Victim of its success

Nigel Goldie works as an independent research consultant
specialising in mental health, substance abuse, social exclusion
and wider public health issues. He worked for many years as an
academic and subsequently was an assistant director with Lambeth
Council’s social services department.

At the end of August, the government announced that the
Supporting People programme budget was to be cut by £80m (down
to £1.72bn from £1.8bn) in 2005-6. For each of the
following two years, the budget would remain at about
£1.7bn.

When inflationary costs are considered, this represents a
significant real-terms cut. There is already evidence of services
being affected by the freezing of the budget in the current
financial year, and there is widespread concern about the impact
this reduction will have in future.

This provides an opportune moment to reflect on what has been
achieved to date by the Supporting People programme and what stands
to be lost as a result of this budget reduction. The Sainsbury
Centre for Mental Health has been examining the implications of the
Supporting People programme for people with mental health
problems.¹ Commissioners, providers and other
stakeholders, including some service users and front-line staff,
were interviewed. This article draws primarily on the experience of
mental health services, yet the findings probably reflect what is
happening in the social housing sector.

Rarely has a major innovation in social care provision been
subjected to so many reviews so soon after being initiated. An
Audit Commission review is currently awaited, a House of Commons
(Office of the Deputy Prime Minister) committee has recently
reported its findings,² and before that there was the
government-commissioned Robson Rhodes report.³

The latter has been the most influential in highlighting the manner
in which the actual spend on the programme increased from an
initial estimate of £300m-£700m to £1.8bn. Its
findings – that the budget rose too high because some local
authorities used it opportunistically – were largely endorsed by
the House of Commons report, although MPs warned that “real cuts in
annual provision, applied blindly to each authority, could damage
services for vulnerable people in an unacceptable way”.⁴

The House of Commons report, drawing as it does on the views of
commissioners and providers, echoes the findings of our research.
Above all, there is the recognition that, for all the flaws in the
manner in which Supporting People was introduced, it has provided
much-needed “housing-related support” to large numbers of
vulnerable people. It is clear from the experience of mental health
providers that many people with multiple needs have been assisted
in ways that would not have been possible before. The growth of
“floating support schemes” (seen by Robson Rhodes as arising
opportunistically to gain funding within the deadlines before March
2003) provides an example of this.

Another change the Robson Rhodes report queries is the spate of
de-registrations that suggested providers were seeking to maximise
their incomes from the new funding scheme. However, it is evident
from one major mental health service provider that it has been the
incomes of residents that have gained most. In a review of 10
schemes that were deregistered, it was found that the benefits
included:

• Greater flexibility in staffing levels depending on levels of
  need.
• New legal rights for residents who become tenants and have
  additional personal income to spend for themselves.
• New types of support that aim to encourage greater independence
  and encourage people to take more responsibility for their
  lives.
• More freedom to make building changes and refurbish premises
  according to the new support arrangements.

Such national providers have clearly been able to adjust to all
the monitoring and regulatory requirements that have come with
Supporting People. But many smaller and locally based providers are
facing an uncertain future. This is a matter of some concern for
the future provision of supported housing across all client groups,
especially where this has evolved around local voluntary and or
community groups. As research in London has shown, one of the
biggest gaps in “move on” housing provision is that geared to the
needs of people from minority communities.⁵

One London-based specialist mental health provider with eight
projects and funding from three local authorities reckoned its
future was bleak – along with that of others with incomes of less
than £2m. In its view, a turnover of £5m is required to
survive and sustain all the financial and other management systems
now required of the voluntary sector. It is reportedly looking for
strategic partners and other means of securing its financial
position.

Clearly, the more a provider is dependent on Supporting People as
its major source of income, the more vulnerable it is to not only
major funding reductions but also the incremental cuts occasioned
by the absence of any inflationary uplift. The provider cited above
was already having to make staff reductions to meet the shortfall
of funding as a consequence of this year’s funding freeze.

Looked at from a commissioning standpoint, the world can look very
different with a multiplicity of providers and little rationality
to the current range and quality of services. So far there has been
considerable variation between commissioners as to their ability to
manage the market and actively intervene to shape its future. Many
are struggling to undertake the required reviews of services and
are also a long way from developing their required
strategies.

After all, Supporting People was sold to the voluntary housing
sector as providing a more secure, planned and regulated
environment than that which had previously existed. Administering
authorities, such as one in the Midlands with 31 providers and 46
floating support services on its books, have an enormous task to
face in bringing some rationality into the system. They have to
serve local needs while not heavy-handedly destroying providers
that may not accord with regulatory requirements.

Many commissioners see the issue as one of new systems bedding
down. For some, the future is positive for the opportunities it
provides to set clearer standards and work towards more effective
joint commissioning. Such initiatives may help to tackle the issue
of the boundaries between the separately-funded “housing-related
support” and “social care”.

Anecdotes abound of commissioners telling providers that clients
should only be assisted with shopping once, otherwise it is “social
care”, or not advised about personal hygiene as that is “personal
care”. Fortunately, sense seems to be prevailing in most areas and
commissioners and providers alike are using the broadly defined
guidance in a pragmatic way. But there are real concerns that
budget reductions will undermine what has been achieved by the more
joined up services funded to date by Supporting People.

One of the biggest reported benefits of Supporting People has been
to provide assistance to many people on the margins and to bring
people excluded from services some limited support. It may well be
those who have benefited most are the first to lose out as
eligibility criteria are raised and services are targeted at those
most in need. For those who witnessed the introduction of community
care legislation in the 1990s, there is already a sense of deja vu
around Supporting People. Once again an “uncapped budget” has
arisen out of the rationalisation of different funding streams,
while the scale of demand has been greater – and the costs of
providing services higher – than expected.

Supporting People has been a victim of its own success. It has
become an important means of promoting independence and social
inclusion. At a time when the government is promoting the case to
end social exclusion among people with mental health problems it
does not bode well if the planned budget reduction leads to a
withdrawal of the very services that should be at the forefront of
this effort.

Abstract   

Future funding levels for the Supporting People programme have
been reduced. Based on material collected by a Sainsbury Centre for
Mental Health project this article points to benefits of the
programme for users in terms of greater flexibility of support
provided, more independence and improved incomes. It sets out
issues for providers and commissioners and draws attention to
current budget pressures and their impact on services.

References   

¹ Sainsbury Centre for
Mental Health, Briefing Paper 26, The Supporting People
Programme and Mental Health, SCMH, 2004 

² House of Commons, ODPM,
Housing Planning, Local Government and Regions Committee,
Supporting Vulnerable and Older People: The Supporting People
Programme, Session 2003-4 

³ RSM Robson Rhodes LLP,
Review of the Supporting People Programme: Independent
Report, ODPM, 2003 

⁴ ibid, p18  

⁵ Sainsbury Centre for
Mental Health, Briefing Paper 25, Getting a Move On: Addressing
the housing and support issues facing people with mental health
needs, SCMH, 2003

Further information   

To access ODPM documents and links to websites of other agencies
go to: www.spkweb.org.uk

Contact the author

Contact: mail@goldie.eu.com