Modernising Supported Housing for adults with disabilities in Lancashire - the development of a county wide delivery plan

The council is taking a strategic approach to building a case for change. As a first step, staff decided to develop a housing needs assessment for this group, as part of the information needed to deliver the Council's recently published Housing with Care and Support Strategy.  

Council staff already had data about older adults aged over 65 but a lot less information about possible working age adult accommodation and care needs. 

The challenge

As a 2 tier authority working across 12 District Councils LCC has previously mainly offered accommodation in small shared households for working age adults needing support and accommodation. This is still one of the best ways of supporting some adults but a growing number of vacancies (over 200 out of a stock of 700 properties) suggests this offer isn’t suited to everyone’s needs.

The county council has a plan to address choice, access and under occupancy and wants to offer more self-contained accommodation with people able to have their own front doors near to community facilities.  LCC have found that compatibility issues within a shared house can be a major concern, as well as a desire to give this group an informed choice over who they live with.  Currently choice is often driven by housing availability.  

Furthermore, Lancashire has a historically high spend on learning disabilities and mental health compared to other councils. The current funding model used for supported housing does not provide value for money due to its complexity. Staff know that the current way the council is meeting demand is unaffordable for the future because of the current high vacancy levels and associated costs, allied with the high average weekly costs of support, and the particularly high 24-hour back up support costs for tenancies of three people or less.

There can be significant problems when someone leaves the tenancy in a shared house leading to gaps in funding for background support.  Very often, the council subsidises this gap until a new tenant moves in, but this can take months or typically years, with current vacancies in shared households leading to significant costs. Furthermore, if there is a Housing Management Agreement in place for the property, the council becomes liable for subsidising the rental cost of the vacancy.

As well as the cost to the county council, the costs to district councils are also considerable because existing shared households have higher than market rent claims for housing benefit in properties with exempt accommodation status  (This is a type of supported accommodation whose tenants are excluded from the social size criteria and benefit cap introduced in 2013 which limited the total amount of benefits that most out of work, working-age households can receive. Exempt accommodation is a category of supported housing created in 1996 to enable Housing Benefit to cover the additional costs of providing supported housing which enable higher than local reference housing benefit claims, Social care is funded separately. Find out more).

There is limited information currently to demonstrate what has led to these higher costs, so further research is needed to make sure this issue does not also affect any new housing with care option models developed (“The Supported Accommodation Review:  The scale, scope and cost of the supported housing sector”, estimated the annualised cost of the supported housing sector that is funded by Housing Benefit across Great Britain at the end of 2015 at £4.12bn.  The review also conservatively estimates that the additional annualised spend on support and care services (that is in addition to Housing Benefit spend) at the end of 2015 is around £2.05billion.).

Because of these issues LCC recognised the need to radically rethink and change its approach. Lancashire is not alone in facing the need to modernise the housing with care and support service offer for working age adults and local government best practice is now developing in this area.

Key facts about this service area in Lancashire:

• In the LCC area there are over 1,500 adults with a learning disability/autism receiving care and support in over 700 settings (mainly shared households with an average gross weekly cost of £928 per person)
• There are already @ 40 apartment schemes, in the 11 LCC district council areas, however very few match with LCC strategic intentions
• LCC is currently paying rent voids on 36 properties (costing £0.614million per year) and support voids on 71 properties (costing £2.37million per year)
• LCC has Housing Management Agreements with nine landlords
• Some HMAs have an Early Sales Clause. LCC estimate a typical penalty would be in the region of £30,000 to £60,000 per scheme
• Approximately 50 per cent of support providers invoice LCC for support voids, so the potential full costs could be more significant
• LCC has a large adult disability supported housing service with increasing numbers of vacancies.

The intention

The LCC Housing Care & Support Strategy aims to address these challenges and:

1. improve outcomes for individuals
2. enhance quality of life
3. reduce costs.

Lancashire intended to review and reduce the numbers of shared houses across the county, especially where:

• its uneconomic to modernise the properties
• there are incompatibility issues between people living in the property
• there are long standing voids at the property which is being subsidised by the council suggesting the property isn’t suitable
• the property no longer meets the needs (such as mobility) of the service users living there
• the service does not represent value for money.

As well as new alternatives to shared housing, LCC is considering new models as an alternative to residential care (which for this group of people can end up being a home for life, increasing institutionalisation and creating unnecessary dependency.)  There are people currently living in residential care who may want move to a community setting.

Lancashire is considering other options, for example Apartment Schemes. The council wanted to work with a partner to ensure this view is “checked and challenged” and so it worked with CHIP to find a partner to take on this role. It wanted to pilot the changes first with a specific group of people where data is more readily available so the approach could be more accurately tested. The same approach could then be used for other working age adults with care and support needs.

It is hoped that new style apartments will be more accessible to more people sharing background costs whilst providing an improved home with care offering more affordable, aspirational and sustainable supported living accommodation.

The models for new schemes will aim to:

• give people a real say about where they live, as far as reasonably possible taking account of the supply of suitable housing, affordability and their housing rights
• help people get their own home which is part of a local community, with security of tenure, private space and control over their own front door
• give people choice and control over how their care and support is provided
• with this agreed separately to their accommodation
• offer person-centred care and support which promotes independent living, helps people connect to their family, friends and community, and helps keep them safe.

The solution

To underpin the strategy LCC worked with the Housing LIN to develop a population housing needs assessment model, which provides an estimate of the amount of supported housing needed as a guide to future supported housing development, alongside the identification of unsuitable property. 

Firstly, existing data relevant to potential future need was reviewed, and then used to develop estimates of future need for housing or accommodation using existing data, alongside reasoned assumptions, drawing on local intelligence considering agreed LCC policy intent.

Data sources used included a combination of the Short and Long Term Support (SALT) returns and LCC’s internal data on service user numbers.

Population baseline

LCC produced a baseline population using the current primary adult learning disability population (which includes adults with autism with eligible adult social care needs and secondary data from adult social care data SALT return for 2017/18.)

Current housing/accommodation status

This data was used to create a model for each district identifying the accommodation status of the known current adult learning disability population.

Projecting the future population of people with learning disabilities

Secondary data from PANSI (data available to councils and provides estimates of population cohorts with social care needs) and local data was then used to model  estimates of population growth taking account of younger people with disabilities becoming adults (typically referred to as young people in ‘transition’) as well as the growth in older people with learning disabilities as people in this group live longer.  

Assumptions about the likely use of different housing/accommodation types were then applied to the estimated population up to 2030/31 to model projected housing numbers needed based on:

• assumptions in relation to population growth factors from estimated changes in the population cohorts in different settings
• analysis of the current housing and accommodation stock and offer to identify potential gaps and over/under supply of particular housing/accommodation options 
• the likely impact of LCC’s housing with care commissioning intentions. In particular:  

1. Planned decrease in the use of residential care. It is assumed that where the use of residential/nursing care is above the current Lancashire average of 4.5 per cent in a District, the intention is to reduce this use by at least 2 per cent by 2030/31.
2. Where the use of residential/nursing care is already at or below the this target it is assumed that the intention is to reduce this use by a further 1 per cent by 2030/31.
3. A trend towards further supported housing provision. There is assumed to be a reduction in the use of shared houses and growth in the use of self-contained flats based on one scheme in most districts by 2021, 2 schemes in most districts by year five, five schemes by year 10.  This assumes there are between 10-12 people living in each scheme.
4. It is assumed that there will be some ongoing need for access to mainstream housing with care/support packages and for more cost-effective supported housing where people are living alone with 24/7 care packages.
5. A likely gradual decline in the population living with older family carers because of changes in expectations of people with learning disabilities as well as older carers being less likely to provide ongoing care.

Lancashire intend to refine these assumptions using local qualitative intelligence, including the housing preferences of people with learning disabilities.

Outcome from the needs assessment

Between 18 per cent and 44 per cent of adults with Learning Disability and Autism are supported in shared housing at present across the 12 districts. Using the population needs assessment work LCC have modelled the following likely phased reduction in use of the older type of shared housing over next 10 years by this group of people.

Considering the population needs assessment and decommissioning plans LCC estimate future requirements are for up to an additional 498 units of accommodation.  As a result, the council set the following targets to make sure assumptions and progress can be monitored.

Vision and principles

There are three critical aspects to the vision for supported housing:

1. Size – the size of scheme has to balance not being institutionalised with economies of scale. Learning from other councils suggests that their ideal number in a scheme is 12 flats.
2. Location – within the community in order for the people living there to become part of that community and not to become segregated from it.
3. Culture – focused on maximising the independence, choice and control of people living within these schemes.  Support will be strengths based, designed around what an individual can do within a culture of positive risk taking.  So, for example employment opportunities are actively encouraged and supported.

The new apartment schemes care model - principles

• a different model of support for new apartment schemes based on an equal contribution from all people who use the background day and/or night support.  
• the county council does not expect to make any capital contribution to development costs or to pay for any vacancies within schemes.
• Lancashire are also using the following I statements to check new policies, procedures and developments against:

Success will be if people living in LCC accommodation say:

1. I have maintained or improved my independence, health and quality of life
2. I can make informed decisions and I am empowered by having choice and control
3. I am treated with dignity and respect and I have privacy when I want it
4. I am safeguarded and protected from harm and abuse
5. I feel safe and secure and my home is well maintained and looked after
6. I feel part of my community and I am able to maintain or develop relationships.

LCC have agreed that priority groups for schemes include:

• people with urgent risks and safeguarding issues
• young people transitioning from children's services
• people currently supported in unsuitable or high cost single tenancies
• people currently supported in one, two or three person tenancies where there are higher support costs than other services likely to be linked to compatibility issues between service users
• people in under occupied properties
• people currently supported in an out of country care home who may want to return to Lancashire and may be unaware of alternative options.

Implementation

1. There are several priority districts where LCC wanted to pilot the new approach in 2019/20, working in partnership with district councils, the NHS, service providers and key stakeholders.
2. The needs assessment is being developed with the public health Joint Strategic Needs Assessment team to produce an interactive dashboard of information on a district by district level. This will help district strategic housing leads understand the population needs assessment and the new strategy rationale.
3. Phase 1 will focus on a mix of urban and semi, rural districts. 2 new developments have already been approved.
4. To implement the change LCC has invested in additional capacity with 2 specialist project managers who will lead the implementation of the Housing with Care and Support Strategy for younger adults with disabilities. They will design new models of accommodation in line with the council’s strategic objectives and intentions and produce a business case to show that any new development will meet the needs and choices of people intending to live in the new style accommodation in a sustainable way.
5. In addition, a Positive Living Outcomes Team of social workers and social care support officers has been set up to work with people needing accommodation and manage nominations to the new types of supported housing. The team will work with housing providers to make sure that people needing accommodation and family members have a strong voice and are supported if they change accommodation. LCC have committed to not rush people into changes and to ensuring that advocacy services are available where best interest decisions need to be made about accommodation moves.
6. LCC are also reviewing policies including direct payments support planning and maximising occupancy policies to make sure these fit with the new strategy.
7. As part of the implementation plan, training and guidance on roles and responsibilities and new ways of working are being introduced in the new teams. Strength based assessments to maximise independence are a key part of this approach.
8. Lean processes linked to individual record systems across adult social care teams should assist Lancashire better manage of accommodation capacity for this group.
9. Lancashire aims to develop a Supported Housing Portal and pathway to create an up to date resource for both people and professionals to identify vacancies best suited to individual needs.
10. A new Approved List of providers who will support younger adults in supported housing is being set up. Providers will be asked to report on how they deliver against outcomes align with strengths base practice.
11. Lancashire also hopes to identify and co-produce specifications for new developments and identification of unsuitable properties tailored to the needs of 3 districts prior to scaling up across the county.
12. Lancashire has also supported several provider led initiatives that it makes sense to support in light of the strategy.
13. The council will review approved provider development plans with each provider to consider exit strategies if housing stock isn’t fit for the future so property can be sold, or reused, linking to other local district housing priorities.
14. Given the relatively small numbers of people with learning disabilities in some districts LCC decided to work with colleagues who are developing extra care schemes to see if there are locations suitable for people with learning disabilities aged over 55 who may want to consider extra care housing.
15. The availability of land and planning consent will inevitably affect where new schemes are located. The best locations will be identified with partners making sure the sites link to the strategy intentions.
16. Alongside the development of new accommodation LCC will review and remodel existing shared housing to maximise occupancy, reduce support / care costs and any void costs.
17. Other initiatives are planned including:

• Increased cooperation between service providers to make changes to night time support services
• Introduction of technology to offer new types of  support to people
• Networking support where shared households are in close proximity.

The impact

Looking at the current patterns and cost of support there is a significant cost difference in the cost of small shared households as opposed to small scale apartments.

Analysis of the cost of care and support in self-contained accommodation with “own front door” has highlighted a cost difference of between 20 and 30 per cent less when compared to the average weekly cost of care in a typical shared household. Another council that implemented this model of Apartment Schemes has made average weekly savings of between £295 and £600 per person.

Historically LCC has signed lengthy management agreements with private sector / specialist supported housing providers that have led to higher than market rent and service charges and void and / or early exit penalties. LCC will now take a fresh approach. For example, by measuring added social value, using a calculator like the Social Development Unit (SDU) calculator, staff will capture and quantify some of the environmental and socio-economic benefits (social value) associated with provider approaches.

How is the new approach being sustained?

Lancashire is implementing this approach carefully by piloting and testing the accuracy of the forecast assumptions in 2/3 districts. Hopefully this will mean that models of accommodation that are like by people living in them, affordable and fit for the future will be rolled out across the county in due course.

Lessons learned

Working with the “check and challenge” partner, the Housing LIN, has been beneficial, giving council staff an opportunity to learn from best practice elsewhere and to sense check the approach. The project has meant that LCC was able to produce a conservative estimate of units of accommodation at this stage, rather than exact types of accommodation required. 

Contact

Dawn Astin Service Manager

[email protected]

David Lovelady

[email protected]

Links to relevant documents

Housing with Care and Support Strategy 2018 – 2025

Further links