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ITEM EX9

EXECUTIVE - 26 NOVEMBER 2002

LEARNING DISABILITIES – SUPPORTED LIVING

Report by Director for Social & Health Care

1. Accommodation services for adults with a learning disability have been reprovided in line with the recommendations contained in the Oxfordshire Learning Disability Strategy adopted by the County Council in 1995. This re-provision has lead to the rehousing of more that 50 people from hostels into ordinary housing in the communities of their choice. From the original five hostels run by Social Services, only two remain. The purpose of this report is to brief the Executive on recent progress in this programme and to recommend that Marywood House Hostel be closed and declared surplus to requirements.

Background

2. The Learning Disability Strategy committed the Council to endeavouring to provide accommodation and support services, as far as possible, that gave choices to people with a learning disability about where they lived, and with whom. Services should move towards each shared unit of living accommodation having a maximum of four people with a Learning Disability.
3. It was agreed that the accommodation and support needs of every person living in the then five hostels spread throughout the county, should be assessed on an individual basis. Following this, as appropriate, people would be rehoused in ordinary houses, with staff support, to enable them to have the maximum independence, choice and control of their lives.
4. Working with each hostel in turn, people have been enabled to think about where and with whom they wanted to live through a process of re-assessment and care planning. They have then moved into accommodation in the community. Each individual has become a tenant in his/her own home with all the privileges, responsibilities, and security of tenure that that implies. The Supported Living Scheme now supports 56 people in houses throughout the County.
5. Three of the former hostels have now closed: Chalkwell Hostel, Banbury in January 1999: Eastfield House, Oxford in July 2000: and Dailey Hill House, Witney in October 2002. The hostels remaining are: Marywood House (Oxford), Stowford House (Shippon) and a smaller house in Fettiplace Road, Marcham. Not only has this programme marked a dramatic change in how services are provided, but there has also been an important change in the values informing the work in that services are individually tailored to meet the specific support needs of each individual in so far as is possible.
6. For the people who use this service the change has been significant. It is evident that each individual has experienced an improvement in quality of lifestyle in terms of independence, choice, responsibility, and the nature of individual support provided. All these improvements have brought challenges to people who were unused to expressing their needs and they have required much help to begin to use more fully the benefits they have gained. Not one has requested to return to hostel living. Carers were initially hesitant, as they saw this as a decrease in care. They have become more confident that this will not happen and are now very supportive.
7. In many ways the Oxfordshire Learning Disability Strategy was ahead of its time and providers of services in Oxfordshire have been steadily improving and raising standards to those which has most recently outlined been in the Government White Paper ‘Valuing People’. Two other changes have influenced this Programme as it has progressed.
8. The Care Standards Act 2000 has brought more stringent standards to registered care homes enforceable by 2007. To meet these standards Marywood and Stowford would have to reduce their capacity by up to 50% so that individual rooms could be enlarged. There would also be a requirement for significant work in other communal areas. It is estimated that the work to achieve registrable standards will cost £750,000 to £1 million for each hostel. If the occupancy is halved in each case, then alternative accommodation costs for up to 24 people will be incurred without any significant saving to cover these. Finally there will be costs associated with the alternative accommodation whilst such work is carried out as well as the consequences for the individuals involved. There has recently been some information to the effect that these standards may be relaxed. The details are not known at present; however, necessary maintenance to Marywood and Stowford, including complete re-wiring, re-plumbing and modernisation would incur costs of a similar nature.
9. Where the care provider is not the same organisation as the housing provider, it is not automatically necessary to register properties as care homes. The care provider would still have to register as a Domiciliary Care Agency, under a section of the Act coming into force on 1 January 2003. It must be established that the person receiving care is living in their own home and able to have an understanding of this. The introduction of Supporting People has enabled tenants to claim financial assistance for the support they receive in their own home. Additional funding for each individual who qualifies is significant: the last successful claim in this scheme was £300 per week.

Current Position

10. A year ago members agreed that the re-provision programme should continue at Marywood House. Assessments and care plans have been made for the 22 residents. During this period carers have been consulted on a group and individual basis and their wishes have been successfully integrated into the planned outcomes for each individual. Seven people have relocated as properties have become available. Two further houses will be available for occupation by mid November. Three people will move to individual placements. This leaves six people. It is intended that these people should move into temporary rented accommodation in the City before moving to a permanent house, which is their preference. Accommodation costs will be met through benefits. We are assured that permanent houses will be available by the end of March. From the experience in the closure of Dailey Hill in Witney, where a small group was left in the building, this temporary arrangement is a better option than leaving a small number of people behind in a big hostel.
11. Marywood House would thus become surplus to requirements from January 2003. The staff currently working there will continue to be re-located into the Supported Living Scheme to support people in their new homes.
12. The remaining hostel is Stowford House in Shippon with 19 residents, 4 vacancies and another 9 people in 3 smaller houses on the site. In addition there are 6 residents in one large house in Marcham, Fettiplace Road. So far assessment of future housing needs has revealed a picture unlike the other hostels. Approximately half of the residents in Stowford House would like to live in a smaller house on a more independent basis. There are however up to ten residents who have lived for many years in a hostel environment and have expressed a wish to remain in this type of provision. These residents are supported by the carers organisation, which is concerned that the best outcome for each resident should be achieved. These residents constitute the only demand for hostel accommodation that remains, and no new demand has been identified from new care management assessments.
13. The cost of bringing Stowford up to the registration standards by 2007 is £750k to £1 million, and again occupancy would fall by half leading to an increase in unit costs, plus a need for additional revenue to provide to those who wanted to move out. Even if Care Standards are relaxed additional costs will be incurred due to Health and Safety work, maintenance and refurbishment.
14. Due to the competing demands, it is not possible to propose a clear solution for Stowford at the present time. To maintain the current hostel will need additional capital expenditure. Not everyone wants to live in Supported Living Accommodation, leading to the need for some residual, but probably, short term, hostel arrangements that fulfil the new standards. The position on Supporting People income for placements after April 2003 is unclear. Therefore, it is proposed that after the closure of Marywood, a feasibility study is conducted on the future options for Stowford and Fettiplace, taking into account all Capital and Revenue costs and benefits, including any additional income into the service through the Benefits system this will be completed by March 2003. If, however, any houses do become available before April 2003, it would be cost effective to move people who wished to them, to maximise Supporting People income.

Financial Issues – Capital

15. The capital planning for this programme has been considerable, as properties have come in and gone out of OCC ownership. Below is a summary of the current position. These figures exclude any receipt in respect of Marywood, and any costs of refurbishing Stowford House.
    
    

    Expenditure	£000
    Refurbishment costs	285
    Property Purchases	295
    Total	580
    Income
    Net Receipts -Houses	781
    - Hostels	1,212
    	1,993
    Net Gain	1,413

This capital gain has gone to fund other areas in the Capital Programme and to contribute to offsetting overspend on the department’s revenue budget.

Financial Issues - Revenue

16. It is not possible to provide an equivalent statement on revenue costs and expenditure for the strategy to date. Whilst the savings following the closure of the hostels are easily identifiable, the costs of the alternative provision are more complex. Former clients of the hostels have moved into supported living schemes supported by in-house staff, supported living schemes covered by external contracts, adult family placement settings, and residential settings. Our systems do not track the costs of the former hostel clients separately from other clients.
17. The other complication in examining the revenue costs, is the impact on income levels under supported living. It has always been found that the average gross unit cost of supported living is higher than the average cost of a hostel placement. However, the tenant, and therefore the Council, can recover a far greater element of this gross cost through transitional housing benefit, so making the net cost to the Council less under Supporting People. Whatever saving that has been made under the current moves from hostels to supported living have contributed towards the £2m target for increased income from transitional housing benefit.

Financial Issues, Stowford House

18. The financial position is more complex for two reasons. Firstly, new claims for Transitional Housing Benefit under Supporting People can only be established up until 31 March 2003, and it is unclear how many residents will have re-located by then. Secondly, the final pattern of required accommodation remains unclear. Further work needs to take place with individual residents and their carers to identify the most appropriate outcome for each of them and the costs based on these. Following that a Feasibility Study on all the options and especially the financial implications will take place. A further report will be brought to Executive, before decisions are made on the future of Stowford House and Fettiplace Road.

Staff Issues

19. The original hostel staff have had to learn different skills to enable the people they care for to achieve the maximum benefit of Independent Supported Living. This has led to a revised staffing structure and further changes will be required to ensure that the service provided is not another form of residential care. There has been a need for further training, greater support and more flexible ways of working. The difficulties in achieving a fully staffed position is leading to changes in the methods of recruitment and to greater flexibility in employment contracts. The use of agency staff impacts on care and costs and necessitates action to minimise both. The transition from hostel to supported living has been difficult for some staff, but once they have become more confident with the new way of working, none of them would want to return to a hostel.

RECOMMENDATIONS

20. The Executive is RECOMMENDED to:

1. agree the re-provision of services formerly provided at Marywood House as described in the report;
2. declare Marywood House surplus to requirements;
3. note the issues surrounding Stowford House and Fettiplace Road, and agree to a Feasibility Study, including financial implications, on the future options for future consideration by the Executive.

CHARLES WADDICOR
Director for Social & Health Care

Background Papers: Nil

Contact Officer: Jean Carr, Assistant Director, Adult Service Provision Tel: (01865) 815565

November 2002

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