Paris or Bust…..
Earlier in November I attended the 1st Expert Consultation on Integrated Services and Housing in Paris. It was an international affair – with delegates from across Europe, USA, Australia, Japan as well as a number of representatives from the UK. The focus was on what integration of housing and services might mean, and critically what it might achieve in a universally understood climate of austerity. The consultation was arranged by the OECD and it is hoped that this will raise housing further up the agenda of the member nations, and has been driven through the social policy focus within the OECD.
This was my first experience of this kind of environment, and I felt that the UK is in a positive position to both contribute significantly to the debate – but also there was much to be learned from both the approaches of other countries to service delivery and configuration as well as understanding how policy development is informed. The focus on prevention in services inherent in the UK Supporting People agenda is of interest to European Union – and it is anticipated that this will drive some European Funding opportunities around prevention going forward. In addition, much of our work around cost benefits of intervention, understanding of social return on investment and early forays in Social Investment Bonds are either of interest or being mirrored in other countries.
The Housing First model was discussed at the OECD event in some detail, and I was reminded of the prevalence of this model in the US and across large parts of Europe. As yet it remains limited in its application in the UK, and for those with an interest in what this might contribute to our debate on how we deal with homelessness then the origins of the model and its founder Sam Tsemberis can be found here. I had first encountered Housing First through some discussions involving Nicholas Pleace, a leading Housing academic from York University. Nicholas produced a report (Demonstrating the Effectiveness of Housing Support Services for People with Mental Health Problems: A Review) was published by the NMHDU and brought together some of the challenges for the future funding and development of housing support. He focussed on the comparison between the wealth of data and longitudinal research, particularly in the US, which has driven investment in new models and ways of working. His comments are particularly pertinent when we look at the new challenges of seeking to engage new commissioners with housing support, without the back up of this detailed longitudinal ‘evidence’ base.
However, as our work on data has demonstrated, there remains a solid commitment within the sector to continue to evidence our work through the collection of common data. This week Sitra has launched a survey to all commissioners to prepare for the collection of national data in next Spring. Anyone wanting to know more about this essential project check out our pages on data – or get in touch directly.
Things are changing thick and fast out there! Sitra, like many others in the sector, are thinking through the implications of the significant changes at the ministerial table, and recognising that the next few weeks and months will be very significant in understanding how those with new ministerial positions will respond to their new role. Will the direction of travel remain the same, or will we experience some seismic shifts in direction. For those of you who like spreadsheets, a complete listing has been posted by the Guardian and can be found here.
For those of you who want a shorter list of some of the changes of faces directly connecting with our sector – see below:-
|Department of Communities and Local Government
|Department of Health
|Department of Health
||Minister of State for Care Services
|Department of Work and Pensions
||Work and Pensions Minister – Disability
|Ministry of Justice
||Lord Chancellor, Secretary of State
In addition there have been a number of changes of Parliamentary Under Secretary posts within key departments, and at present there are no clear listings of specific responsibilities allocated to ministers. Updates to follow.
I spent yesterday at one of the Sitra Festival of Ideas for Personalisation with a fantastic and inspiring group of housing support service users, providers and commissioners talking through the hopes and challenges of personalisation. I took the opportunity to ask those delegates what questions or comments they had for the incoming ministers, and whilst this clearly does not cover all their thoughts – the key concerns on their agenda included:-
- Joint commissioning is not working as effectively as it could. Will the push towards Community Budgets continue, and will they see the true joining up of a localities approach to prevention?
- Constant squeeze on budgets is meaning that organisations are for going staff training and development. Do ministers recognise the need for a well qualified staff to ensure quality and safeguarding remain high on the agenda.
- Will any new directions for government retain the focus on personalisation? If so, how will the new ministers explore the relationship between the impact of welfare reform on vulnerable peoples ability to take up the mantra of ‘choice and control’
Going local has been the driving force of the last two years, and in many ways the answers to these questions may be beyond these new ministers, as they will lie with local decision makers, providers of services or the users of the services themselves. However, as all the talk of central directives to address stimulus take hold, it seems unlikely that there will not be a strong push from the centre in one way or another around these issues, in some shape or form which have a direct impact on the lives of our clients, the work of our members or the economic circumstances of our funders.
There are no great surprises to those working in the sector, that as cut backs hit elsewhere, the level of need, and the complexity of issues experienced by clients arriving at services continues to increase. I have been struck by the variety of responses from providers, commissioners and service users as to how to respond to this ever challenging agenda – and to share a few examples of this.
Firstly, a brief reflection on the recent increased interest in an approach to provision looking at the Psychologically Informed Environment. I recognise this approach is not brand new. Guidance issued in May 2010 DCLG and National Mental Health Development Unit giving a detailed overview of this approach, and including some excellent case study examples about how organisations were taking this forward. The fundamental premise for a PIE is that it is run in a way which centres on the emotional and psychological needs of the service users. I was reviewing this guidance again and was struck by the way in which organisations continue to innovate and challenge provision – but how – critically – this approach was seeking new ways of working with those who might otherwise be unable to engage to change.
The second response is epitomised by an event I am attending in May – The launch of the new Southampton Service User Network. The network has been set up to support current, former and potential service users of mental health services. The network not only offers support and information to those experiencing mental illness or distress – but also acts to inform the strategic and policy direction of the locality. This seems like exactly the right moment to be launching this kind of network, when commissioners new and old need to understand and hear, in an incredibly tight commissioning environment, exactly what works for individuals and how groups and individuals will need support going forward. Sitra staff have been supporting this network in its development, and I am really pleased to be part of this celebration.
Finally I wanted to flag up Sitra’s contribution to equipping the sector to support those with high needs. For the first time, we will be running a new course Different Worlds: Hallucinations and Delusions. We are working again with the acclaimed Dr Ian Bourne – and the courses will look at strategies and approaches to supporting those in crisis, and experiencing delusions, hallucinations and paranoia.
It is critical as a sector that we continue to innovate and respond to high need, but recognise that those experiencing the need are a fundamental part of the solution, and that commissioners and providers will best serve need by making the service user voice central to future direction. That surely is how we maximise the reward for all.
Health and Housing – Sharing a passion for prevention……….
Last year Sitra ran a series of regional events http://bit.ly/gBcBsT looking at bringing together health and housing and understanding how each other could better communicate and understand our relative contributions to work with the most vulnerable.
Sitra have been continuing these debates with some smaller roundtables. The second of these was held yesterday in London – and was a great opportunity to get upto date on some examples of good practice – but also an insight into the challenges ahead.
The roundtable focussed on four areas. The joined up agenda around prevention – with particular reference to further opportunities to feed into the Caring for Our Futures White Paper. The new role for public health within Local Authorities – of which almost no providers or commissioners present had felt an impact. The development of Health and Wellbeing boards – and future opportunities to influence their understanding and prioritisation of housing and housing support and finally Clinical Commissioning Groups and the emergent Commissioning Support Organisations.
Whilst these areas of debate are not new, what struck me is how much there was still to learn – on both sides. Many commissioners with a Supporting People background had not been able to effectively make a connection with developing public health agenda within the local authority. Language barriers remained an issue of key concern, the jargonised worlds of both health and housing were keeping the silo walls high. The ability to evidence need was still of concern, with many Joint Strategic Needs Assessments still not including Housing related support.
However, as ever, the innovation and drive of those with a passion for prevention was finding a way. Comments around success ‘in spite of’ rather than ‘because of’ seemed ever relevant – but positive steps included:-
- Providers were making direct approaches to individual Health and Well Being boards to encourage them to establish sub structures to address the needs of vulnerable and marginalised individuals
- Commissioners developing positive road maps to show the connections between public health and housing
- Examples of capital as the lever, with PCTs and Foundation Trusts responding positively to approaches to speed up hospital discharge
There is still much work to be done in the coming year, and Sitra will continue to work directly with both the health and housing sector to make clear ‘what works’ and to find productive ways to challenge the barriers which pour water on the shared passion.
Sitra held our annual policy conference in February raising the question of whether or not the sector was ‘Coming off the ropes?’
There were a range of presentations and perspectives in the morning that focussed on how challenging the current environment is, and how some have managed to identify and carve out a new position in that context which has provided them with a direction and opportunity to flourish in this new world. Many others reflected on the ongoing challenges affecting the sector and most importantly the most vulnerable clients that we work with.
The final session of the day focussed on ‘The race to the bottom’, which was looking at the response of some providers to the current market – by feeling forced to downgrade the terms and conditions of employees– and a question as to what we can collectively do about it. The challenge was also placed as to what Sitra can do about it – and in many ways it is to this that I turn my attention.
The perspective raised by Broadway and Unison focussed on the way in which competitive tendering practices have in some authorities brought about a shift in the balance of tender awards from quality to price – and how this has brought down the contract hour price – thereby putting providers in the position of reducing terms and conditions to meet the price on offer. Whilst this was not a universal experience – many providers in the room had gone through some change to either direct salaries or terms and conditions. I have spoken with many of our members who have talked about the very real shift in contract pricing – with one recent example talking about contracts which in 2003 paid £27 per hour, and are now offering the contract at £12 per hour. In this scenario, it seems unlikely that this kind of shift in price can be matched by anything other than a significant reduction in terms and conditions to bring the service costs in line with the commissioned price.
Whilst there were a number of good practice examples raised around commissioning practice – and speakers acknowledge that practice varied – the commissioner voice needed to be more clearly articulated. In addition, the voice of the service user was not there - who certainly have would have an opinion about how these changes were impacting on quality of service. It felt to me at the end of the debate that there was more potential for a collective solution than we had had the opportunity to explore. And there were some comments from the floor which raised some possibility of ways forward, and I think that these are areas which Sitra could usefully explore with providers and commissioners over the coming months:-
- What is the balance of contract between quality and price. Are we working on a shared understanding of a universal shift towards price based commissioning– or are there in fact some shining examples where commissioner focus on quality remains and what can we learn from them?
- Do outcomes based contracts provide more flexibility for providers around how they control cost – or does a contract price squeeze have an inevitable impact on salaries and terms and conditions?
- We need a more detailed debate about volunteering. Whilst both speakers felt that the use of volunteers in front line services was ill advised, there are an increasing number of organisations who are increasing their usage and the development of contracts which recognise volunteering within the procurement process. Does/should the sector have a position on this?
- How can commissioners and providers together recognise the quality and professionalism of workers in the sector and agree
- What are the impacts of saying ‘no’ to contract price. How can providers be supported in understanding their bottom line
- Where reductions to terms and conditions are an outcome of negotiations on contract price – how can providers manage that transition in a way that is predicated around the notion of ‘fairness’
- How are the reductions in wages impacting the kind of staff that providers attract. What other things can providers do to augment the experience of working within the sector – and how can we continue to attract high calibre staff? What role for training, apprenticeships, broader talent management approaches?
- There has been an historic distinction between the salary levels of care and housing support staff – in organisations which operate both care and support services – has the pressure all be downwards?
I am interested in getting these debates aired and would be glad to hear from those in the sector would like to get round the table to see if we can understand how Sitra and others can raise these issues and respond. Contact me directly if you would be interested in taking part.
In February this year the Department of Communities and Local Government (DCLG) announced that it was halting the national programme of data collection carried out in relation to both the National Outcomes Framework and the Client Records Forms. Undoubtedly, in the current climate of reducing ‘centralised’ bureaucracy this decision might not be seen to be surprising. However, having recently secured the ‘relative protection’ of the national Supporting People pot on the basis of solid robust national evidence, many felt that the potential vacuum left could be destabilising for the future.
At the time of notifying the sector of the changes to the national commitment to data collection, a consultation was promised. Sitra is delivering this consultation – with support from the DCLG. The official purpose of the consultation is stated as:
“Consultation with the housing related support sector on the future of Supporting People data and feasibility of developing a common framework for housing related support.”
The full details of the consultation can be found on our website and in addition to an online consultation there are a series of events that are being held around the country – participation in these are free.
Having spoken at the recent NHF/Sitra Housing and Support conference in the South West – the issue of data and evidence was very much on peoples’ minds. However, what we need to make sure we are clear on, is that we pull together an understanding of the data that will be needed in the future – and that will be useful for the whole sector. Key areas that seemed to emerge which will need to tackle head on include:
- Common systems and requirements: For both providers and commissioners, the level of pressure on ‘back office’ functions is significant. Any future data requirements going forward are going to have to balance the needs of creating a simplified ‘light’ system, which meets local needs – with a system that allows for the collection of common data for those providers who work across authorities
- Consumer-led demands: Discussions with the sector are focusing more on the understanding of the commissioners of the future being service users. There is no reason to expect that our own expectations as consumers with a right to ‘compare’ and seek ‘best value’ for our purchases will or should be any different for service users. Therefore a data set fit for the future will need to have at its heart the data and information needs of those individuals
- Future changes to adult social care: The recommendations launched on the 11 May by the Law Commission talk about the portability of a central assessment system. If service users are moving between localities, the need for themselves, their carers or their new care manager to find a like for like service would lend itself towards areas of comparability
- Partnerships and consortia: Finding a new partner is never easy! Concerns raised at the conference linked into what to do when a partner was underperforming. The ability to benchmark in advance and to assess compatibility through using data to identify the strengths of the different partners will be essential.
These are just some of the many considerations that the sector must grapple with over the next few months. I am sure that you have other thoughts – and we are very keen to hear them.
Please do contribute to the consultation. We look forward to hearing your views.