The twain shall meet

In the first of two articles on the progress made by Supporting People, Robin Johnson looks at how the demarcation line separating support and care services is being erased

The new Supporting People national strategy, unveiled for consultation in November, represents a major step forward for this complex but important area of social and welfare policy. It shows that the Supporting People programme has turned a corner, and is ready to rebuild and reposition itself as a key social policy platform of this government.

Government proposals in the consultation suggest that the strategy should adopt different approaches for those needing housing support with care; those needing low-level support; and people needing crisis support.

Yet there are already signs that health and social care services are missing the significance of this new approach. This is perhaps understandable. Health and social care services are pre-occupied with their own core priorities, budgets and modernisations. Three years of hectic service and policy development in Supporting People, followed by two years of cuts and painful retraction, does not tend to give clear signals to other local agency partners about where it is going.

Those early cuts caused additional frictions between local Supporting People teams, providers and community care agencies, jeopardising both the credibility of support services, and the original ambition for the programme to co-ordinate services locally. Small wonder, perhaps, that health and social care have tended to get on with their own affairs, disappointed at the lack of resources, but otherwise simply shrug and leave Supporting People to sort itself out.

But the new strategy moves us on. The consultation document itself is thoughtful and clear about the dilemmas and options. It is also refreshingly frank in its dismay at the way that some local authority Supporting People teams have interpreted their new responsibilities. But let us consider the two aspects of the strategy that will have most impact on social care.

First, we are told that the support services of the future can cross the care-support boundary. For the service users, support provides an invaluable new form of low-key and practical assistance, as part of a package of interventions. It makes little sense for the resources for one aspect of the service to be inflexibly and hermetically sealed from others or to work to any artificially brief timetable – in effect, to impose a funding-led black and white distinction upon a needs-led patchwork of greys.

But we had simply not heard this from the Office of the Deputy Prime Minister before. For two years, we have instead seen attempts by local Supporting People teams to demarcate between support services and care services. It has been argued, for example, that anything over eight to 10 hours a week, or taking more than two years to achieve full independence, cannot be support; it must be care.

Now, it seems, these artificial boundaries may be crossed. In fact, that may become the expectation. As the Supporting People document states: “We believe there are opportunities to improve how these services are commissioned and provided as an integrated package”, and later, “where services are commissioned by a local authority, there seems little reason why they [care and support] should be provided separately”.

This is welcome. But even this is only a prelude to what is perhaps the most radical suggestion of all. Discussing the pros and cons of retaining the Supporting People grant as a separate funding stream, the document states: “Whilst a ring-fenced grantÉhas helped to manage any risk of funds being diverted to other service streams, it seems to have created a perception that this is the only public funding which can be invested in housing-related support.”

This opens up a host of issues about the development of new services for the most vulnerable clients, crossing the artificial care-support divide. The strategy re-opens the debate about the role of preventive support, of supported housing as a base for community care services and an alternative to more conventional statutory services. At a stroke, this new strategy transforms Supporting People from being simply yet another beleaguered and under-funded welfare programme, restoring it to its intended role as “the glue that binds other programmes together”.

National policy statements on Supporting People have consistently emphasised an ambition to see a wider range of vulnerable individuals supported by bringing many client groups excluded from community care into the welfare net; with a greater stress on preventive services; and with local authorities playing, through Supporting People, a key co-ordinating role at local level between disparate programmes and agencies.

There have been many sceptics who argued that the real purpose of Supporting People was simply to cap the rise in benefits spending on housing. The new strategy suggests a far wider and bolder vision. The three Rs of Supporting People are: re-focus social and community care services on preventive work; repatriate to local authorities their role at the centre of joined-up government at locality level; and re-position the Supporting People programme as the broker of interagency partnerships to meet cross-cutting needs.

The new proposed national strategy is bold, sophisticated, realistic and radical. It redraws the map of established boundaries between services and agencies, including between health and social care, and between the voluntary sector and statutory agencies. It will have a major impact on community care policies in the years ahead. Inevitably, it is complex, but it deserves careful consideration and response from social and community care services, planners and managers, and service user groups.

Next week we will use the mental health sector to explore the implications for the development of more integrated services and more integrated commissioning of services.

Robin Johnson is a social worker, researcher and adviser on mental health and housing, and a member of the National Institute for Mental Health in England’s national housing reference group. He was the principal author of the At Home? study for the institute on mental health issues arising in social housing.

Training and learning
The author has provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals’ learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.

Abstract
After three years of hectic service and policy development, followed by two years of painful retraction, it looks like the Supporting People programme is poised to become one of the government’s key social policy platforms. The implications for community care are huge. But will other community care agencies, and particularly the health service, now take the chance to become involved?

Further information
For more about the consultation go to www.odpm.gov.uk
R Johnson et al, At Home?, interim report summary, Nimhe, 2005
C Williams and R Johnson, What is to Be Done?, Nimhe, 2005

contact the author
robin.rja@ntlworld.com