Rutland County Council

Leicester, Leicestershire and Rutland Supported Living Strategy for Mental Health 2009 - 2013

Foreword This strategy sets out the Councils and the NHS strategic approach for community living across Leicester City, Leicestershire & Rutland for adults experiencing mental health difficulties. The plan has been developed in partnership with people using mental health services, carers, providers and other stakeholders. In recent years it has been recognised that a more co-ordinated approach is needed to meet specific health and social care needs between the local authorities and the NHS for supported living services: an approach which makes certain that both health and social care needs for people with mental health difficulties are met within the communities where people live. This strategy takes account of the different needs and the range of supported living options required across the city and counties. It is our vision that: People are supported to be as independent as possible People are enabled to actively take part in their communities Supported living choices are available that are good quality, easy to understand, easy to receive and are value for money. Supported living can mean different things for different people and for the purpose of this strategy supported living is defined as the combination of housing and support that enables people to live as independently as possible, to have choices and control of their own lives. The following representatives and their respective agencies have made a firm commitment to improve the housing options available for vulnerable adults and to ensure that these options are based around individuals personal preferences and choices. Mick Connell Director of Adult Social Care & Health Leicestershire County Council Kim Curry Corporate Director Adults & Housing Department Leicester City Council Colin Foster Director of Adult Social Services, Health & Housing Rutland County Council Catherine Griffiths Associate Director for Health Care Reform Leicestershire County and Rutland Primary Care Trust Tim Rideout Chief Executive Leicester City Primary Care Trust Prof. Antony Chief Executive of Leicestershire Partnership NHS Trust Sheehan

Contents 1. Summary 2. Introduction 3. The purpose and aims of the strategy 4. The main findings from the research in developing this strategy 5. The key drivers for the strategy 6. Strategy development 7. Consultation with people using mental health services 8. Value for money 9. Commissioning for the future 10. Appendices Appendix 1 - Definition of Key Terms Appendix 2 - Additional Information and references Appendix 3 - References Appendix 4 - Delivery Action Plan 2009-2013 Appendix 5 - Consultation Action Plan Appendix 6 Draft Equality Impact Assessment 3 6 9 11 12 17 23 25 31 34 34 35 36 39 52 57

1.

Summary

The Purpose of the Strategy Leicestershire County, Leicester City and Rutland County Councils and their partners want to make sure there are an adequate range, number and quality of housing and support available for people with mental health problems. (Leicester, Leicestershire County and Rutland Local Implementation Teams Action Plan 2005/2006)

What is Supported Living? Supported living is a combination of housing and support services provided to help people to be independent, have choices, and take control of their own lives.

It provides the opportunity for vulnerable people to live in their own homes instead of residential care; It provides flexible, individualised support to people and gives people a much bigger choice of housing options; This choice of housing includes social housing and home ownership.

What are the aims of the Strategy?

To put people at the centre by giving people real supported living options through supporting their choices and enabling them to have control over their lives; To promote healthier communities, ensuring peoples mental health is supported and raised through good quality homes and support; To help people to achieve their goals in independent living; To deliver better commissioning through local service and needs profiling to understand supported living needs and deliver personalised services

The outcomes we want to achieve The key outcomes of the Strategy are to:

Improve health and emotional wellbeing Improve quality of life Support adults in making a positive contribution Make a commitment to providing greater choice and control Ensure freedom from discrimination Improve economic wellbeing Promote personal dignity

How will we measure outcomes?

People with mental health difficulties will receive greater value for money in social care Fewer people with mental health difficulties will live in residential care More people with mental health difficulties will receive treatment in the community It will take less time to find housing when someone leaves hospital or a residential care home Fewer homeless people will be in need of mental health services There will be more housing choices for people who use mental health services There will be more help for people using mental health services who want to live independently There will be more help for people using mental health services who want to be more involved in their communities We will review progress through looking at the information available to us about where people live and how they are supported, how much this costs, and what people think about where they live.

What do we need to improve or change to achieve our aims? Be clear about who is responsible for making decisions Be clear about who is responsible for providing the different types of support that people need Be clear about who is responsible for paying for each element of the support required for each individual Look at ways to increase the housing choices available to people Help people prepare for moving to supported living Help staff to understand new ways of working Look at how to meet more specialised needs Identify the money available and where it comes from Make sure we treat people equally

What do we know about our existing supported living provision? In all areas, the support required varies from between 1 and 5 hours per week up to 24 hour daily support. There is a need for specialist support for people with a dual diagnosis (mental health problems and substance misuse, mental health problems and a learning disability, people with Aspergers Syndrome), and for people from black and minority ethnic communities. In Leicester City, 205 people with mental health difficulties (of working age) live in residential homes. There are 288 accommodation units with support. There are waiting lists for both accommodation and support, and it has been estimated that 689 units are required in total to meet existing and future needs.

In Leicestershire there are 71 people living in residential care. Estimates show that 103 units are currently needed across the whole county, and a further 82 units are needed for the future. In Rutland, 3 people are living in residential care and 11 have already moved into supported living units. There is an estimated need for a further 52 supported units for the future (Ref Snapshot figure 31/3/2007). The Strategy Based upon the research completed for this strategy, Local authorities will work with their partners to develop a range of supported living options for people with mental health difficulties. The first priority will be supported living for people currently living in residential care homes. The range of options will include: One-site/Extra Care schemes: people have independent accommodation units with their own tenancy agreement on one site where support is provided through staff based at the site. Shared houses: people have separate tenancy arrangements but share the accommodation, facilities and some costs, and visiting support is provided to meet individual needs. Cluster schemes: independent accommodation units in the same area, with visiting support from staff who may either have a base in that area or be based elsewhere.

How this can be achieved Local authorities should develop a procurement plan for Supported Living services, to award contracts where providers could provide one or more of the following elements: o Accommodation and on-site support o Accommodation and visiting support o Visiting support only Identification of existing and new developments which can provide suitable accommodation, including shared ownership and outright purchase for individuals Development of housing allocation policies to ensure pathways into suitable accommodation at all stages of independence Deregistering residential care homes and remodelling into Supported Living schemes Individual assessments must ensure that all potential funding sources are explored (including the use of Housing Benefits, Individual Budget arrangements, Direct Payments, Disability Living Allowance). This will ensure best value for both individuals and local authorities. Supporting People Strategy (2005-2010).Currently under review. Supporting People Strategic Review of Services in receipt of Care & Support (2008-2009)Outcomes to be finalised.

2. 2.1

Introduction The National Context

In the Mental Health and Social Exclusion Report (2004) a number of areas were addressed. The report found: Adults with mental health problems are one of the most excluded groups in society and have the lowest employment rate for any of the main groups of disabled people. Mental health problems cost the country over 77 billion per year through care costs, economic losses and premature death. Early intervention to keep people in work and maintain social contacts can significantly reduce these costs. Social isolation is an important risk factor for deteriorating mental health and suicide. Being in work and having social contacts is strongly associated with improved mental health. People with mental ill health have much to offer and if they are able to fulfil their potential the impact of mental health problems on individuals, their families and society can be significantly reduced.

The government identified a stable and appropriate home as critical for people to work and take part in community life, a lack of stability or unsatisfactory housing led to worsening mental health and people with mental health problems are particularly likely to have vulnerable housing. Compared with the general population they are: Twice as likely to say they are dissatisfied with their accommodation Four times more likely to say their health has been made worse by their housing

2.2

The principles of Supported Living Kinsella (1993 cited in Social Care Research 1997) set out five key principles of Supported Living: Separating housing and support to provide flexible combinations of both. Focusing on one person at a time, moving away from the group home model. This would involve using detailed person centred plans to provide services that are genuinely individualised Zero Rejection meaning that nobody is seen as too disabled to live in their own home Housing is centred on individuals own concerns, not those of organisations providing services which would give people much more control over their homes and lives. Make sure that relationships, family, friends and community are at the centre in the design of services.

These principles are crucial in defining supported living characteristics, the idea of separating housing and support plays a central role as this is a key factor to avoid the requirement to register a home. This has a number of significant effects on the whole system including increasing individuals incomes, opening up different funding sources and promoting security of tenure.

2.3

The Local Context

It is clear that successful collaborative working arrangements at both strategic and operational levels are vital to meeting the needs of people with mental ill health and vulnerable people with complex needs. Collaborative working in supported living for mental health is particularly key in the local context where the provider function, operational case management and individual commissioning sits with community mental health staff at Leicestershire Partnership NHS Trust but funding and strategic commissioning remains with the Local Authority. There is also a lead commissioning arrangement with the Primary Care Trust getting a number of partners involved in services. Alongside this there is a range of accommodation providers including Local Authorities, District Councils, Registered Social Landlords and even private landlords and there will be a range of support providers.

It is very important that partners work together at every level and clear lines are drawn on who takes the lead both strategically and operationally. In Leicester, Leicestershire and Rutland, the Local Authorities have taken the initiative by funding the development of this strategy, however the work needed to transform the aims of this strategy into deliverable outcomes will require joint commitment from all partners. This strategy links with other key local strategic plans: Local Implementation Team Action Plans Leicestershire, Leicester and Rutland. Sustainable Community Strategy, Vulnerable Adults theme Supporting People Strategies: Leicester City Council, Leicestershire County Council, and Rutland County Council. Homeless Strategies for Leicester, Rutland and Leicestershires boroughs and districts. Housing Strategies for Leicester, Rutland and Leicestershires boroughs and districts. NHS World Class Commissioning Leicestershire Partnership Trust 2012 Vision.

Key Note: At present there is a strategic approach to Supported Living in the early stages of development along with the establishing of a competitive market for supported living for individuals with mental ill health across Leicester, Leicestershire and Rutland. This strategy will increase the capacity of all councils within Leicester, Leicestershire and Rutland to work jointly and proactively on achieving a range of affordable Supported Living housing options. The delivery of supported housing for people with mental ill health will provide better social and health outcomes for them and allow them greater independence and choice in their housing and support. Developing the current level of Supported Living environments would need the involvement of private, public and Social Housing Landlords. The Housing Corporation stated in their Investment Statement 2008-2011 (April 2008) that 316 million has been set aside to provide new affordable housing: 140 million is still waiting to be invested in the East Midlands region building programmes. It has been recognised that in the East Midlands the following housing requirement initiatives need to be developed: A continued focus on the supply of new homes in smaller villages A continued aspiration for new Supported Housing Schemes, particularly for those facing social exclusion Care leavers (at 19) Adult Offenders Adults in contact with Secondary Mental Health Services Adults with moderate to severe learning Difficulties.

3.

The Purpose and Aims of the Strategy Leicester, Leicestershire and Rutland Local Authorities and their partners want to enable vulnerable people with mental ill health to be more involved in their community. They want to make sure that there are enough houses and choices of houses for people with mental health problems. They want to make sure that these houses are good quality. They want to make sure that vulnerable people are safeguarded.

3.1

The Purpose The purpose of this strategy is to examine current housing support services for working age adults in the localities and to focus on local need and new strategic priorities. The Strategy sets out how we can begin to reshape existing services to: Deliver our vision of good quality, cost effective supported living options for people with mental ill health who are currently in residential care and; Meet the future needs of those who would have been placed into residential care due to a lack of appropriate housing options.

3.2

The Aims To put people at the centre by giving people real Supported Living options through supporting their choices and enabling them to have control over their lives. To promote healthier communities, ensuring peoples mental health is supported and raised through good quality homes and support. To help people achieve their goals in independent living To deliver better commissioning through local service and needs profiling to understand supported living needs and deliver personalised services To make a real difference to peoples lives through allowing them to live independently and supporting people to participate in their communities. To ensure that agencies work to prevent abuse and to support vulnerable people to maintain independent living The key outcomes Improving health and emotional well being Improving quality of life Supporting adults in making a positive contribution Commitment to providing greater choice and control Ensuring freedom from discrimination Improving economic well being Promoting personal dignity

3.3

3.4

How we will achieve this: Through person centred supported living options which enable service users to have control over where they live and the support they receive. Through building healthier communities where peoples mental health is supported and raised through good quality homes and effective support. Through better commissioning resulting in personalised, individualised services achieved through local service input and effective needs profiling. Through making a real difference to peoples lives, enabling people to achieve their goals in independent living and enjoying an active life in the community.

4.

The main findings from the research in developing this strategy: The research showed that it needs to be clearer who is in charge of leading the Supported Living plan between the Local Authorities and Local Implementation Teams The Mental Health Supported Living Steering Group will work best by getting all of the partners working together. Leaning Disabilities services in England are ahead of the Mental Health services in their work on Supported Living. Residential care can be more expensive than Supported Living. There are a lot more people in residential care than in Supported Living. The only Supported Living houses that are available at the minute have been set up using the money from the Supporting People fund. There are not enough Supported Living houses for the number of people wanting to live in Supported Living. Changing residential care homes into Supported Living homes is an option but this needs to be looked into further. More work is needed to get people ready to move from residential care to Supported Living. People who move out of residential care into Supported Living have a great need for visiting support staff. Reshaping the Supporting People one site schemes for additional hours but would still not meet demand Joint referral pathways need to be created between Supported Living and Intensive Community Support Team to ensure that there is no duplication of service. Supported Living may cost more in the short term, but could lead to long term savings as long as cases are effectively managed by staff and individuals, giving people the opportunity to be more empowered to cope with living independently with little or no support The research into the Mental Health Supported Living Strategy identified that more work is needed to provide for the needs of people with Aspergers Syndrome more effectively. A strategic approach needs to be undertaken with property developers in both the private and social housing sector to capacity build the number of units available which could be used as Supported Living environments. A more joined up approach is needed with planners and local area housing needs. Equality Impact Assessments would need to be undertaken in each locality to ensure that the needs of all sections of the community are taken into account. This would make sure that Equal Opportunities become a working statement.

5. 5.1

Key Drivers The Local Government and Public Involvement in Health Act (2007) Section 116 This places a duty on local authorities and Primary Care Trusts to identify the current and future health and well being needs of the local population, informing the priorities and targets set by Local Area Agreements (LAA) and leading to agreed commissioning priorities that will improve outcomes and reduce health inequalities.

5.2

Putting People First: A Shared Vision and Commitment to the Transformation of Adult Social Care This looks at ensuring that social policy addresses the holistic needs of people. The focus should be on tailoring services around the individual persons needs so that they are maximising their independence and economic and social participation in the communities in which they live.

5.3

Department of Health (2006) Our Health, Our Care, Our Say: A New Direction for Community Services A strategic shift towards personalisation, early intervention and prevention meaning that everyone across the spectrum of need will have choice and control over the shape of his or her support. Clear pathways between the agencies involved need to be created and implemented to ensure: Better prevention and early intervention for improved health, independence and well-being More choice and stronger voice for individuals and communities Tackling inequalities and improving access to services More support for people with long term needs.

The challenge in the next five years for Leicester, Leicestershire and Rutland is to enable people with mental health illness to have choice and control in their accommodation and support.

5.4

Communities and Local Government - Independence and Opportunity: Our Strategy for Supporting People (June 2007) Independence and Opportunity signalled the delivery of Supporting People through the new Local Government Performance Framework. The Supporting People Grant, which was introduced in 2003, will be paid as a non-ring-fenced named grant from 2009/10, and from 2010/11 as part of Area Based Grant. This will bring together a number of grants into a single non-ring-fenced grant, providing authorities with greater flexibility to respond more effectively to local needs. The ODPM (2005) looked at the impact of Supporting People services in 5 areas; independent living, health, crime, homelessness and social

services. This research has identified that residents were most content when they lived in supported accommodation with some degree of independence. There had also been the value added cost of: Improved quality of life including greater independence, improved health, greater choice of options on where and how to live and lessened dependence on relatives and carers; Prevention of further mental health problems and fewer suicides; Easier access to appropriate services. For cost benefits, they took the working assumption that without Supporting People services a proportion of people with mental health problems currently receiving this support would be unable to cope with living independently and would have to move into residential or inpatient care and that those receiving high levels of support, who could not cope without Supporting People services, would move into long stay hospital services. This gave added value to the Supporting People services of spend to save efficiency savings of: 47,476 per person per annum for those requiring high level support 16,692 per person per annum for those with low to medium support Given the numbers receiving support, this put a value on the independent living of 90.12 million per year. Adult Social Care could deliver supported living services in addition to Supporting People and has done so, particularly for people with learning disabilities. Development for vulnerable adults with Mental Health needs, however, has not been developed to a great extent. Joint commissioning of housing support has been recognised as under developed. The provision of a stable home has been seen as the building blocks not just for emotional and physical needs but also for helping to build sustainable communities.

5.5

The Commissioning Framework for Health and Well-Being (DOH 2007) This established 8 steps to effective commissioning which would link into Sustainable Community Strategy, Local Area Agreement and strategies which would improve Health & Well-Being and reduce health inequalities. These are: Putting people at the centre of commissioning Understanding the needs of populations and individuals Sharing and using information more effectively Assuring high quality providers for all services Recognising the independence of work, health and wellbeing Developing incentives for commissioning for health and wellbeing Making it happen: local accountability Making it happen: capability and leadership

The idea is for statutory and voluntary organisations to work together to not only meet existing health & welfare needs but also to plan for the future, to look at future housing aspirations and the needs of vulnerable members of the community. Partnership working enables a pro-active approach to meeting and sustaining peoples support needs and prevents the duplication of resources and a crisis management approach which can be costly in terms of finances, human respect and dignity.

5.6

Individual Budgets Individual budgets enable the service users to buy in services which they would like to use as opposed to in-house services provided by public services. Individual budgets has enabled greater freedom of choice for service users to have a real say in how and when they would like their support needs met. It has improved choices and facilitated a cultural change in attitude by involving service users in their care process, thus, enabling them to take ownership and responsibility for themselves.

5.7

Communities and Local Government (2007) The New Performance Framework for Local Authorities and Local Area Partnerships Strong and Prosperous Communities set out the Governments ambition for services and outcomes through a new local government framework built around a new set of relationships between local authorities and their partner agencies, Government Offices in the Regions and government departments. The Government's priority outcomes are expressed through the Public Service Agreements set out in the Comprehensive Spending Review 2007, or Departments Strategic Objectives. The delivery of housing support relates to a number of these, including Public Service Agreement 16, which covers, as one of four groups, people with mental illness, and aims to Increase the proportion of socially excluded adults in settled accommodation and employment, education or training. Under the Comprehensive Spending Review all public services are required to achieve a 3%, net cash-releasing, value for money saving per year between 2008/2009 and 2010/2011. The key aims are for agencies to work together, looking at joint commissioning, procurement and a redesign of services. In order to obtain government grants each local authority area needs to identify joint strategies which address needs holistically. The government has made Local Area Agreements a prerequisite and has also established a basket of performance indicators. In terms of performance management public bodies are to embrace partnership working via Public Service Agreements which would be

governed by the Local Area Agreements. Performance Management Frameworks have been based on Our Health, Our Care, Our Say (DH 2006) and Every Child Matters (Change for Children 2003).

5.8

World Class Commissioning Competencies for Primary Care Trusts (PCTs) In the NHS the World Class Commissioning Programme is there to improve commissioning capability. There are three main areas which the programme concentrates on: Articulating a vision and purpose for world class commissioning to inspire and motivate the NHS, and setting out the key competencies that commissioning organisations will need in order to become world class. Create an assurance model to reward PCTs for delivering world class commissioning and to hold them accountable. Putting in place a support and development framework to help PCTs attain world class commissioner status. The World Class competencies are seen as vital tools for the PCTs to engage with and also contribute towards the joint strategic needs assessment. The World Class Commissioning Competencies for Primary Care Trust: Locally lead the NHS Work collaboratively with local partners Engage with the public and patients Collaborate with clinicians to inform strategy, service design and resource utilisation Manage knowledge and assess current and future needs Identify and prioritise investment requirements and opportunities Influence provision to meet demand and secure outcomes Drive continuous improvement in quality and outcomes through innovation Deploy procurement skills that ensure providers have appropriate contracts Manage the local health system Make sound financial investments

5.9

Public Service Agreement 16 The key public service agreement which applies to Health and Social Care in the context of this Strategy is PSA 16 Socially Excluded Adults. This Public Service Agreement aims to increase the proportion of Socially excluded adults in settled accommodation, employment, education or training. Vulnerable people achieving independent living Vulnerable people who are supported to maintain independent living

5.10

Performance Indicators Which Link Directly to Housing Support

Safer Communities: Alcohol harm related hospital admission rates Drug users in effective treatment Adult re-offending rates for those under probation supervision

Adult Health and Well Being: Self-reported measure of peoples overall health and well being People with a long-term condition supported to be independent and in control of their condition DH DSO Achieving and maintaining independence for older people through rehabilitation/ intermediate care Delayed transfers of care from hospitals Timeliness of social care assessment Timeliness of social care packages The number of emergency bed days per head of weighted population People supported to live independently through social services (all ages) Healthy life expectancy at age 65 Satisfaction of people over 65 with both home and neighbourhood People over 65 who say that they have receive the information, assistance and support needed to exercise choice and control to live independently

Stronger Communities: Percentage of people who feel that they belong to their neighbourhood

Local Economy: Number of households living in temporary accommodation Percentage of decent council homes Environmental sustainability:

Tackling fuel poverty- people receiving income based benefits living in homes with a low energy efficiency

6. 6.1

Strategy Development Local Implementation Teams (LITs) One of the aims of the LITs is to assess the needs of every working age individual with mental ill health who has a residential care placement by the local authority. Different locality areas will have different needs and it is the remit of the local implementation teams to ensure that localised needs and aspirations are addressed and that outcomes are consistently delivered. The Supported Living Mental Health Strategy will have different implications for the different LITs to take into account. The Mental Health Supported Living Steering Board (MHSLSB) The role of the Board is to develop and drive forward the work plan for a supported living strategy for people with mental ill health across Leicester, Leicestershire & Rutland. The key objectives of the Board are: To advise and make recommendations on all aspects of the work undertaken on the project To ensure robust links with the City Implementation Team and Counties Implementation Team for residential care assessment and enable scheme development. Identify any benefits of a consistent approach across City and County in all activities To steer new commissioning approaches for Mental Health Supported Living To ensure the engagement of all stakeholders

6.2

6.3

Consultation The Steering Board and the LITs have actively overseen the development and production of this Mental Health Supported Living Strategy. Both groups are aware of the importance of this strategy being jointly owned by all partners and stakeholders and the value of an effective consultation process giving all partners the opportunity to contribute to and comment upon the Strategy. The draft strategy was taken for consultation and a full list of those agencies consulted is available in the appendices of this document. For the purpose of this exercise, agencies were asked to look at a snapshot of service provision on a particular date. This date was 31/3/2007. The main work streams identified and undertaken in the strategy development project plan were; Project Launch - letters to all stakeholders, visits to key stakeholders. Supply data - Service Profiling, Mapping and Utilisation - service assessments for SP providers, Support Time Recovery Teams, data analysis on residential care

6.4

Needs data - Residential Care - service user questionnaire and self assessment tool, staff recruitment (County only), assessment process, City LPT service user assessment questionnaire, LPT City/County Case Load Census Consultation with The Peoples Forum and Open Assembly and people using supported living services Options Appraisal - good practice and preferred models of delivery Scheme Development - funding identification, potential opportunities, ordinary residence and cross boundary agreements Joint Commissioning Work - joint tendering agreements Mental Health Housing Group - action plan delivery Case Work Monitoring - to identify gaps Strategy Delivery

Supply Data The data has identified three types of support across Leicester, Leicestershire and Rutland: Residential Care Homes Three Supporting People Programmes Social Care provided under the Community Care Programme The Service profile assessment was based around three questions: 1. The extent to which existing services meet the needs outlined or could be re-shaped to meet these needs? 2. The level of current and demand for existing services? 3. Projected future need and demand for future service development? In the framework only mental health funded projects had been asked, Learning Disability projects had been excluded. Headline Findings Leicester 205 residential placements of which 43 people had been assessed as being able to live in a Supported Living Environment. Move on Supported Living assessment found 37 people who could move out of residential care but were unable to due to lack of suitable accommodation and support. The Local Authority is currently working on several models to address this. Service user preferences have identified a One Site/Extra Care Scheme with waking night staff has the preferred model located in Leicester. Current provision was mainly self contained accommodation with support tied to the property (288 units) waiting list for both Supporting People projects and Community Support teams evidence that demand exceeds supply and that current provision does not meet the needs of those leaving residential care in terms of support hours and needing to see staff members on demand when needed. Community Care services predict that 689 units are needed to meet current and future needs of which 111 units being One Site/ Extra

Care . Existing services provided via supporting people do meet some of these needs. From the research varying levels of support hours were identified to meet peoples support needs: Low level - 1-5 hours Medium level - 5-15 hours Medium to high level - 15-20 hours High level - 24 hours Equality Impact Assessments. Demographics trends illustrate that in order to stay receptive to changes and ensure that service provision is accessible and culturally sensitive future provision does need to take into account the needs of BME communities. 24% of the service users had Dual Support where both support and personal care had been identified as necessary to enable them to live independently. There is a need to develop domiciliary care services in order to meet the needs of people with mental ill health. Unmet need for specialist Aspergers Syndrome Supported Living services Need to develop 24 hour support in the community.

Action Points Identified For Leicester Performance Management Framework to chart Support Planning outcomes in residential placements so that, when residents are able to move on, pro-active measures are taken to facilitate this. Rolling Needs assessment reviews would chart the positive outcomes that service users experience. This would then help to assess the type of move on accommodation which would suit their individual needs. Pre-move on support work is needed with current residential service users so that they are prepared and able to make informed choices with regards to their future independent living options. Individual Support plans will tailor the specific support needed around individual concerns and needs. A range of Supported Living schemes need to be considered in order to provide choice and options to suit individual needs. Allocation Processes need to be reviewed in order to create pathways for residential placements to access the housing register. Exit Strategy from residential placements. Joint working protocols need to be drawn up between Supporting People funded schemes and public bodies to ensure that re- housing pathways are created for those trying to leave residential care and entering Supporting People funded schemes so that effective and efficient use is made of resources. Closer working relationships need to be established with providers of supported living environments so that provision meets the overall agenda of all parties in terms of offering choices in accommodation provision and facilitating outputs into independent living and ensuring that accessibility is part of a managed process.

Public awareness around Supported Living: Raise profile of supported living to service users, staff and carers. Need to advocate a Culture of Change and Promotion of independent living giving people who do want to leave residential care a choice in where they would like to live. High Need for a specific Mental Health Floating Support Service. Effective use of specialist resources. Performance management frameworks such as a common assessment framework which assesses on both clinical and social need would enable current resources to meet the needs of those who do need intensive support and not create a dependency culture on resources for those who could live independently in a Supported Living Environment. Community Support Services need to work alongside any specific mental health floating support service to ensure that referral pathways and joint protocols are established to ensure that appropriate referrals are taken by the receptive services. Reduction in hospital beds has enhanced the need for providing support services in peoples homes. In the main current Supporting People schemes only provide 9-5 support, schemes may need to be modelled in order to provide support hours which are flexible to service user needs. The development of resources supporting difficult to place people, people with high support needs and people with multiple needs who require 24 hour support. Need for Specialist women only care. Cross agency training is needed to improve joint working around Mental Health Awareness and Housing Solutions in supporting service users. Better communication and more collaborative working with other services including drug and alcohol and housing services which are supporting clients. Allocation and exit pathways need to be established with providers of Supported Living environments so that accommodation is allocated effectively and more choices are made available to service users. This would also lead to a greater level of trust in the Supported Living allocation system. Local Area Agreement performance indicators between partner agencies would enable providers and commissioners to plan and provide for unmet needs more effectively. Leicestershire and Rutland 71 working age adults in residential care in Leicestershire. 3 working age adults in residential care in Rutland. Full assessment completed on 43 people in Leicestershire. 11 People had already moved into independent living 13 people are unable to leave residential care due to lack of out of county specialist placements, terminal illness and severe dementia. Pre-move on support work is needed with current residential service users so that they are prepared and able to make informed choices

with regards to their future independent living options. Individual Support plans will tailor the specific support needed around individual concerns and needs. Scheme preferences had been 1st One Site/Extra care, 2nd Shared Houses, 3rd Key ring Cluster or Core & Cluster with staff support in order of preference on site with waking nights, on site with sleep in, visiting day staff. 1 bed roomed move on accommodation was needed in the following areas, in order of highest to lowest demand: Charnwood, Harborough, Melton, North West Leicestershire, Blaby, and Leicester City. Leicestershire Community Care Services predict that there is a need for a range of supported living environments to meet the current needs of 103 units of support and future predicted needs of 82 units of support to meet the needs of those wanting to live in the community. Rutland Community Care Services currently have 14 cases but predict future needs of 52 supported units. Dual Support Needs: Services need to be commissioned to take into account the needs of those users of services who need both domiciliary help and a supported living environment. High need for self contained accommodation with Support. Mental Health Floating support service across all household types. Location for Supported Living Schemes in order of highest to lowest demand: Charnwood, Harborough, Melton, North West Leicestershire, Hinckley & Bosworth. Support Hours ranged from Low level - 1-5 hours Medium level - 5-15 hours Medium to high level - 15-20 hours High level - 24 hours Supporting People Providers in Leicestershire felt that there was an unmet need in the following areas: Dual Diagnosis including Substance Misuses, People with Aspergers Syndrome, and support for those leaving long term hospital care. Equality Impact Assessments. Demographic trends illustrate that in order to stay receptive to changes and ensure that service provision is accessible and culturally sensitive future provision does need to take into account the needs of BME communities. There is a lack of BME support services in the areas where people want to live. Action Points Identified For Leicestershire & Rutland Effective use of specialist resources. Performance management frameworks such has a common assessment framework which assesses on both clinical and social need would enable current resources meet the needs of those who do need intensive support and not create a dependency culture on resources for those who could live independently in a Supported Living environment.

Assessment reviews. Regular reviews need to be undertaken with service users to prepare them for independent or semi independent accommodation. More training is generally needed for support staff especially in relation to supporting people with Aspergers Syndrome and Personality Disorder. Better Communication across all services especially housing authorities across Leicestershire: it would be useful to have a Housing Link Worker. More use of direct payments Need for Self Contained accommodation offering a mixture of Supported Living Options. New Social Housing which is accessible for vulnerable people with mental health difficulties ensuring that housing allocation policies create pathways for people in residential care to access longer term housing options. Choice Based Lettings District housing departments need to ensure that the needs of vulnerable people are met within the new schemes. Floating Support Scheme: Supporting People team predict that there is a need for 35 units of visiting support currently there is only 7. More Collaborative working between Supporting People and Community Care Services so that the support needs of those experiencing mental health difficulties can be supported earlier and to support the needs of those who are not on the Care Plan Approach threshold and enhancing clearer referral routes between schemes. Review current residential provision and consider deregistration into a Supported Living environment - close working is needed with the local authorities to see if this is feasible. Preparation to prepare for independent living would need a time line of 12 months. Staff would need to work jointly with residents to build up their capacity to sustain future accommodation.

7.

Consultation with People Using Mental Health Services Consultation Focus Groups were formed with the following groups to ascertain their viewpoints during the mapping process for the strategy: The Open Assembly (service user organisation, Leicester City) Service users living in current Supported Living Schemes The Peoples Forum (service user organisation, Leicestershire and Rutland). All 3 groups identified common themes around eligibility, support, flexibility, finance, employment and accommodation issues What were the key findings from the Focus Groups? Development of support services would enable people to be more independent. It costs more to keep people in residential care than in Supported Living. A range of support needs from low to high is needed in these schemes, including support during evenings and weekends. The groups liked the idea of consistency in their support to enable people to build up trusting relationships and felt a dedicated support worker was needed. Felt their support workers enabled them to develop their independence moving from higher intensity support to a lower level by developing their skills and coping mechanisms for when they felt vulnerable. The support provided enabled them to discuss worries and concerns without these escalating and helped them to deal with problems. Support was also invaluable when they met with health professionals. All felt that support services should be in place for life if the person needed them. The development of tender will provide the place for views on support, accommodation, eligibility and flexibility to be implemented within the schemes. Representation during the tender process of people using mental health services in Leicester and Leicestershire is recommended. There is a lack of social housing in Leicester and limited choice of types of house because of this.

Eligibility One person summed up the groups general responses to this: ..Problems occur when Council and health services deem service users are well enough and push them into the state system where there is no continuity of rehabilitation and support.

Flexibility Any model which had been developed needed to be flexible enough to manage movement between high and low levels of support needed at different times, particularly if weekend and evening support was needed Freedom of choice and mobility between Leicester City and Leicestershire without losing all support services in place, was impossible and restricted their choices about where they could live and the support they received. Financial Most thought that direct payments had not been a success as it was too stressful People using supported living services said they did not want to be employers and couldnt cope, which was not perceived as a good idea for people with mental health as it could worsen their illness. All were interested in the development of Individualised Budgets which were a good idea in principle; however this would depend on the money given and the eligibility criteria used. Individualised budgets were considered a good development as long as they are supported and more simplified. Some service users cannot afford to live off benefits, but are exposed to financial problems as soon as they come off them as they cannot afford to work either. All felt that people with mental ill health that had to live on benefits if unable to work found it extremely hard financially and only by providing an increased benefit payments could their real independence and choice be developed. Employment Affordability: Chance of getting back into work on a salary that could cover the benefits you would lose was extremely difficult. Indirect Discrimination: Once you had suffered from mental ill health this was often more stigmatised than someone with a physical disability particularly for employers. Accommodation Issues Although the focus groups did not identify a specific needs range, the location of the accommodation in support services was considered very important in developing schemes for people in Leicester as living in a poor environment and enduring harassment can affect mental health. People needed support to move to other, safer areas, but not have their independence taken away from them. Quieter areas near to shops and community facilities were considered ideal such as Clarendon Park or Knighton area. They also raised concerns about the lack of social housing in Leicester and the limited choices this presented to people.

8. 8.1

Value For Money Current Resources There is a considerable amount of revenue spent annually by the three local authorities on residential care for working age adults with mental ill health. Local Authority Residential Care Working Age MH 2007/2008 Net 3,389,864 1,183,144 111,644 4,684,652 Supporting People MH 2007/2008 Net 1,535,3874 867,047 67847 2,470,281 Total
Formatted Table

Leicester Leicestershire Rutland Total

4,925,251 2,050,191 179,491 7,154,933

8.2

Potential Initiatives to Enable Cost Savings De-registering residential care homes and remodelling into Supported Living Schemes. This can have the benefits as the majority of the cost can be recouped by government grants and not paid for directly by the local authority, however, this does no meet the overall aims of the personalisation agenda since people need to be given different choices of where they would like to live. Currently Local Authorities in their provision of residential care are not making effective use of government budgets which would assist towards accommodation cost. At the moment they are paying for both accommodation and support cost. Accommodation cost in rented property can be claimed back via Housing Benefit. The availability of using private and other social landlord housing stock would enhance the level of accommodation choices which are available offering the service user involvement in their future housing choices. Service users who are placed under Section 117 would be able to claim back their accommodation cost, this would save the authority paying via their Community Care Budget. Current Budgets are mainly spent on support charges. At the moment the Supporting People market has budgeted 20 per hour, whilst costs from Adult Social Care Learning Disability support schemes have been found to be around 13 per hour. With clear specification and performance management frameworks this would provide efficiency savings. Support costs in residential homes remain static. By introducing individualised Support Packages support hours commissioned could change depending upon the need of the individual. This could see support hours being commissioned to a lower or greater extent.

The models that are most cost effective to provide high or medium intensity support are ones where the support is accommodation based with staff on site, and unsupported hours can be pooled perhaps at night or for drop-in office cover during the day, therefore reducing costs to individuals as the office cover hours and the night cover can be shared between the number of individuals in that scheme. People that need lower levels of support may be most cost effective in accommodation based schemes, where there are no travel costs for staff or in floating support schemes with a lower rate of visits. Planned Move On high or medium support needs do need to have some drop in support, particularly for those on an initial step down from residential care who are used to the availability of staff on site 24 hours a day.

8.3 Personalised Support Packages For Service Users who may not need night cover but may need access to one in times of regression, several options could be considered; telephone support which may not suit everyones needs or a floating support service. Range Of Support Options There is a need for a range of supported living schemes with different hours of support available in order for the individual to vary their support hours further as their independence increases. This type of system would allow the Local Authorities to save money on support commissioned. This transition towards independence requires careful management to ensure the service user does not stay in a scheme with more support than they require. Assistance under Section 117 Duty Local Authorities and Health Trusts under section 117 have the duty to provide after care services for service users to meet their mental health needs and prevent further hospital admissions; if housing benefit claims were submitted then this would recoup some of the cost which had previously been paid for by community care budget. Independent Living Fund (ILF) ILF enables people to live more independently in the community by way of contributing support revenue to the support package, further reducing costs to the authority. People who receive or could receive Disability Living Allowance care components at the higher rate, for example, have a social care package contributing 32 per week towards the support, the ILF will fund up to an additional 455 per week to a maximum care package of 785. This could allow those with higher support needs to move into supported living and the authority would not have to find the full support revenue costs. For those whose support costs would be much higher, the care package can be above 785, but the contribution of the authority and ILF cannot be above 785 for the first six months. This means that those who have continuing care funding from health or Supporting People funding could still make use of the ILF revenue towards support costs.

8.4 Waking Night Cost It is more cost effective for these costs to be shared rather then commissioned on an individual basis. For example, if an individual needed a waking night for 15 hours of support per week, but did not live in a scheme where this night support could be shared, this would bring the cost to 1105 per week per individual (based on 10 hours at 13 p/h per night), an increase of 887 per week for the authority and clearly not value for money. Therefore, if a waking night was needed all night this may only provide value for money when sharing the costs. The only time that this may not be true is for individuals on very high cost placements who require one-to-one support for 24 hours a day and whilst the support costs may be high, at over 2000 per week this may still be cheaper than high cost residential care and may be suitable for those whose needs cannot be met in group accommodation schemes. Good Practice: Orchard House (Case Study A): High Intensity Accommodation Based Support Scheme In Leicester, a sheltered scheme had been re-modelled to provide both temporary homeless accommodation to families with low support needs and a Supported Living Environment to accommodate people with Mental Health needs that can be supported in the community with Floating Support. This scheme is a good example of a high intensity accommodation based support scheme where the cost is significantly lower from the outset to the authority. Housing benefit payments have been used to pay for property management services, thus decreasing the need to have drop-in hours paid from support staff and night workers. This has stopped the need to pay for waking night staff. In Orchard House, the direct cost reduction to the authority is show below, figures used are examples. Residential Care per week 0 62 290 (Local Authority pays 228 of this) 290 (Local Authority pays 290 of this) Orchard House per week 400 7 (gas/electric/water) 195 (15hrs x 13p/h) 195 (15hrs x 13p/h)

Housing Benefit Client Charges Support Costs

Support Costs S117

Figures for illustration purposes only

The table above shows that Orchard House has cashable benefits of: 33 p/w on community care budget (person not on s117) the difference between the local authority contribution of 228 in

residential care and the local authority paying support costs of 195. 55 p/w to the person living there For those on a S117, the savings for the Community Care Budget increase to 95 per week Non cashable benefits are developing the skills and abilities of the individual to move on to further independence and participate in their communities. Through enabling this independence, this may lead to further cashable benefits in the future for the Local Authority on reducing the support costs. If the night cost cannot be met by Housing Benefits then it would be expensive for the Local Authority since the Support Charges would be more. Over time, however, as the need for support reduces, the cost would also decrease.

8.5

Cost Benefit Analysis Residential Care per week Accommodation Based Scheme RSL with Waking Night 150 0-20 (dependent on service) Accommodation Based Scheme RSL no night staff 150 0-20 (dependent on service) 195 (15hrs x 13p/h)

Housing Benefit Client Charges Support Costs

0 62

Support Costs S117

290 265 (LA pays (15 day hrs x 13 p/h 228 of this) plus waking night 70) 290 265 (LA pays (15 day hrs x 13 p/h 290 of this) plus waking night 70 10hrs per night x 13p/h/13 people)

195 (15hrs x 13p/h)

Figures for illustration purposes only NB RSL= Registered Social Landlord

The above chart shows that in accommodation based schemes where support is shared, the scheme proves more cost effective for those who have a higher Support Need. Low support needs are often better met by Visiting or Floating Support models since the cost is not shared and increases the cost per individual.

8.6

Integrated Social Care & Health Models

An example of a good integrated model is the Collaborative Care Team initiative undertaken by Derbyshire Mental Health Trust. The team is made up of social worker care managers, one of which came from a housing background, a homeless Community Psychiatric Nurse and discharge social worker whose role is to prevent delayed discharges from the wards. The team act as a brokerage service for any case that needs a placement in the community and provides expertise to care managers for preparing cases for community care funding panel, where all funding decisions are approved. The team manages the access to all Supported Living schemes in Derby which enables the team to have an extensive knowledge at all times of current and expected vacancies, the mix of individuals in each supported living project and also allows the team to oversee all issues that arise as one point of liaison.

The savings are made as the authority no longer has to pay the accommodation charge. Housing benefit covers this and the Local Authority pays the support charges, in these cases using Supporting People funding. The client pays the ineligible service charges; all residents pay this, even those that are under S117 duty. This model is an excellent example of where a Mental Health Trust has been engaged with Supported Living services and the overall figures for residential care use in Derby City area show the success in the downturn in residential care use. Total residential care expenditure (millions) 04/05 05/06 06/07 56.85 53.78 54.91 35.24 31.85 30.18 16.74 15.97 18.77

Leicester Nottingham Derby

Action Points Identified The issue for people with mental ill health is that many do not meet the eligibility tests for Disability Living Allowance higher rate care, so would automatically be ineligible for the Independent Living Fund. This should not, however, stop assessments of people for Disability Living Allowance Care by the care managers when they are being supported to move into independent living in order to maximise the potential revenue savings for the Local Authority. Individuals should also receive cashable gain in a Supported Living scheme, rather than residential care. For those on means tested benefits (excluding s117), the reduction in these towards the costs in their residential care home fees to the level of their personal allowance, leaves them effectively with only pocket money to spend. However, if they were in a Supported Living scheme they would be eligible to receive maximum housing benefit to pay their accommodation costs, keep all of their benefits including their

Disability Living Allowance for care, if received, and only pay for their daily living costs. For those people who own their own home and go into residential care and have a charge placed on the property or have to sell to pay their costs, they could also be better off as they could be enabled to stay in their own home with a floating support service and only pay towards the support costs. Extra care schemes were developed which included outright sale or shared ownership properties, within them they could purchase a property within the scheme and not have to have a charge upon their home. People could also be enabled to purchase shared ownership through the scheme and then could receive floating support to maintain their independence in this accommodation, again stopping the need for their property to be sold or have a charge placed against it. Residential care services generally do not provide value for money in terms of quality of independence. Individuals in residential care receive a hotel style service where they have to undertake very little for themselves and effectively everything is provided for them or delivered to them; the individual normally being a passive recipient of services rather than an active participant. Residential care promotes dependency, which may stop the individuals from participating fully in the communities in which they live. Whilst the residential care homes may promote a dependency culture they do, however, have a positive aspect for some people in the security that the individual feels. Leicestershires Service User Assessments often showed that many of the residents who had been in residential care for many years often felt secure in the environment and looked upon the homes residents and staff as their family, this benefit in itself cannot be overlooked, however, this is not to say that this level of security couldnt be replicated within a supported living setting, just that this would need to be considered carefully if looking to move someone to a supported living scheme. Charging Processes need to be reviewed so that there is an incentive to pursue supported living and ensure a fairer charging system for community care services. There needs to be an incentive to move from residential care. All three authorities have an opportunity to question how they deliver Supported Living options which are both affordable for those living in them and not at a higher cost to the authorities community care budgets. Processes would need to take into consideration the governments Personalisation agenda and joint strategic needs assessments, leading to shared accountability and cost efficiency savings.

9.

Commissioning for the future Leicester, Leicestershire and Rutland are developing strategic commissioning arrangements for the purchasing of Mental Health Supported Living Services which fall outside of their Supporting People programmes all however do have established arrangements for the commissioning of supported living services for learning disabilities and so have some expertise in the developing of commissioning for supported living.

9.1

Commissioning Developments Before any Mental Health Supported Living Schemes can be developed each authority must undertake a tender exercise for Mental Health Supported Living Services. These could include support providers alone, providers of both support and accommodation together, or sole accommodation providers. Sole accommodation providers, however, do not require a competitive tender process unless there is capital gain involved. The issues surrounding tendering for providers that can provide accommodation and support is a complicated one, as this effectively ties the support provider with the accommodation, therefore if there are problems with the support provision or it needs decommissioning the question arises of how to de-commission the support without losing the accommodation. Despite this issue, given the nature of the lack of housing opportunities that may be available, joint accommodation and support provision should not necessarily be ruled out. Tenders would also need to be flexible to allow people using selfdirected support to either commission services directly or opt out from their commissioned service in favour of one of their choice. This is a challenge and will require flexibility from providers in adapting to new commissioning directions. Flexibility to change support hours: In order to map positive outcomes and development of independent living skills the commissioning of support hours need to have the capacity to be increased or decreased to ensure Value for Money for the authority and that the individual independence is fully maximised. A framework agreement is an agreement with suppliers, the purpose of which is to establish the terms governing contracts to be awarded during a given period, in particular with regard to price and quantity. This is a general term for agreements with providers, which sets out the terms and conditions under which specific purchase (call-offs) can be made throughout the term of the agreement. The benefit of this type of agreement is that whilst it sets out the terms and conditions of the subsequent call offs, there is no obligation for the Local Authority to buy anything. Advocating a Framework Agreement would assist with Value For Money and commissioning services which would be suitable for the individual needs of the person and not a model which the individual

needs to accommodate. The model of wrap around services which suits the needs of the individual ensures that money is not wasted by engaging services which the service user does not need or want. Clarity of service specification would also ensure that a pricing mechanism can be devised which is either fixed or based on market prices and quality. When awarding call-offs under the framework agreement, authorities do not have to go through the full procedural steps in the EU directives again as long as the rules were followed appropriately in the setting up of the framework itself and may award either to the supplier with the best value for money or undertake a mini competition. The contracts involved in the tender for services are estimated to maximum value over the lifetime of the contract and these are likely to exceed the relevant EU threshold then it will need to be undertaken following EU rules. This is a considerably lengthy process that can take between nine and twelve months and therefore needs implementing as early as possible as no supported living services can be commissioned without this being in place. As there is no current market for mental health supported living service (outside of the SP programme), this is a market area that needs developing and a joint tender across the three authorities would provide the best value for money for both cashable and noncashable benefits. Efficiencies could be gained from the pooling of resources that are required for the tendering process, which can take considerable time and effort from staff resources and also would make staff commissioning arrangements easier for LPT who work across the three authorities. As a developing market area, combining the purchasing power of three authorities could give efficiencies in keeping prices competitive and also allow Rutland the opportunity to participate in the framework agreement without the need to call-off if they found this unnecessary during the agreement period. The undertaking of a joint tender for the three authorities does not require joint commissioning or contracting arrangements.

9.2

Deregistering Whilst new supported living services are most likely to be funded through the commissioning budget and the recycling of funding locked into residential care from Adult Social Care, these budgets are already over-stretched and cannot make significant increases in expenditure without decommissioning services that are no longer fit for purpose. The funding of placements in residential care needs to be reviewed in the light of the Personalisation Agenda and the possibility of accessing alternative revenue funding avenues. Another way of de-commissioning residential care and providing supported living is to enable the residential care home to deregister

in favour of becoming a supported living provider. This may provide efficiencies for the authority in the long term of cashable savings: they would no longer pay for the accommodation, as the service user could claim housing benefit to cover this and as peoples independence increased support costs would decrease, however the level of savings would be dependent upon the needs of the people in the scheme. 9.3 Advantages of Re-Modelling into Supported Living Environment Service User has greater security as it would be a independent tenancy Financial advantages as the service user would not have the residential care deduction in the money down to the personal allowance level and/or charges made on their capital. The level of charge for the support would also need consideration under the fairer charging system of charging for community care services to make sure it would not be unaffordable for the person to live there independently. A move away from the dependency nature of residential care in support giving them greater choice and control in the support they need. Key Points Identified The first priority will be to identify options for people currently living in residential care homes and to support them to move to Supported Living schemes. There has already been a successful de-registration of a mental health residential home into a Supported Living scheme in Leicester City at Glengarry Court owned by Advance Housing Association, and this is a good example of how this can be achieved. Both Leicester and Leicestershire have also worked with care homes for people with learning disabilities to de-register them. Further work is required with privately owned residential homes across the authorities, with providers to look at the possibilities of de-registration and developing Supported Living schemes. This work requires cross-authority collaboration due to the impact that de-registration may have upon issues of ordinary residence, S117 responsibilities and out of area placements as previously identified.

9.4

10.

Appendices

Appendix 1
Definition of Key Terms Healthcare Activities which, unless self-administered, should normally (i.e. except in emergencies) only be carried out by suitably trained and qualified healthcare staff. Personal care Assistance with ordinary activities of living, at one or all of four levels: Assistance with bodily functions such as feeding, bathing and toileting. Care which falls just short of assistance with bodily functions, but still involving physical and intimate touching, including activities such as helping a person get out of a bath and helping them to get dressed. Non-physical care, such as advice, encouragement and supervision relating to the foregoing, such as prompting a person to take a bath and supervising them during this. Emotional and psychological support, including the promotion of social functioning, behaviour management and assistance with cognitive functions.

Social care Support with arranging and escorting to social activities and social events and other activities intended to promote community engagement and social inclusion. Note that social care in this more limited sense can be regarded either as an aspect of personal care (the promotion of social functioning) but more generally as an aspect of support (help in developing social skills and managing disruptive or dysfunctional behaviour. Help in establishing social contacts and activities) Support Support activities include:Help, prompting or encouragement in developing domestic and practical skills; help in developing social skills and managing [disruptive or dysfunctional] behaviour; risk assessment and management help in managing finances and dealing with benefit claims; help in establishing social contacts and activities; supervision and monitoring of health and well being; advice, advocacy and liaison with statutory agencies; help gaining access to other services (e.g. training courses) help in finding [and moving onto] other accommodation; emotional support. Counselling and advice; peer support and befriending. Note that the definitions here should not be confused with particular agencies or funding sources.

Appendix 2
Additional Information and references The Mental Health and Social Exclusion Report (2004) This study had three broad conclusions: Social Housing has become the main vehicle in practice for successive governments policy commitments to treat and to house the most vulnerable in the community; that social housing should therefore now be seen as constituting one of the essential resources for community care; that this community care role needs to be properly recognised and that what is seen as good practice in social housing should be seen in that light. Mental Health services cannot continue to regard the housing needs of their clientele as simply the responsibility of another agency; that mental health services should be positively engaged in identifying these housing needs working with local housing agencies on fully comprehensive local needs analysis and strategies, and feeding this information on local and unmet needs into regional and national housing strategies. General Needs social housing and supported accommodation cannot be seen as separate worlds and must be seen as part of a continuum of housing services, which includes; shared ownership and private sector leasing, floating support, networked housing, supported accommodation rehabilitation units, and residential care and that a whole systems approach to the housing and support needs of those with mental health problems needs to encompass this entire range. List of agencies consulted regarding the strategy: Leicester City LIT, Leicestershire & Rutland LIT Leicestershire Supporting People Forums Rutland Supporting People Forums Leicester Supporting People Forums Open Assembly The Peoples Forum Leicester City Council Adults and Housing Directorate Leicester County Council Adult Social Care Rutland County Council Adults and Housing Directorate Chief Housing Officers Group

Appendix 3
References Brewis, R, 2007. A Voice and a Choice. Self directed support by people with mental health problems. In Control Care Standards Act 2000 HMSO Commission for Social Care Inspection, No Date. Annex A Policy and Guidance: Assessing whether a care service needs to be registered. Draft Communities and Local Government, 2007. Providing Housing and Support Lessons and Good Practice HMSO Department of Health, 1999. National Service Framework for Mental Health. Modern Standards and Service Models HMSO Department of Health, 2001. Valuing People. A New Strategy for Learning Disability in the 21st Century. HMSO Department of Health, 2005. Independence, Well Being and Choice: Our Vision for the Future of Social Care for Adults in England. HMSO Department of Health, 2006. Our health, our care, our say: a new direction for community services. HMSO Department of Health, 2007. Breaking down barriers Clinical Case for Changed: Report by Louis Appleby, National Director for Mental Health. HMSO Department of Health, 2007. Putting People First: a shared vision and commitment for the transformation of adult social care HMSO Johnson, Robin. 2006. Towards a whole systems approach. Power point presentation. King, Harker, Hall & Young, 2004 Housing and Support Choices. Housing Options. 2004 Kinsella cited in Social Care Research 94, June 1997. The Early Years of Supported Living in the UK. Joseph Rowntree Foundation

Leicester City Council, 2007. Mental Health Needs of Working Age Adults in Leicester: Part 1 Demographic information, prevalence and trends. Leicester City Council et al, 2006. Leicester City, Leicestershire and Rutland LocaI Implementation Team Combined Action Plan Leicestershire County Council, 2005. Mental Health Needs of Working Age Adults in Leicestershire Draft.

Local Government and Public Involvement in Health Act, 2007. HMSO Mental Health Act 1983. HMSO National Institute for Mental Health in England, 2004. At Home? A study of mental health issues arising in social housing . NIMHE Office for Disability Issues, 2008. Independent Living A cross-government strategy about independent living for disabled people HMSO Office of Government Commerce, 2004. PRINCE 2 Managing Successful Projects with PRINCE 2 HMSO Office of Government Commerce, 2006. Framework Agreements OCG Guidance on Framework Agreements in the new procurement Regulations. London Office of the Deputy Prime Minister, 2004. Mental Health and Social Exclusion. HMSO Office of the Deputy Prime Minister, 2005. Creating Sustainable Communities: Supporting Independence- Consultation on a Strategy for the Supporting People Programme. HMSO OMalley & Croucher, 2003. Supported Housing Service for People With Mental Health Problems: Evidence of Good Practice? Paper presented to HAS Conference Housing and Support University of York 2003. Centre for Housing Policy, University of York. Supporting People Strategies: Leicester City Council, Leicestershire County Council, and Rutland County Council.

Appendix 4 Delivery Action Plan

Common Assessment Framework Effective use of specialist Performance Management Framework which assesses resources. on both clinical and social need enabling resources to be targeted to those with the greatest need ensuring that People in residential care supported living environments are devised to meet the will have developed the changing needs/ preferences of people with mental ill skills and ability to enable health and their changing aspirations. them to move to further independence in a Better communications across all services, especially supported living scheme. housing across Leicestershire & Rutland. Partners take ownership of this strategy and it is linked into local strategies Establish a housing link worker who could link up with the NHS to look at hospital discharge and assessment reviews and to look at preparing people for independent living skills.

All involved in Local Area Agreements/ World Class Commissioning Competencies for Primary Care Trust Timescale Dec 09

Staffing level increase for new housing link worker job role Publicity awareness around Supported Living Options targeted towards Staff, Patients and carers. Need for an information booklet Culture of Change awareness training for staff and people using Mental Health Services. Identify funding for costs relating to delivery of training and developing training packages, time out for staff to attend training, expenses relating to venue hire, catering, and cost of speakers

Engage with Providers on de-registration.

Capacity building available Supported Living units. We will know if there are registered care homes that have the capability and willingness to work towards de-registration and whether or not this would meet the needs of people living there.

Development work with privately owned residential homes across the authorities to develop the possibilities of deregistration and the development of Supported Living. This work requires cross authority collaboration due to the impact that de-registration may have upon issues of ordinary residence, S117 responsibilities and out of area placements. Development of a work plan to enable residential homes to become supported living providers. Allocation Procedures need to be created to ensure that void periods are minimised. Resources needed to maintain property standards so that Health & safety aspects have been covered in terms of property management and landlord obligations. Funding needed to encourage property owners to forward plan and remodel existing units to meet future needs identified Joint working with Environmental Health Officers to monitor standards. Incentive and assurance measures through financial risk management of property and direct financial payments and ensuring that tenancy conditions are adhered to

Leicester, Leicestershire and Rutland Local Authorities Mental Health Supported Living Project Manager to coordinate Dec 09

Resources needed to consult with owners and appeal for units. Web page/press releases. Job role of a Floating Support Worker needed. Joint Funding from NHS/ Local Authorities Local Area Grant. Housing Link Worker position needed. LAA Funding around joint Performance Indicators.

Cross Boundary Agreement needs to be agreed between Local Authorities looking at Ordinary Residence & Section 117. Freedom of Choice and Local Area Agreements Agreement on ordinary residence and S117 between improved mobility and Leicester, Leicester, Leicestershire and Rutland for those placed housing options for those Leicestershire and Performance Indicators. Cross out of ordinary residence and people who may wish to who are vulnerable. Rutland Local Boundary agreement needed access supported living in the future outside of their area The Personalisation Authorities between authorities around finance of ordinary residence. agenda to become a and hosting with regards to long reality. term responsibilities and cost. There will be an agreement between the three local authorities on people moving into supported living or Timescale Potential creation of a Finance deregistering homes into supported living which meets Dec 09 Officer post to look at Ordinary the requirements of those currently placed out of ordinary residence and continuing care residence and/or on a S117 to remain living in their concerns. current local authority area. Training around Protocols.

Housing Allocations policies to be amended to improve access pathways for residential placements wanting to move to independent accommodation / Fair Access and Inclusion for Vulnerable Service users to take part in Choice Based lettings. People with mental ill Ask housing providers to review their housing allocation policies Consistency for Local Area Grant funding health can get on the and lettings figures to ensure that people with mental ill health County/ Districts & housing register; have the can access their housing register and have an adequate priority LAs Housing Link Worker position correct level of priority awarded to their application. This would then reflect mental health needed. awarded to their and housing needs so that service users are able to compete for application for social vacancies. Staff Training - identify and housing and that this will Timescale resource funding for costs relating reflect their housing need Set up service level agreements between housing providers and Dec 09 to delivery of training and and mental ill health. public agencies who are engaged in the Local Area Agreements developing training packages, time to have joint performance frameworks which will allow for greater out for staff to attend training, Local Authorities who do choice and an improved level of appropriate, person centred expenses relating to venue hire, not have a housing housing. catering, cost of speakers. function would have an enabling role by entering into service level agreements with those who do have properties. Pathways created with joint protocols to facilitate move on

. Joint Working Arrangements There are clear referral Review work of the Community Services to consider developing routes between the joint protocols with Supporting People providers. This would then Community Services and identify referral routes between schemes and enable move on Supporting People from Supporting People schemes and to create vacancies to new providers to enable move NHS clients. on from SP schemes. Also roles and responsibilities Support providers would need to review their models of service will be clearly defined for delivery to take account of the increasing needs which the providers of support implementation of the strategy will lead to. This increase will be services mapped to identify what change has occurred inline with the

Local Area Grant funding Local Area Agreements Performance Framework Sept 09 (achieved in Counties April 09)

implementation of the strategy.

The supported living needs of people with Aspergers Syndrome will be identified and appropriate action taken to meet these needs.

Needs identification to be undertaken on the supported living needs of people with Aspergers Syndrome in residential care and in the community. This work could be undertaken jointly by Leicester and Leicestershire as further needs assessment is required in both local authorities.

Local Authorities Timescale Dec 09 (to be confirmed when Aspergers Strategy is completed)

Needs Mapping process to be completed. Outcome of World Class Commissioning Competencies for Primary Care Trust in the NHS.joint commissioning processes between NHS and Local Authorities. Look into potential funding with Specific Aspergers Syndrome Commissioning progress.

Personalisation agenda making sure that support services are commissioned to improve independent living in the community. The provision of Further work on domiciliary care services that meet the needs of Individual budgets and Direct domiciliary care services people with mental ill health living in the community. Commissioners Payments in the community that around Personal Assessments from people in residential care found meet the needs of people Care Outcomes of RAS. minimal need for domiciliary care but for people in the with mental ill health Outcome of World Class community need identified by the NHS gave 24% would Timescale Dec 09 Commissioning Competencies for need some domiciliary care services. Primary Care Trust in the NHS.joint commissioning processes between NHS and Local Authorities.

Supporting people who have low level Mental Health distress to settle in the community and to prevent further relapse in Mental Health welfare.

Floating support services will offer further choices to people who have mental ill health. This can be self-managed and will allow people to settle in the community instead of having to live in residential care, allowing more individualised support. Shared performance management framework which encompasses new level of Floating Support to ensure target cohesion.

Local Area Agreements Performance Framework Aug 09 ongoing

Personalisation Agenda Increase in floating support workers. Publicity awareness around Supported Living Options targeted towards Staff, Patients and carersneed for an information booklet. Culture of Change awareness training for Staff and People using Mental Health Services. Identify and resource funding for costs relating to delivery of training and training packages, time out for staff to attend training, expenses relating to venue hire, catering, cost of speakers

We will know from the NHS and Local Authority who are the leads on which aspects of supported living. This will enable further action and commitment from the organisations for the future development of services. Improving communication links between agencies. The strategy will constantly remain fit for purpose. People with mental ill

The strategy is reviewed and refreshed annually through the relevant cross-authority group, and strategically linked documents updated to reflect this. The review process will include equality and diversity strands.

Leicestershire Local Authority & Supporting People & NHS Counties & Housing across Boroughs and District Councils Leicester Adults & Housing Supporting People On Going Reviews

Staff Time to devise action plan and regular review of action plan. Attendance at LIT meetings. Regular update meetings between key personal from Stakeholders to implement the action plan and drive the Supported Living Strategy Forward.

Working jointly with Registered Social Housing Landlords to look

Local Authorities

Culture of Change awareness

health have their needs met in the development of Choice Based Lettings schemes and they are able to participate fully in the Choice Based Lettings scheme in that area and bid for social housing. Increased potential of capacity building.

at Developing a mixture of Supported Living Environments which accommodate according to individual housing choices and preferences. Introduction of contact base through a central website, contact form and email address alongside already existing contact methods. Creation of contact database to ensure coherent pathways for public, private and registered social landlords to ensure that development pathways are optimised. Fair access and inclusion become a working reality and are sustained. Project leads to work with Housing Districts to increase the capacity of Supported Living properties. Linking in with the Sustainable Communities Strategy to ensure that current and future housing needs are mapped with priority neighbourhoods and wider local Area Agreements. This will then ensure that Public Service Agreement 16 is implemented.

District Authorities Timescale: On Going

training for Staff. Funding via Local Authority Capital programmes and Housing Corporation development bids. Renewal Grants Staff Time and Resources needed. Online resources for Supported Living website. Potential for inspections within Environmental Health remit. Resources needed for publicity awareness campaign, potential for regular press release.

The development of supported living schemes in the private sector in all three Local Authorities.

Gain legal Advice on extending beyond 10 years on short term leased schemes with housing benefits. Look at potential use of service level agreement/management contracts with property providers to utilise units for supported living environments. Research financial incentives to encourage participation. Financial risk assessment to be completed by all authorities.

Adults and Housing Department (Leicester City) Leicestershire and Rutland Authorities to discuss potential Timescale Aug 09 ongoing NHS City and Leicester Housing Department Leicestershire Local Authority and NHS Counties and District and Borough

Staff time out for development and coordination from: Environmental Health Department Legal Services Housing Departments from District and Local Authorities Housing Corporation Landlord Forums

Remodelled existing housing units which can be utilised for supported living.

There will be some general need stock that can be reshaped into supported living schemes. Under utilized schemes may be particularly useful for reshaping to one site models. Stock appraisals by public bodies of current unit available for use in supported living via lease hold arrangements. Pursuit of Service Level Agreements to meet outcomes

Mental Health Supported Living Project Manager working jointly with housing departments Local Area Grants Potential for Housing Corporation

set out by Indicators.

Local

Area

Agreements

Performance

Councils Housing Department On Going

funding and renewal grants. Regional Housing Group staff to ensure service level agreements are developed and sustained. Publicity awareness around Supported Living Options targeted towards Staff, Patients and carers. Need for an information booklet. Culture of Change awareness training for Staff and People using Mental Health Services. Identify and resource funding for costs relating to delivery of training and training packages, time out for staff to attend training, expenses relating to venue hire, catering, cost of speakers. Local Authority staff time to work with supporting people teams.

All staff across all housing providers in the three Local Authorities and the NHS staff are aware of protocol towards lack of move on and are working towards it.

Liaise with training departments in Local Authorities and NHS to develop joint working between Supported Living strategy and Personalisation agenda. Raise awareness of joint protocols and joint Service Level Agreements. Raise awareness of local area agreement performance indicators and NHS World Class Commissioning Competencies for Primary Care Trust.

NHS City and Leicester Housing Department Leicestershire Local Authority and NHS Counties and District and Borough Councils Housing Department Timescale December 2009

People with mental ill health currently residing in Supporting People funded schemes have clear exit pathways to pursue long term housing solutions and are able to join housing registers in the pursuit of this. There is clear guidance and information for people and staff on what supported living services are, where they are

Review SP providers allocation policies to ensure they do not have policies that disadvantage people who want to leave residential care Review Housing Enabling pathways to address lack of move on in current SP Schemes. Pursue commissioning groups and local authorities to devise joint protocols/amendments to allocation policies. Additional work is undertaken with people living in residential care who could move into supported living but currently do not want to. Liaise with training departments in Local Authorities and NHS to develop joint working between Supported Living strategy and

Supporting People

Timescale Dec 09

Leicester , Leicestershire and Rutland Adults & & Supporting People & NHS

Publicity awareness around Supported Living Options targeted towards Staff, Patients and carers. Need for an information booklet.

located, what people can do to access them and who is eligible. Enables informed choices to be made about supported living options.

Personalisation agenda. Utilise Peoples Forum and Genesis projects to inform people using Mental Health Services around choices and the supported living project as a whole. All supported living schemes funded by SP, Adults or NHS, have cohesion within the publicity information regarding the service, access and eligibility in order for mental health staff and the people they work with to make informed choices about the service. Timescale December 09 Culture of Change awareness training for Staff and People using Mental Health Services. Identify and resource funding for costs relating to delivery of training and training packages, time out for staff to attend training, expenses relating to venue hire, catering, cost of speakers. Care Programme Approach Pathways process to consult service users Culture of Change go through the whole process Timescale Sept 09 ongoing Outcome of World Class Commissioning Competencies for Primary Care Trust in the NHS. Joint commissioning processes between NHS and Local Authorities. Culture of Change awareness training for Staff and People using Mental Health Services.

People in supported living schemes will have good quality, regular reviews of their support packages to continue to develop their independence and reduce their commissioned support. This would ensure the service user does not get stuck in a scheme with more support then they require which would deskill them.

Care management by staff of people in supported living is regular, timely and effective in considering the current support needs of people. Performance Management Framework which assesses on both Clinical and Social need will enable resources to be targeted to those in greatest need ensuring that supported living environments are devised to meet the changing needs/ preferences of people with Mental Health and their changing aspirations. Better Communications across all services especially housing localities across Leicester, Leicestershire & Rutland. It would be useful to have a Housing Link Worker who could link up with NHS looking at Hospital discharge and assessments reviews and looking at preparing people for independent living skills.

People moving from residential care into supported living have their benefits maximised

Benefits advocacy is provided to people before they move from residential care into supported living or people in residential care homes that deregister.

Rutland Local Authority & NHS Counties Leicestershire Local

Engagement of Welfare Rights Worker, possibly a cross-authority funded post.

and if Disability Living Allowance higher rate care received the Local Authority can utilise Independent Living Fund towards the cost of independent living packages. People who move into supported living schemes from either residential care or the community are not financially disadvantaged by this move and supported living remains a financially viable option for people on low incomes and means tested benefits. That the supported living needs for people with mental ill health will be identified in the following strategies: Supporting People, Homelessness, Housing

Fairer charging for supported living services are considered and developed.

Authority & NHS Counties Leicester Local Authority & NHS City Timescale Sept 09

Fairer charging for supported living services are considered and developed.

Leicester Local Authority & NHS City Leicestershire Local Authority & NHS Counties Rutland Local Authority & NHS Counties Timescale Sept 09

Engagement of Welfare Rights Worker, possibly a cross-authority funded post.

The needs for supported living identified in the strategy are strategically linked and prioritised across three Local Authorities, Districts and Borough Councils, SP, Homeless and Housing strategies.

Leicester Adults & Housing & Supporting People and NHS City Leicestershire Local Authority & SP & NHS Counties & Housing across Boroughs and District Councils Rutland Adults and Housing and SP and NHS Counties. Timescale Sept 09

Outcome of World Class Commissioning Competencies for Primary Care Trust in the NHS. Joint commissioning processes between NHS and Local Authorities.

The housing and support needs, including unmet needs, for people with mental ill health are recorded and reported to provide needs data for future service development.

A data recording system is developed which enables the recording and reporting of needs data on the support and housing needs of people with mental ill health which is based around performance indicators in Local Area Agreements and World Class Commissioning Competencies for Primary Care Trust and recovery models. The full ranges of supported living needs are identified for development. Action planning can be undertaken with those people or services requiring further work from these assessments.

All involved in Local Area Agreements and World Class Commissioning Competencies for Primary Care Trust Timescale Sept 09 ongoing

Funding for integrated data recording system. Local Area Grant within establishing/re-modelling existing supported living environments.

There will be supported living services that meet the needs of people from BME groups.

The needs for BME specific support services are considered by current SP service providers.

Leicester Adults & Housing & SP and NHS City Leicestershire Local Authority & Supporting People & NHS Counties On Going

Equality Impact Assessment to be completed by NHS and Local Authorities.

People using mental health and supported living services (and their carers) are involved in service design, development and monitoring There will be supported living services to meet the needs of those in one site schemes who need access to support for

Service users and carers are represented on cross authority monitoring groups Service users and carers participate in commissioning and contracting decision-making processes Service users and carers contribute to delivery of action plans

Leicester, Leicestershire and Rutland Local Authorities, NHS Ongoing

Engagement with service users and carers via existing forums.

The reshaping of current Supporting People funded support services to meet the needs for out of hours care and 24 hour staffing on one site schemes.

Leicestershire Local Authority & SP & NHS Counties Timescale August 2009

extended hours or 24 hours.

Joint Commissioning pathways between NHS and Local Authorities Publicity awareness around Supported Living Options targeted towards Staff, Patients and carers. Need for a information booklet resources needed to implement. Culture of Change awareness training for Staff and People using Mental Health Services. Identify and resource funding for costs relating to delivery of training and developing training packages, time out for staff to attend training, expenses relating to venue hire, catering, cost of speakers. Housing Link Worker who could link up with NHS looking at Hospital discharge and assessments reviews and looking at preparing people for independent living skills...Staffing Capacity for new job role Mental Health Floating Support increase. Funding from Local Area Grant

Staff within and around residential care will be working towards the outcomes of the personalisation agenda, in terms of realising and informing upon the benefits of supported living and working alongside the culture of change.

Supported living assessments of people in residential care continue to be undertaken in a programmed way until completed so the needs of those in residential care is fully identified. This may include further work with staff to identify the reason that they view people as unsuitable for supported living.

Leicester Local Authority and NHS City. Leicestershire and Rutland Local Authority & NHS Counties Timescale Review Sept 09

That people with mental ill health in Rutland not on a CPA will also have access to supported living services.

Examine the eligibility to the Rutland Supporting People provider in support to people who do not have a Care Plan Approach in place.

Rutland Local Authority and Supporting People Timescale to be confirmed

Appendix 5 Consultation Action Plan Message To inform and obtain views on the strategy and publicise the consultation methods and events. Stakeholder Group ALL stakeholder groups and general public. Method Newsletter 1. Publish and distribute hard copies with key questions 2. Distribute electronic copies to all stakeholder groups and key contacts 3. Publish on LAMP website with links to other key sites Key questions 1. Publish on LAMP website with links to other key sites 2. Distribute electronically Flyers 1. Distribute flyers publicising strategy and consultation methods and events Lead Time Frame 19/02/09 Status Completed

A Maullin/T Fisher

To Be Confirmed

tbc

To Be Confirmed

19/02/09

Completed + ongoing for further events

Web Publication of Strategy 1. Confirm final draft then arrange for publication on LAMP website with key questions 2. Arrange link information from Leics, Leicester, Rutland, LPT and NHS websites

To Be Confirmed

tbc

To inform and obtain views and authoritative acknowledgment from Local Authorities.

Commissioners and decision-makers

Press Release 1. Prepare press release and liaise with Press Officers Leicestershire County & Rutland LIT Meeting 1. Report and Presentation Leicester City LIT meeting 2 Report and Presentation Leics County Council Management Team 3 Report and Presentation Leicester City Council Management Team 4 Report and Presentation Rutland County Council Management Team 5 Report and Presentation

To Be Confirmed

Deferred to formal launch 17/02/09 Completed

S Patel/ A Maullin S Patel/A Maullin

17/02/09

Completed

To Be Confirmed

Feb 2009

Completed

To Be Confirmed To Be Confirmed

Not required

Not required 20/02/09 Completed

To publicise the strategy and obtain views and opinion from the people using Mental Health Services.

People Using Mental Health Services

Consultation events 1. Mail-out completed for Peoples Forum and Open Assembly Consultation events 1. Leics County Consultation events

To Be Confirmed

To Be Confirmed Leicester

20/03/09 Completed

2. Leicester City

City Council

Consultation events 3. Rutland Consultation events 4. Interpreted Event Consultation events 5. Ward Forums Liaise with Peoples Forum and Open Assembly to arrange consult. To inform and obtain opinion from informal and family carers of people who use mental health services Carers Forum meeting(s) 1. Arrange with Carers Action and In Touch Group Consultation event 1. One event publicised to all partner organisations Housing service providers existing and potential 1. Contact all district councils and arrange meetings to discuss strategy and gather views

To Be Confirmed To Be Confirmed To Be Confirmed

Not required Need to be reviewed

To Be Confirmed

20/03/09

Carers Action Completed Completed

A Maullin

Event arranged for 07/05/09 30/04/09

To inform and obtain opinion from housing service providers and build new and strengthen existing relationships with both potential and existing housing providers.

J Green

2.

Invite all sectors housing providers to information event once Strategy agreed.

To inform and obtain opinion from Mental Health Service Providers

Mental Health service providers

Consultation event(s) Included in event to be held on 07/05/09

To Be Confirmed

07/05/09

Completed

Subsequent Actions Collection of Data Analysis of Data Report on Findings Present to Strategy Board Final Version of Strategy Completed

Status 08/05/09 Completed 12/05/09 Completed 15/05/09 Report ready to present 15/05/09 31/05/09

Equality Impact Assessment

Title of policy being assessed: Department and section: Names and roles of officers completing this assessment:

Contact telephone numbers:

Date assessment completed:

Mental Health Supported Living Strategy 2009 - 2013 Adult Social Care, Strategic Commissioning and Service Development (Adults) Sangeeta Patel, Strategic Commissioning Manager Alison Maullin, Service Development Officer Chhaya Macdonald, Planning Officer 0116 225 5232 0116 305 4994 0116 305 5206 06 July 2009

Defining the policy 1. Why is the policy necessary? What are its aims and objectives? What outcomes is the policy designed to achieve and for whom?

Aims and objectives: Main objectives for this strategy are: Putting people at the centre, giving them real supported living options through supporting their choices and enabling them to have control over their lives in where they live and the support they receive Promote healthier communities, ensuring peoples mental health is supported and raised through good quality homes and support Focus on outcomes to help people achieve their goals in independent living Deliver better commissioning through local service and needs profiling Making a real different to peoples lives through allowing them to live independently with support to participate in their communities Outcomes: The main outcomes for this strategy are: Improve health and emotional wellbeing Improve quality of life Support adults in making a positive contribution Commitment to providing greater choice and control Ensure freedom from discrimination Improve economic wellbeing Promote personal dignity

2. How have these aims, objectives and outcomes been determined? What research and engagement/involvement/ consultation has been undertaken/used to inform design and delivery of the policy? How have the needs based on race, gender, disability, age, religion/belief or sexual orientation been taken account of? Research:

Mapping of current service provision Mapping of use of existing provision Research questionnaires about requirements for additional or different services both currently and in the future Focus groups with current users of services Analysis of demographic information Research into good practice in other localities Meetings with neighbouring local authority to look at alternative models of supported housing provision Visits to existing supported living schemes

Consultation: As broad a spectrum as possible of stakeholders were consulted, which included: Peoples Forum members (service users) Genesis members (service users and carers) Carers Action members (carers) People using supported living services Focus groups Leicestershire County Council Adult Social Care Management Team NHS Leicestershire & Rutland NHS Leicester City Leicester, Leicestershire and Rutland Recovery Fair Open consultation events Meetings with all District and Borough Councils in Leicestershire, to explain the strategy and explore the implications. Communication and consultation plan drawn up and approved by the Mental Health Supported Living Project Board

In order to meet any specific identified needs, research and analysis were undertaken as follows: Race There was a specific examination of the use of services by people from Black and Minority Ethnic Communities. There were some indications of over- and under-representation within different areas of service provision, however further work to address understanding of need is required this has been recognised as a high priority for all services, and actions relating to achieving

this will be recorded in the Equality Improvement Plan and incorporated into the Strategy Delivery Action Plan. Gender More detailed data collection and analysis is required in order to ensure any equality issues can be fully addressed. Specific actions to achieve this will be included in the Equality Improvement Plan and incorporated into the Delivery Action Plan. Age More detailed data collection and analysis is required in order to ensure any equality issues can be fully addressed. Specific actions to achieve this will be included in the Equality Improvement Plan and incorporated into the Delivery Action Plan. Disability Whilst all the service user data collected relates to people with a mental health difficulty, details of any additional disability were not collated. More detailed data collection and analysis is therefore required in order to ensure any equality issues can be fully addressed. Specific actions to achieve this will be included in the Equality Improvement Plan and incorporated into the Delivery Action Plan. Sexual Orientation This data is not routinely collect, and therefore more detailed data collection and analysis is required in order to ensure any equality issues can be fully addressed. Specific actions to achieve this will be included in the Equality Improvement Plan and incorporated into the Delivery Action Plan.

Other research/engagement/involvement/consultation undertaken in the development of the strategy: Meetings with all District and Borough Councils in Leicestershire, to explain the strategy and explore the implications. Meetings with neighbouring local authority to look at alternative models of supported housing provision Visits to existing supported living schemes Desktop research into examples of good practice elsewhere Communication and consultation plan drawn up and approved by the Mental Health Supported Living Project Board

3. a) Who is responsible for implementing the policy? What processes, procedures and/or criterion will be critical to deliver the policy? Review these against the access needs that various equality groups of people have and consider if they result in barriers which prevent these groups of people from either finding out about the policy or benefiting from it The key stakeholders are Leicestershire County Council, Leicester City

Council, Rutland County Council, and Leicestershire Partnership Trust. The key stakeholders are required to implement or ensure the implementation of the policy occurs. Leicestershire District Councils will also have a role to play in their capacity as housing authorities. Internal departments and sections across the three agencies will have responsibilities in ensuring the policy is accomplished. This process will be undertaken via an overall Delivery Action Plan, with timescales associated over the lifespan of the strategy, actions relating to the department/section with leads and responsible person (s)/teams. Supported Living Service Providers will also be responsible in meeting the strategy outcomes Progress will be reported on a regular to the appropriate local authority management teams and the two Local Implementation Teams. Information will be published on appropriate websites Regular easy to read newsletters will be distributed via websites and partner organisations. Information will be translated into other languages and formats if required.

3. b) Consider what barriers you can remove, whether reasonable adjustments may be necessary and how any unmet needs that you have identified can be addressed. Barriers will be removed through employing the widest possible range of communication methods, ie - Summary documents - Easy to read newsletters - Face to face explanations if requested - Use of websites - Via partner organisations 3. c) when you are deciding priorities for action you will need to consider whether the barriers result in an adverse impact of discrimination that is illegal. These will constitute your top priority. The other priorities will be dependent on such issues as whether a group is particularly excluded or connected to the core business of the service, whether there are adjustments that would mean several groups benefit. Needs data will be re-examined and the requirements for targeted consultation will be reviewed in relation to identified hard-to-reach communities. Monitoring systems will be put in place to ensure ongoing review of any adjustments required.

4. what measures and methods have been designed to monitor the application of the policy, achievement of intended outcomes and identification of any unintended or adverse impact? How frequently will the monitoring be conducted and who will be made aware of the analysis and outcomes? The Delivery Action Plan illustrates the milestone and timescales for taking the plan forward. Each local authority should have in place a system for review and evaluation of the strategy after implementation, to measure progress in terms of planned service developments and to evaluate the extent to which services are leading to better outcomes for people with mental health difficulties and carers. There should continue to be liaison and partnership working between the three local authorities to ensure consistency of service provision and accessibility. It will be the responsibility of the identified monitoring group in each local authority area to review and evaluate progress and the impact of the strategy. Any identified unintended or adverse impacts will be addressed within the appropriate Action and/or Service Plans. It is proposed that in each local authority, providers, people using the services, carers and mental health professionals will all contribute to the overall performance monitoring of supported living provision.

5. Consider the answers given in 1,2,3 and 4 and assess whether the policy and implementation results, or could result in adverse impact on or discrimination against different groups of people. If you consider that there is adverse impact or discrimination, or the potential for either, please outline below and state whether it is justifiable or legitimate- give reasons.

This is a positive strategy to address inequalities of supported housing provision for people with mental health difficulties. The full impact will not be clear until the strategy is implemented and outcomes can be monitored. 6. a) whether the adverse impact is illegal if so how to remedy b) if justifiable and legitimate need to consider actions that mitigate its effects on those groups under PSA 15 Council needs to address disadvantage across all six equality strands

Implementation of monitoring systems will help to identify any adverse impact and this will be address in the Action and Service Plans accordingly.

7. Social Cohesion what social cohesion issues could arise? The strategy has been developed as positive action to meet the needs of adults with mental health difficulties and their carers in order to maximise choice, independence and social inclusion across Leicester, Leicestershire and Rutland. The strategy encourages social cohesion by enabling services to be flexible and imaginative and integrated within the community. The strategy encourages and ties in with the personalisation agenda so that adults with mental health difficulties and their carers are able to have choice and control over the services they receive which best meet their personal outcomes. The Delivery Action Plan lists all actions in order to implement the Strategy, and to improve supported living provision. The Equality Improvement Plan includes additional actions to ensure service provision meets the needs of all equality groups.

8. EQUALITY IMPROVEMENT PLAN Please list all the equality objectives, actions and targets that result from the Equality Impact Assessment (continue on separate sheets as necessary). These now need to be included in the relevant service plan for mainstreaming and performance management purposes. Officer responsible

Equality Objective Supported living services meet the specific needs of all people with mental health difficulties and their carers, enabling choice and control to meet personal outcomes

Action Data capture will be reviewed to identify under-representation of any hard-to-reach groups. The specific support service requirements for Black and Minority Ethnic Groups will be determined Determine requirements for specific services to meet the needs of people with Aspergers Syndrome Determine requirements for gender-specific services. Mental health awareness training for housing and accommodation providers Person Centred Planning and Outcomes training for support services providers Partnership working between the 3 local authorities to ensure services are accessible: - physically

Target

By when

Equality Objective

Action - language - in relation to equalities

Target

Officer responsible

By when

The strategy and supported living services provision are monitored in relation to equalities issues

Implement equalities monitoring processes Review processes contained within the Delivery Action Plan to include Equality and Diversity strands. Support providers to include in their monitoring submissions the details of complaints and commendations, information on service users and staff relating to age, gender, disability, ethnicity etc. Establish links with service user and carer groups and advocacy services, ensuring equality groups are targeted, to encourage specific involvement in review, planning and development of services.

Adults with mental health difficulties and carers from all sectors of the adult mental health community are involved in the review, planning and development of supported living services

1st Authorised signature (EIA Lead) .. Date: ..

2nd Authorised signature (Member of DMT) . Date:

Once completed and authorised, please send a copy of this form to the Equality and Diversity Team in the Chief Executives Department.