing the lack of evidence to inform future commissioning.
There is insufficient evidence to show which types of housing and support are most cost effective when people are also receiving significant care and support i.e. the outcomes achieved with and for people compared to the amount of money spent. We would welcome further research into the cost effectiveness of different housing and support models to inform and influence future commissioning.
- The development and provision of resources and training to enable commissioners to take more informed decisions about housing and support.
Our experience suggests that most local authority commissioners are unaware of many of the possible housing and support model options and even less aware of the evidence of impact. We therefore recommend that Governments, together with representative bodies of local government and the NHS, invest in a significant programme of work to inform commissioners of the different housing and support options that are available, the evidence base behind them, and the impact of each on rights, choice, control and inclusion. People who are reviewing their housing options and requiring support may also benefit from clear information to ensure they are able to make informed decisions. In addition to written information about the range of housing and support options, independent advocacy services may also ensure people are aware of their rights and have choice and control over where they live and the support they receive.
- The development and provision of resources and training for providers to enable them to both understand different housing and support options and also to maximise people’s rights, choice, control and community inclusion within the current legal frameworks. Our experience suggests that a similar lack of awareness about different models and a belief in limited or non-existent evidence applies to many providers. For example, in the series of housing papers by NDTi (see link below), we have been contacted by providers using inaccurate definitions and asserting evidence of cost effectiveness which, on examination, did not exist. We know from our relationships and work with them that many providers would seize the opportunity to explore different ways of working that increased personal autonomy. We additionally recommend that Governments and representative bodies of commissioners and providers should work together to develop and promote best practice materials and knowledge about how, within the current legal framework, housing and support providers (with support from commissioners) can change their practice and service design in order to increase rights, choice, control and community inclusion.
We are grateful for the opportunity to comment on the supported housing consultation.
The proposals to plan and deliver supported housing strategically and transparently are welcome.
- We support the ambition to see local planning commissioning and services that work to meet local need, ensure fair access, support collaborative working, promote delivery to a decent standard and encourage innovation in commissioning.
- We hope that this new way of working will enable people to have increased choice and control over where they live; support increased community inclusion by offering a range of innovative alternatives to traditional care and support.
- We believe that the recommendations set out above will support the effective implementation of the plans and improve quality of commissioning and services nationally.