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Supporting People Strategic Review of Older People’s Accommodation Based Services in Oxfordshire – Summary report

Recommendations

It is recommended that the

(a) recommendations of the Supporting People strategic reviews of Older People’s Accommodation Based services for Cherwell, Oxford, South Oxfordshire, Vale of White Horse and West Oxfordshire are agreed

(b) the Core Strategy Group indicates whether or not, following completion of the strategic review and the Commissioning process, the partnership should seek to achieve standardised county-wide responses to and procedures for the issues set out in 5.1 – 5.6 below

(c) the Commissioning process following completion of the strategic reviews should be carried out in consultation with the relevant District and the City Council and taking account of any related recommendations in individual review reports

  1. Purpose of Report

    1.1.
    To summarise the conclusions of the District and City led strategic reviews of Older People’s Accommodation Based services in Oxfordshire, to identify cross-county issues and to propose a way forward.

  2. Background

    2.1. The purpose of the reviews was:

    2.1.1. to evaluate existing Older People’s accommodation-based, housing-related support services in each of the local authority areas by considering whether they met with the requirements of the Supporting People Strategy 2004 to 2009 and other relevant strategic objectives of the commissioning partners

    2.1.2. to compare needs data with service data in line with the agreed standard framework and as appropriate for the client-group in question

    2.1.3. to assess value for money of existing services against agreed benchmarks

    2.1.4. and to propose a commissioning plan for the future direction of services which could meet the target of at least 15% savings on existing contract values over a period to April 2008

    2.2. Summary of vision for these services in 2009, as set out in the Supporting People Strategy 2004-09.

    2.2.1. Services will be available to those in need regardless of tenure

    2.2.2. There will continue to be resident wardens at sheltered housing schemes in West Oxfordshire where this is in keeping with the needs and wishes of existing sheltered residents

    2.2.3. Referral routes for services will be integrated with existing housing, health and Social and Health Care referral routes

    2.2.4. Services will be integrated with other support functions such as Home Support to streamline service delivery

    2.2.5. Accommodation will be of a sufficiently high physical standard to enable physically frail and mentally infirm older people to live there

    2.2.6. Details of how each review was carried out and the conclusions reached can be found in the individual strategic review reports produced by each local authority.

  3. Summary of Individual Review Conclusions

    3.1. Cherwell District Council

    3.1.1. Findings

    3.1.1.1. The most common reason for elderly applicants attaining priority is medical grounds; therefore this is a good indicator of the level of support needs. There is no shortage of interest from Applicants for Banbury, Bicester or Kidlington and there is no significant unwillingness to consider flatted accommodation. 93.7% of elderly applicants are seeking a minimum of a one-bed property. For villages with sheltered housing there are a total of 196 applicants. There is significant interest for accommodation in villages where there is currently no sheltered accommodation. This demand could be met in part through wider floating support service. 59% of applicants expressing interest in village schemes will only consider a bungalow.

    3.1.1.2. 79.2% of elderly applicants currently reside within Cherwell; 4.3% reside elsewhere within Oxfordshire, and 16.5% live outside of the County.

    3.1.1.3. North Oxfordshire PCT comment that the PCT is not currently engaged in joint work with providers regarding assessments for potential sheltered housing clients and it is apparent that more can be done to strengthen associations in order to better meet the needs of vulnerable people in a supportive environment. The PCT would welcome an opportunity to discuss potential joint working in more detail. Social and Health Care confirm a strong interest to include extra care housing within any reviews of sheltered provision as it would not seem right to develop these separately, particularly if we are looking to be able to offer people technology and care that will enable them to remain in their own homes rather than moving to a care home. They also wish to have a strong operational team input but realise that resources are stretched at present. They too welcome the opportunity to discuss possible joint working in more detail.

    3.1.1.4. In order to achieve a 15% saving on current Supporting People funding for sheltered housing in Cherwell a total of £101,447 needs to be found. Options involving de-commissioning and reprovision, no matter how desirable, cannot be achieved without significant consultation with residents, their carers, and providers’ staff groups.

    3.1.2. Cherwell Recommendations

    3.1.2.1. Finalise assignment of contract from CDC to Charter ASAP.


    3.1.2.2. Facilitate discussions between Banbury Homes and Charter regarding potential stock rationalisation.

    3.1.2.3. Facilitate discussions with all providers as to what is deliverable in terms of a minimum 15% reduction in Supporting People Funding.

    3.1.2.4. Hold further discussions with providers regarding potential for decommissioning/ re-provision of schemes identified in this report.

    3.1.2.5. Undertake a "Best Value" review of both warden and community alarm services.

    3.1.2.6. Discuss with Supporting People team how to approach consultations with a view to discussing and considering prospective solutions in context of timetable for budget reductions.

    3.1.2.7. Agree methodology for onward consultation with staff, residents [and their carers].

    3.1.2.8. Confirm to providers that moving to a Floating support service is required in order to address Council’s strategic aims in that it aids individual freedom and delivers a better use of scarce resources.

    3.1.2.9. Utilise general housing needs "gains" from de-commissioning to improve "move on" for other vulnerable housing applicants.

    3.1.2.10. Advise Supporting People team to award short-term contracts pending outcome of discussions and consultations outlined above.


    3.2. Oxford City Council


    3.3. South Oxfordshire District Council

    3.3.1.Bedsits are unpopular and no longer meet older people’s needs and expectations. They should either be remodelled to provide larger sheltered accommodation or decommissioned for sheltered housing.

    3.3.2. Most older housing applicants wish to live in the market towns and larger villages. Sheltered provision should be concentrated in these areas.

    3.3.3. Community support for older people should be encouraged, and older people living in the community should be encouraged to use the communal facilities and social opportunities available in sheltered schemes.

    3.3.4. If an extra care scheme is needed, this should be located in Didcot and should meet the needs of South Oxfordshire and Vale of White Horse.


    3.4. Vale of White Horse

    3.4.1. There are no recommendations for changes to the existing pattern of services or to the provider market at the present time. The options listed below should be explored during the life of the new contracts
    • Achieve savings by excluding tenants who sign a disclaimer with effect from April 2006.
    • Achieve savings by introducing two tiers of service and payment, low and medium.
    • Supporting People agrees the level of service it wants and what it will pay for this service

    3.4.2. The contracts should be adjusted according to the methodology outlined in the report. Details of the contracts will be discussed by the Supporting People team with each provider.

    3.5.
    West Oxfordshire

    3.5.1. Due to the low level of provision of existing services for older people, there should not be an overall decrease in the number of units

    3.5.2. There is a need to improve the standard of accommodation at a number of sheltered housing schemes
    .

    3.5.3.
    A basic minimum level of service should be specified with provision for enhanced levels of service to meet need for greater support

    3.5.4. The way in which the service is delivered must enable effective delivery of the service specification at all times and this may require support staff to be resident on certain schemes where this is necessary to ensure that the service meets with the particular support needs and reasonable expectations of service users resident at that scheme

    3.5.5. Transitional funding protection until April 2007 is proposed in respect of service users who, although assessed as not needing the service, are in receipt of the service as at April 2006, subject to sufficient financial resources being available and subject to annual review

    3.5.6. An extra care housing scheme of between 30 and 40 units should be commissioned when appropriate. The preferred location in the Wychwoods.

    3.5.7. The need for a new community support service that is non tenure specific has yet to be established and further work to establish whether there is a need and for what type of service is recommended

    3.5.8. The benchmark hourly support rate of £14.28 should be used as the basis for service negotiations


    3.6. All of the above proposals are considered to be a strategic fit with the Supporting People Strategy 2004 to 2009.

    4. Financial Implications

     

    Platinum Cut expenditure*

    £

    Target 15% reduction

    Estimated cost of future services

    Can target be met?

    Cherwell

    676,938

    101,447

    557,395

    Yes

    Oxford

     

     

     

    Yes

    South Oxfordshire

    569,227

    85,384

    (a)

    Yes

    Vale White Horse

    911,880

    136,782

    170,243

    Yes

    West Oxfordshire

    260,544

    (b)

    260,544*

    N/A(b)

    Total

     

     

     

     

    *This figure includes HIA and community alarms expenditure. These services do not contribute to the target 15% reduction.
    (a) Figures have not been supplied for us to estimate this
    (b) West Oxfordshire does not have to achieve a target reduction in expenditure due to low levels of provision

    5.Points of discussion


    5.1. Assessing the need for support. Many providers only assess a resident’s support needs after s/he has taken up residence i.e. there is a pre-supposition of need before it has been evidenced. Discussions about an objective model of assessment did not reach a conclusion in the time available, but this should be developed during the course of current contracts, in consultation with all providers. (Many have their own models, and best practice could usefully be shared).

    5.2. Only funding those in need of the service. Providers would no longer receive subsidy for service users who receive a service that they do not need or decline to use. There are issues about the preventative nature of these services and the changeover might need sensitive handling.

    5.3. How to classify support levels. Sheltered accommodation falls within the definition of low to medium support i.e. between 2 and 5 hours per week. However, it might be seen as desirable that there should be a basic minimum level of service and additional levels of service within these parameters available on a menu type basis so that if a service user’s level of need increased either short term or long term, they could receive an enhanced level of service. (This could be achieved by Supporting People paying a fixed price for provision of whole service for period of contract and it would then be up to providers to manage the provision of flexible services within this contract price.) As with 5.1 above, this has not been fully explored, but it is recommended that a model should be developed.

    5.4. Minimum standards for sheltered accommodation. It is proposed that it should be a contractual condition that the service provider must show that they are taking active steps towards achieving the model standard.

    5.5. Decommissioning of services. It is proposed that there should be an agreed set of principles for how to do this properly.

    5.6. Community support model. This is an ambition of the strategy for this group of services (see 2.2.1 above). Questions to be answered in designing such a model include the following: What is the level of need for a service to be provided to older persons outside of sheltered accommodation? What should that service be? What is the need for a new support service for the mentally infirm?

    6. Reasons for recommendations

    6.1. Because of the age and vulnerability of many recipients of these services, it was acknowledged that the pace of change might be slower than might otherwise be desirable.

    6.2. The need to fit with the budgetary cycle of providers was a time pressure, which limited the opportunities to address some major issues.

    6.3. There was a strong interrelationship between other strategic reviews being undertaken, especially Community Alarm Services.


    6.4. It should be noted that Providers have played a key part in the achievement of these reviews, and their cooperation has been valuable. Individual review reports contain various recommendations as to how the commissioning process should be carried out after completion of the strategic reviews in order to ensure that the savings are achieved satisfactorily and without compromising the future quality or performance of services.


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