Title: Support for Living? The impact of the Supporting People programme on housing and support for adults with learning disabilities.
Authors: Rachel Fyson, Beth Tarleton and Linda Ward
Institutions: The University of Nottingham and the Norah Fry Research Centre, University of Bristol
The favoured model for providing housing and support to people with learning disabilities is some variant of supported housing or independent living. The Supporting People (SP) programme aims to improve housing-related support to people who need help to retain their tenancies and secure independence. This research, funded by the Joseph Rowntree Foundation, examines the impact of the programme on people with learning disabilities. Although it reveals that most users are glad to be in their own home, it exposes some problems with the way SP is working in practice.
The study has two broad aims: to examine how local authorities are interpreting SP guidelines on housing-related support services for people with learning disabilities and to examine the impact of the SP programme on the lives of people with learning disabilities. The fieldwork took place in four councils in England with selection based upon several factors – high and low spending records on SP along with variations in social, political and geographical features. Within each site, semi-structured interviews were undertaken with several groups of people, including service users, frontline support staff, managers and commissioners. A review of the five year SP plans that councils are required to produce was also undertaken.
The crucial distinction between types of support is “accommodation-based” and “floating”. The former is provided by a team of staff working round the clock in a single location, and the researchers report that there is often little to distinguish these establishments from registered care homes – indeed many were deregistered care homes.
Floating support refers to staff who are based separately but visit tenants in their own homes to help with specific tasks. Although this approach avoids the re-creation of an institutional model, there are problems in working flexibly to meet peaks and troughs in demand.
About half of the tenants had previously lived in some form of institutional setting, while the remainder had moved directly from their family home. For the tenants in this study, the move to supported living was generally seen as positive. Despite some problems with loneliness and some instances of bullying, every tenant except one was pleased with their current home.
Supported living was often favourably contrasted to residential care in terms of greater choice, control and independence. But tenants’ choice was frequently limited to “the everyday and the mundane”. More fundamental matters, such as where to live, who to live with to receive support from were characterised by limited choices. Where variations in user experiences were discovered this was found to relate partly to ability, but the authors also note that in the case of shared tenancies the values, skills and attitudes of staff are critical.
SP is a cash-limited national programme locally implemented and, predictably, the authors reveal some big variations in local practices. Councils vary in how they define “housing-related support”, and this determines both the availability and scope of any help. The main dilemma facing councils is that if the term is narrowly defined it can preclude people with higher support needs, but if it is broadly defined it can result in a small number of people getting very intensive and expensive packages of support.
Where the demand for support exceeds the available resources, the ground is fertile for interagency disputes about who holds funding responsibilities. The SP budget should only be used for housing-related support, but the researchers note the difficulty of distinguishing housing-related support from social care. The danger here is that the holistic needs of service users are ignored, with agencies concentrating upon “budget-shifting” rather than “budget-pooling”.
The researchers conclude that without a significant increase in the provision of jointly funded support and care packages (covering housing, social care and health) there will be little foreseeable increase in the future availability of supported living as an option for people with high support needs, although there may well be better provision for individuals with low support needs.
The specific plight of older owner occupiers with moderate learning disabilities is the focus of a report from the charity Care and Repair, which improves the housing of older and disabled people. It describes people in this position as “living on the edge” of sustaining their life in local communities. In such circumstances, a crisis is often the only route into support.
This difficulty is a replication of the situation adult social care is facing generally with the application of the Fair Access to Care criteria. Here again there is the dilemma of whether to target scarce resources on those thought to have the greatest need, or to develop preventive support to avoid or delay the subsequent crises.
Councils would doubtless like to do both if more funding was available, but it is nevertheless the case that even under the current arrangements, some seem to manage better than others. In the meantime, some new factors have come into the policy equation since the fieldwork by Fyson et al was undertaken.
First, Valuing People Now includes a focus on access to home ownership, and on forward planning for people with learning disabilities living with older family carers. From 2008, this will be reinforced by the introduction of a new cross-government indicator that will seek to measure the accommodation status of people with a learning disability, and whether they have control over their housing situation.
Second, a cross-government strategy on housing and ageing has been published that aims to develop a more co-ordinated approach to the issue across housing, health and social care. The effectiveness of these measures remains to be seen.
Finally, there is the influence of the personalisation agenda and the emergence of personal budgets – a new way to meet the call for a more integrated approach. The Supporting People reform itself brought together housing benefit, the housing corporation grant and home improvement agency grants now SP in turn has (in the 13 individual budget pilots) been combined with several other income streams to test out the personalisation model.
The strategy on housing and ageing refers to the “major step forward” represented by individual budgets, but it is currently unclear whether the commitment to developing personal budgets in Putting People First extends beyond mainstream social care monies.
Bob Hudson is visiting professor of partnership studies at the school of applied social sciences, University of Durham
● Cross-government housing strategy, Lifetime Homes, Lifetime Neighbourhoods