Adults

The Supporting People (SP) programme is still in its infancy in relation to similar funding and regulatory regimes. Many of the elements relating to the programme are still in development and will continue to be so for some time. The key themes in the strategy are based on the data and evidence we have to date and how we predict (based on knowledge of the sector and the council) the programme can realistically be delivered in Medway. These areas will continue to be developed and be given greater clarity throughout the course of the strategy. We anticipate that the overarching key objectives and outcomes will remain the same and as with the annual plan for 2005/2006 given priority, and Specific, Measurable, Agreed upon, Realistic and Time-based (SMART) objectives as the programme develops and understanding of need improves.

The key strategic objectives and outcomes for the delivery of the programme, and the annual plan for 2005/2006 are contained within appendix 3.

The key objectives and a summary of the action to be taken under each of these headings is summarised below.

Strategic Objective 1:

To shape the future of the housing support service in Medway

We will clearly define the parameters of the SP programme and ensure that providers and other funding agents are clear about unmet need in Medway.

Developing an understanding of need

Needs information is currently poor and Medway must set up systems for collecting ongoing information about client numbers and their needs to facilitate service planning.

We will agree on a common format for data collection, ensure that agencies understand the importance of collecting this data and, with the Housing department, will develop systems to provide needs information, which will link with the allocations process and forecasting.

We will work jointly with the Homechoice team, Community Services, Probation and Health to develop a single assessment process for all needs groups. This will include a common referral and nomination process for use by all of Medway’s supported housing providers. This process will enable access to all supported housing services with or without accommodation. This will dovetail with the existing single assessment process for older people. This process will ensure that priority support needs are linked to provision irrespective of tenure or landlord. This process will also enable more effective needs mapping and long term planning of services to take place. Data will be analysed on a regular basis for this purpose.

As part of developing these processes we will work closely with:

• Social Service;
• The Primary Care Trust (PCT);
• The Probation Service;
• Service providers.

In particular we will work with:

• The Teenage Pregnancy Co-ordinator to research the histories of young teenage parents to gain an understanding of their support needs and aspirations.
• Connexions to research needs of young people and advice regarding development of effective services to meet these needs.
• Community Services and the Health Promotion Team to conduct a comprehensive assessment of mental health needs, assessment of future mental health provision and review the cost effectiveness of current provision funded through health budgets.
• The Homelessness and Allocations section to ensure that assessment capability around the actual needs of clients presenting as homeless on the grounds of mental health, drug and alcohol addiction is improved.

All providers will be expected to approach the council for nominations to the majority if not all of their vacancies. Providers' steady state contracts will reflect this.

Providing clarity to partners and service users of the parameters of SP funding

The Medway SP team has produced a housing/support matrix which defines activities which can be legitimately funded through housing and supporting people sources. This document is based on guidance issued by the Communities and Local Government (DCLG) and has been widely consulted on in the Medway area. The matrix is contained within appendix 6.

Providing clarity to partners about gaps in service provision and objectives for future service development

In most areas of provision our services break down into high, medium and low level support. Our long-term strategy is to concentrate SP resources on low to medium support to encourage people to live more independently. By making this point we aim to encourage providers to shift emphasis away from institutional provision into community based support.

Our aim will be to re-focus resources on the provision of up to 16 hours of support for clients each week. It is important to note in this context that high level support needs are still strategically relevant to the council. This level of support is however outside the remit of SP and if a need is demonstrated and assessed this should then be funded as appropriate through both SP and other sources, e.g. social services and health budgets.

This strategy will impact heavily on provision for people with learning disabilities as the vast majority of provision currently involves high-level support. The focus of SP resource provision to a maximum of 16 hours per week is however compatible with the wider commissioning agenda within the council. In relation to people with learning disabilities this in principle enables access to SP services to all individuals who have a tenure and are assessed by Community Services as having needs identified in level one of the service specification and in some cases level two. This accommodates people who are able to live safe and fulfilled lives in the community with some support. Where care and health needs are also prevalent this may not exclude those individuals from SP funded services but will require those needs to be met through other funding sources, e.g. social services and health.

SP provision will concentrate on moving people, where appropriate from a supported housing environment to an independent home environment with housing related floating and outreach support services.

While SP funding will be directed at the medium to low support groups, SP will continue to commission higher levels of support, with the exception of residential care, through Community Services and Health funding. Section five describes how we intend to shift resources from high needs schemes to low to medium provision over the five-year life of the strategy, thereby increasing the numbers of people we will be supporting.

This strategy will impact on high-level provision for mentally disordered offenders, which is currently ten times the regional average. Instead Medway will increase the supply of floating/outreach support for offenders in general needs properties in consultation with Registered Social Landlords (RSLs) and other partners.

To a lesser extent provision for single homeless will be affected as high support services for this client group are limited. Savings from this group will however be directed at people with multiple needs and who are hard to place.   

Developing an understanding of supply

In partnership with the voluntary sector we will deliver a wide range of options and choice to clients combined with purchasing power to care managers. We will build an understanding of available provision through information sharing with other local authorities.

We will review the allocation of SP grant to schemes which do not meet our strategic objectives including:

• Schemes that are aimed at young people at risk, but exclude those with challenging behaviour.
• Schemes where there is no local demand and where vacancies are filled in the main through referrals from outside the area.
• Direct access accommodation by developing more targeted approaches to assisting people with drug and alcohol dependency issues.

Strategic objective 2:

To develop and promote effective services that benefit clients and make a difference

Getting more for our money

Our programmes will be capable of demonstrating good value for money and measurable success for Medway service users.

We will continue work with other local authorities through the South East Regional Implementation Group (SERIG) benchmarking initiative to build an understanding of market costs in the south-east and the scope of provision. Our aim is to develop an hourly rate calculation for each scheme through a standard formula. This will facilitate cost comparison between schemes and value for money assessment. The formula will be applied to all services. We will develop a committee membership and promote information sharing.

Where needs exceed the threshold of 16 hours of support, assessment of individuals supported by such services will take place to identify appropriate options for funding their support, e.g. other agencies such as Health and Community Services may need to top up SP budgets to provide the additional care/support which is not eligible for SP funding. This will have the affect of reducing our payments to very high cost schemes (e.g. mentally disordered offenders and high support learning disability schemes) enabling us to redistribute the savings to lower cost schemes.

By investing in lower cost support schemes and shifting expenditure from expensive residential schemes we will effectively spend to save in Medway. In order to achieve this the PCT and Community Services will consider a commitment to providing a top up to SP budgets over the five years of the strategy. If implemented this would result in an increase in SP funding and an opportunity to fund more support services. See Section five for further detail.

We will aim to shift the balance of expenditure from the current position:

to the following pattern:

We anticipate that our effective and innovative programme based on assessed need will encourage other commissioners such as health and Community Services to invest more widely. We therefore hope to see a gradual increase in funds from these sources as the benefits of our programme are demonstrated.

In addition we will work with our providers to re-model services and to re-direct funds to mutually agreed strategic priorities. We will also work with some of our more specialist providers to see if they have the capacity to accept clients with more complex needs, who have not been able to access services before. This will be facilitated through the scheme review programme and following review negotiations for steady state contracts.

Developing a broad range of options to suit the needs and preferences of individual clients

There has, in the past been an over-reliance on residential care and SP provides an opportunity to develop a range of services. We will develop a spectrum of support for each client group ranging from low level floating support through to supported housing offering up to 16 hours a week of support. Support will range from measures designed to alleviate loneliness and isolation through to specialist services.

It will be essential to assess the needs of each client prior to placement and to ensure that a support package is put in place from the outset. Where people are leaving residential accommodation, for example, the process of needs assessment and preparation for greater independence will take place well before they leave. For people in temporary accommodation it will take place through floating and outreach support services.   

We will increase our housing related support service to new extra-care provision to reduce the demand for permanent residential care.

We will consider and consult with service users in sheltered schemes to explore opportunities for delivering support (warden) services to this client group in a more flexible way. This will include diverting resources from service users living in sheltered schemes that do not wish or need to receive a support service to floating/outreach support or peripatetic (roving) services to older people living in the community. Such support will be based on needs assessment. We will also promote Tele-care services and advanced wrist-worn sensor technologies to extend options for people who wish to remain in their own homes for longer.

Our aim is to provide a range of support services including Home Improvement Agencies to enable older people to maintain their independence for as long as possible.

Developing ongoing user consultation to inform future service development

We are committed to listening to the views of all our service users and shaping our services in response. We will therefore:

• Develop a user consultation policy and mechanisms for ongoing user feedback.
• Link with existing consultation and user groups and where appropriate develop new groups to ensure consultation throughout Medway in relation to SP.
• Involve users in the review process, development and monitoring of services on an ongoing basis

Putting a robust review process in place

We will review all services on an annual basis. Our review programme will be developed in April each year as part of the business planning process to enable us to prioritise schemes based on our current knowledge.

Reviews focus on ensuring that the overarching aim of the programme, to deliver effective housing related support to enable individuals to maintain and increase their independence is being achieved. The quality standards on which providers are assessed are contained within the Quality Assessment Framework devised by the DCLG as a consistent model for quality assessment in SP services. This assessment framework includes ensuring that effective and appropriate support is being delivered in order to enable maintenance and progression of independence. This framework underpins the other methods of assessment contained within the review including providers meeting performance indicators and demonstrating they are providing good value for money.

The review framework principles and Medway’s approach to the review process and value for money assessment is contained within appendix 7.

We will use the outcomes of review to determine the future procurement of services.

Effective and appropriate procurement of services

Providers will continue to be encouraged to work with the SP team to improve service delivery and quality. Any action plans agreed with providers as part of the review process may in some circumstances be undermined by the need to re-tender services wholesale.

Most existing services are accommodation based with the support provision being an intrinsic part of the property or scheme. In such circumstances, the landlord is either the provider of support services or will have entered into a separate managing agent agreement with another organisation. Consequently it would be difficult to separate the provision of support from the accommodation for tendering purposes. It is also well recognised that there is a great shortage of affordable housing in the south-east and it may be complex to tender for both accommodation and support. We will only contract with providers where it can be clearly and consistently demonstrated that there is sufficient need for the service.

Medway will take the approach that following the conclusion of a review and discussion at Core Strategy Development Group (CSDG); the Lead Officer will make a report to the Commissioning Body. This report will include a recommendation on whether or not to continue the service. If the report recommends continuation of the service they will also make a recommendation on whether a new contract should be entered into with the existing provider. In order for a recommendation to continue with the service provision and the current provider to be made, the following must be demonstrated:

• The service meets, or will meet within three months (from the date of the final review report), at least a level C in the core objectives of the Quality Assessment Framework (Appendix 7);
• Accreditation is obtained by the service provider in accordance with criteria, set by the DCLG, the Commissioning Body and the council;
• The service has produced a clear, time bound action plan to demonstrate and ensure continuous improvement;
• The service provides or will provide under the terms of the new contract good value for money in accordance with the criteria established by the Medway Supporting People team.

The Commissioning Body will decide whether or not to adopt the recommendations of the Lead Officer. If the Commissioning Body decides to do so it will also recommend whether a new contract should be entered into with the existing provider. As a process this does not follow the standard procedures in the Contract rules but has been agreed as an exemption from usual procurement rules by Cabinet (decision ref 438/2004).

Where a provider fails to demonstrate the above requirements but the service remains of strategic relevance and a priority for Medway the contract will be re-tendered. Where the service is no longer of strategic relevance it will be decommissioned or remodelled prior to tendering. Any tendering would follow the standard procedures in Medway Council’s Contract rules.

Such a system of procurement will provide the basis for both continuity of the majority of provision and the opportunity for continuous development of high quality services that are increasingly responsive to the needs of the service users and improved value for money.

Improving performance and promoting continuous improvement

We will agree key performance indicators to monitor service outcomes with individual providers for them to incorporate in their own business plans. Wherever possible we will specify and agree measurable outcomes.

We will develop clear aims in consultation with service providers to raise Quality Assessment Framework assessed standards. We will also develop a risk assessment matrix to identify, classify and ameliorate risk.

Where partners are small organisations we will help to build capability in key areas e.g. business planning, risk assessment and performance management.

We will promote continuous improvement through:

• sharing best practice with other local authorities through our established benchmarking group;
• developing an innovations group consisting of service providers, service users and statutory partners;
• publicising good practice within individual schemes;
• organising training on quality and excellence.

Strategic objective 3:

To develop and promote accessible services which meet the needs of diverse groups

Providing effective move-on, resettlement and ongoing support

Lack of move on has been identified as an important issue for service users and service providers. Without timely move on for residents who are ready to move to more independent living situations, schemes become silted up and motivation is lost. We will work with the allocations team to develop a move on strategy which includes:

• engaging Community Services in a pilot scheme to introduce tapers, i.e. to pay a higher rate of SP at the beginning of a placement when more intensive support is required and lower rates later on;
• improving information to support providers about available housing options;
• developing a comprehensive web-based information system which maps provision and guides and informs users, advocates, providers and all others engaged in support and care;
• encouraging providers to restructure services (in consultation with SP and other applicable statutory agencies) to develop move on outreach services where applicable.

Maximising nominations to Supported Housing schemes and floating support services

We will work in partnership with the Allocations team to ensure that all nominations for support service provision are made through the allocations service and that Medway controls allocations to the majority of support vacancies. This system will ensure that; there is a clear policy which enables access to social housing and related support services to be co-ordinated via one system; those in greatest need of housing related support in Medway receive priority and that access to housing related support services is clear, transparent and fair to providers, users, stakeholders and the council. This system will also ensure that evidence of strategic housing-related support need is clearly identified and used to inform the contracting and decommissioning of services. Data collection will also be used to identify where services users are being imported or exported to and from Medway in order to access the services they need. Once such data is established this can be used to negotiate with the authorities concerned with regard to funding. This is also an objective of the Cross Authority Group (CAG) group.

The SP Team would like to see a more effective and needs driven approach to supported housing allocations including floating and outreach support. Better needs information is required at application stage to make an appropriate assessment and allocation. We wish for the grant to be used more flexibly wherever possible and would also like to introduce the option of service users being able to access higher or lower levels of support should this be needed. This may be particularly appropriate for older people and people with learning disabilities. (See paragraph 4.2.2.)

Where schemes for young people are excluding certain client groups e.g. Youth Offending Team (YOT) clients and Children Leaving Care it may be necessary in order to enable individuals with these needs to access services from which they are currently excluded to introduce a quota system, remodel the service or develop alternate provision. Any such developments will be agreed jointly between the Housing department, YOT and Leaving Care teams and will involve other specialist agencies as applicable such as Connexions.

Researching the ongoing needs of special needs groups

We recognise that many of our clients are vulnerable and may be difficult to engage. We will:

• work with our partners to develop plans to meet the needs of special needs groups;
• set targets and monitor the Black and Minority Ethnic (BME) user profile of special needs groups;
• consult hard-to-reach groups through a range of methods and develop a comprehensive and accessible consultation programme with service users and ongoing proposals for participation in service development;
• develop publicity materials in user-friendly format including picture format, audio and Braille geared to specific client groups, e.g. people with sensory impairment, people with learning disabilities.

Strategic objective 4:

To develop and promote multi-agency strategic partnerships at all levels

Developing partnerships at a strategic level

We will provide a fully engaged and committed partnership to deliver a co-ordinated multi-agency approach linking social care, health and housing. This senior level, strategic partnership will drive the commissioning, de-commissioning and remodelling of services in line with strategic priorities. The SP team is part of the same larger team which commissions statutory care services, this ensures that all commissioning matters are fully explored and debated in relation to their impact upon one another.

On a strategic planning level we will ensure that:

The Commissioning Body at senior level and the CSDG at an operational level will continue to monitor the key strategic objectives and outcomes including six-monthly review of the yearly business plan, risk assessment plan and contingency planning. The Commissioning Body includes the Director for Health and Community Services and the Portfolio holder Councillor Howard Doe, for Medway Council, the Chief Executive of Medway Primary Care Trust, and the Director of Public Protection, Performance and Prisons of the Kent Probation Area.

The primary aim of the (CSDG) is to enable the Commissioning Body to implement the SP programme for Medway by providing expert input to the strategic planning and commissioning of the programme. The CSDG will advise and report to Commissioning Body on all operational matters pertaining to the programme. This includes formulation and recommendation of the yearly annual plan for the programme.

Membership of the CSDG consists of the lead commissioners and/or managers in the council including agencies, with the primary responsibility for planning for the client groups covered by Supporting People. The CSDG includes all statutory and regulatory partners in Medway including, housing, health, social services, youth and child services, Connexions, Probation, and YOT. Two provider representatives are also elected to this group. The two provider representatives are two individuals are elected from the Supported Housing Forum to which all providers and key partners are invited to attend.

We will continue to encourage members to attend the CSDG on a regular basis and ensure that the group has a clear purpose and direction.

• External scrutiny is provided through regular meetings of the already well-established Supported Housing forum at provider level.
• The team is also subject to audit by the Audit commission and have to work closely to guidance issued by the DCLG.
• Linkage is developed to other forums, e.g. Race Relations Board, Crime and Disorder partnership and the homelessness forum.

Developing partnerships at an operational level

At an operational level we will:

• Develop linked processes and protocols with the Allocations service to ensure those in need receive appropriate support services enabling them to sustain their housing occupancy.
• Develop improved operational links with mental health teams through regular liaison particularly through specialist floating and outreach support workers. Improve communications by enduring joint attendance at key forums and develop individual contacts.
• Develop protocols for dealing with mental health and substance abuse (dual diagnosis).
• Require through the commissioning of services that all support staff are trained in the use of the Drugs Use Screening Tool (DUST) and/or other approaches and link vulnerable people at risk of losing their tenancies to treatment programmes through referral.
• Agree with the allocations team and statutory partners more effective processes and protocols to trigger the involvement of floating/outreach support in cases of anti-social behaviour.
• Raise the profile of floating and outreach support services and opportunities to access these for vulnerable individuals including those facing eviction as a result of anti social behaviour.
• In partnership with the homelessness team, ensure that all young people who become homeless are assessed by the Young Persons Homelessness Prevention Officer to ensure that support needs are identified and needs linked to provision.
• To work in partnership with the Leaving Care and YOT teams and the Housing Department and other agencies as applicable to develop a co-ordinated multi-agency prevention strategy for young people at risk of homelessness including resettlement services provided through the Connexions Team.

Strategic objective 5:

To develop and promote effective monitoring, review and administration of the SP programme

Continue to ensure effective team performance

• The SP Team will continue to develop their skills and expertise supported by the Lead Officer to ensure that they are able to meet the demands of delivering the SP programme in Medway. The Lead Officer will in turn be managed by the Procurement Strategy Manager to ensure that all procurement and commissioning functions are undertaken with due consideration and in consultation with appropriate stakeholders.
• We will streamline the payment processes and procedures and clarify payment issues, e.g. the position with regard to payments of SP grant to people who come off benefit and ensure compliance with the Data Protection Act.
• We will develop steady state contracts in time for the procurement of new contracts and agree long-term procurement procedures.
• We will ensure that each party formally sign memorandums of understanding.
• We will develop an annual SP business plan to drive the strategy and steer the work of the team.

Ensuring transparent and fair charging

In Medway, all providers will have and will continue to be issued with contracts, which will determine whether or not a service is chargeable to service users.  If a service is not chargeable, the SP Team will pay the provider the contracted sum, less an allowance for voids. The Grant Conditions make clear that Charging Rules should be transparent and fair. This means that they should not differentiate between services of an equivalent nature simply on the basis of the service provider or landlord. Such differentiation would be unfair to service recipients. We will ensure that our approach is consistent and subject to review. Medway Council’s SP charging policy and processes are attached as appendix 8.

Effective cross linkage with other internal departments and external organisations

• Improve communication between the SP Team and other colleagues including Community Services, Health and Housing to ensure that provision and funding are co-ordinated
• Develop a communication strategy aimed at ensuring that providers/ users/ statutory agencies and the rest of the council are kept informed about developments.
• We will incorporate SP material into Medway’s website to communicate with partners.
• We will encourage strong linkage between housing based support services and specialist care services to establish a continuum of support ranging from intensive support through to a light touch.
• Links and contacts are maintained and improved with the CAG and SERIG.
• Develop effective referral systems for all support services to partner agencies and visa versa.
• Work closely with CAG to:
  • To identify gaps in existing provision and jointly commission services for specialist or mobile groups.
  • To ensure that all CAG services are delivered to a consistent quality and represent value for money.
  • To share information on the contracting and commissioning of all services to improve our understanding of supply, value for money, procurement and to develop the provider market.

A CAG statement is contained within appendix 9

^ (back to top)