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to Agenda
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
- 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.
- 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.
- 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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