Supported Housing Review - Haringey: Evidence, Outcomes, and Care Act 2014
The Supported Housing Review in Haringey, conducted between 2016-2017, focused on the connection between housing and health for vulnerable populations. It examined various support models and environments for different client groups. The review resulted in approved recommendations to improve housing-related services. Additionally, the Care Act 2014 plays a significant role in shaping adult social care and wellbeing, emphasizing system leadership, prevention, and quality service provision.
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Evidence & Outcomes from the Supported Housing Review A community led approach to supported housing - Haringey 19thSeptember 2018 haringey.gov.uk
What is Supported Housing? For the purpose of the review; Short-term services (referred to as Housing-Related Support or HRS); up to 2 years - for single homeless adults, young people, domestic violence, mental health, substance misuse and offending. Includes refuges, hostels, foyers etc Mid-term services; more than 2 years for clients groups such as people with learning disabilities, physical disabilities, mental health. Long-term services; lifetime for older people and people with learning and/or physical disabilities. Includes sheltered housing, Extra Care etc Residential care homes, crisis/recovery houses & general needs housing were not within direct scope of the review. haringey.gov.uk
Supported Housing in Haringey Housing- Related 2002 122 53 Social Care 160 157 131 Group Older People Mental Health Learning Disabilities Physical and Sensory Disabilities Young People inc. Care Leavers Single Homeless Substance Misuse & Offenders Domestic Violence 0 20 64 94 180 0 52 0 21 0 Total 2494 562 haringey.gov.uk
Background The Supported Housing Review commenced in January 2016 as a joint project between Adults & Housing; it was a project intended to highlight the particular connection between housing and health for vulnerable people It s purpose was to consider supply & demand, and the efficacy of support models & built environments for a range of client groups & service types Complemented & contributed to Housing & Homelessness Strategies, Homelessness Delivery Plan and redesign work around assistive technology models The review concluded in March 2017 with a suite of recommendations which were approved by Cabinet. Although many of the recommendations have now been delivered, or are in progress, the analysis the review generated is still relevant haringey.gov.uk
The Care Act 2014 The Care Act 2014 is by far the most wide-ranging legislation affecting adult social care and related partners. It consolidated existing legislation and provided a more systematic focus on the wellbeing of all adults, including informal carers of those with eligible care needs. The Care Act 2014 frames the role of the local authority as one of system leadership. It extends beyond the responsibility of Adult Social Services to meet eligible care needs wellbeing is broadly defined and all areas of the council have a role to play in: Promoting individual well-being Preventing needs for care and support Promoting integration of care and support with health services etc. Providing information and advice Promoting diversity and quality in provision of services Co-operating with relevant partners One key development was the introduction of more systematic safeguarding arrangements so key organisations and individuals with responsibilities for adult safeguarding can agree on how they must work together and what roles they must play to keep adults at risk safe. Another key element introduced by the Care Act was the market shaping duty placed on local authorities, underpinned by principles of: focusing on outcomes and wellbeing; protecting quality services; supporting sustainability; ensuring choice; co-production with partners.
The Homelessness Reduction Act 2017 The Homelessness Reduction Act 2017 will place new legal duties on English councils so that everyone who is homeless or at risk of homelessness will have access to meaningful help, irrespective of their priority need status, as long as they are eligible for assistance. The Act will amend part VII of the Housing Act 1996 and is adapted from the model introduced in Wales in 2014. The focus of the Act is prevention and the act extends this duty beyond Housing departments, placing a responsibility on a range of partners to identify and respond to homelessness threats and triggers: A household is threatened with homelessness if they are likely to become homeless within the next 56 days. Local authorities must secure the provision of services that give appropriate information and advice about preventing homelessness, securing housing and legal rights Personal Housing Plan (PHP) anyone who is at risk of homelessness, regardless of priority need is entitled to a PHP to understand their housing and support needs and identify their housing options Prevention Duty the council is required to take reasonable steps to prevent homelessness for all homeless households Relief Duty the council is required to take reasonable steps to help all homeless households find accommodation for at least six months as a relief from homelessness Duty to Refer applies to statutory bodies and requires them to refer anyone at risk of homelessness within 56 days to the local Housing department (with their consent)
Its purpose is to consider supply & demand, and the efficacy of support models & built environments for a range of client groups & service types supply & demand do we have the right types of supported housing and housing support for vulnerable people? Are we utilising what we have effectively? support models are we delivering support that prevents homelessness and dependence? Do we deliver innovation & best practice? built environments is supported housing in the right places? Are we meeting modern standards? Are we using limited stock effectively? haringey.gov.uk
Review Activities Qualitative Study Quantitative Study Service User Surveys Service User Focus Groups Stakeholder Group Literature/Policy Review Best Practice Visits Members Working Group Population Analysis Population in Need Analysis Performance Analysis Financial Modelling Pilot Sites Appraisal (Ridge) Cross-borough benchmarking Since then A range of co-production activity has taken place, especially with older and younger people A review of the Mental Health and Single Homeless Pathways was conducted Data analysis has been updated to with reflect 2017/18 figures where available A range of commissioning activity has taken place Haringey s Cabinet has changed haringey.gov.uk
Key Findings Supply & Demand Group Demand Gaps Low demand for HRS provision 52% increase in demand for supported living 40 young people transition to Adults each year Large proportion of people placed out of borough No independent or alternative tenure options Purpose built provision for very complex cohort Independent specialist housing models In-borough provision Learning Disability 116% increase in referrals to HRS mental health provision since 2013 54% increase in demand for supported living Need for additional 50 units by 2030 (pop) Significant problems with delayed discharge and over- staying in Recovery Houses Purpose built provision for very complex cohort Housing solutions with support Supported housing for older people with MH Mental Health Population set to increase by 15% by 2023 Less than 10% demand on sheltered housing Increasing demand for housing with care 4% of population diagnosed with dementia Social isolation high links with frailty Over-supply of low support provision 200 units of Extra-Care 50 units of Nursing Care Adaptable/Homes for Life Older People Only an average of 9 presentations per quarter Long stays in supported housing Increasing demand for semi-independent No supported housing for young parents Over-supply in pathway Need more specialist Gap in supply for care leavers & parents Young People haringey.gov.uk
Competing demands - homelessness 2nd highest c3000 7m 59% level of homelessness in the country; 1 in 29 people households in Temporary Accommodation (TA) Council spend on TA each year Of households in TA headed by a lone parent 25% 450 9194 967 Increase in rough sleeping since 2016/17 Young people in Haringey s care leaver cohort On housing register 300 with medical needs 7000 overcrowded Approaches for help in 2016/17, resulting in 435 preventions Highest Loss of AST 48% 712 Acute psychiatric admissions for homeless people in London Primary reason for homelessness Of households in TA affected by welfare reform Total number of 4 bed council properties 45% 138% 10 years 35% Reduction in number of social lets since 2011/12 More single people in TA in 2018 compared with the same time in 2016 Average wait for a 3-bed social tenancy in Haringey Increase in footfall since the HRA was implemented in May
Key Findings Support Needs & Models Group Key Findings - Support Models There is little focus on move-on/increasing independence No independent living option for people with LD No focussed provision for young adults Residents want their own homes & to be included in activities and communities Learning Disability Over-representation of BAME men aged 25-44 Women with complex needs in cycle of homelessness & crisis Data about outcomes achieved needs improvement Significant proportion of people in Pathway are blocked from moving on Housing First showing excellent initial outcomes Mental Health Significant number of residents with no or very low support needs Inconsistent quality and availability of support dependent on scheme Older people with LD & MH fall through the net of eligibility Support is often double funded by Community Alarms & floating support Residents want more activities, to feel safe, better access to health services Older People Not enough focus on tenancy-readiness & EET Need for supported housing that addresses wider spectrum of need e.g. VAWG Limited support to practice how to live independently No supported housing offer for young parents who are homeless/vulnerable Young people feel unvalued and demotivated, stigmatised and trapped Young People haringey.gov.uk
What older people said I want to stay in my home, I ve lived here for 30 years - but it s hard to manage my garden and the cleaning I want access to health services nearer to where I live, why can t someone arrange for a chiropodist to visit our scheme? I m not old yet, I don t want to play bingo and have coffee mornings! I want more choices about what my life looks like who I see, when and where I get help with things. Why would I want to live in sheltered housing, it s full of old people! We want more to do, there used to be activities and now they ve all stopped
Key Findings Built Environments Group Key Findings Built Environments Need for fully accessible, purpose built supported living units Much of the current low-support supported housing is purpose built and has under- used sleep-in & office facilities No alternative tenure options for people with LD e.g. part-buy Much of the current supported living is heavily adapted for each individual Learning Disability Need for fully accessible, purpose built supported living units No services suitable for women with complex housing, health & wellbeing needs Built environments are not trauma/psychologically informed Much of the current supported living is heavily adapted for each individual Mental Health Wide variance in building quality, location suitability & specification Communal spaces in sheltered housing are mostly unused & not accessible to wider population People with access needs were poorly catered for Our Extra Care schemes exceed modern standards (HAPPI) & best practice but some report feeling they are too much like a hotel Older People Large, mixed-age foyer model is no longer suitable There are no small specialist schemes within the current portfolio There is a need for purpose-built learning spaces (IT/cooking/study/tenancy skills) There is a need to develop more shared move-on housing options for this group Young People haringey.gov.uk
The Outcome Housing Support Transformation
Summary Conclusions The needs of our population change rapidly and our supported and specialist housing is not currently able to respond to this as it should Housing support is often reactive to crisis and not proactive to life changes We need to do more to enable & sustain housing independence There are disjointed pathways between housing support and social care More can be done to prevent & break the cycle of homelessness Supported and specialist housing is often in unsuitable buildings that are not fit for purpose or of high quality We have a significant gap in suitable alternatives to residential care Social isolation is a significant factor across need, built environments and outcomes Supported housing should be contributing to positive housing, health and employment/education outcomes more consistently There is not enough housing choice for adults with disabilities Supported housing doesn t effectively contribute to our responsibilities under the Equality Act haringey.gov.uk
Proposed Principles Cross-cutting Prevention; housing support services will prevent homelessness, reduce demand on highly specialist housing and prevent escalation into residential care and unplanned hospitalisation. Community Inclusion; housing, with or without support, should reduce social exclusion, isolation, stigma and multiple disadvantage by securing social, work and wellbeing opportunities that bring diverse people and services together. Integrating Support & Care; bringing together services, professionals and built environments to create more robust pathways of housing support & care that enable people to remain in their communities and homes. Our approach should ensure that people don t fall through the net because of multiple or changing needs Commissioning & Building for the Future; maximising the reach of resources to meet the changing demographics and support needs of Haringey residents. haringey.gov.uk
Recommendations Of particular relevance and/or synergy with the St Anns redevelopment project; 1. Create a Supported Housing Tenants Charter that sets out our commitments to ensure resident voices are heard and how they can actively contribute to the design of new models and buildings 2. Build on the proud LGBT history in Haringey by addressing as a priority the lack of data, professional training and visibility of the LGBT community 4. The Housing Strategy commitment to building new supported housing should be rigorously explored for all new proposed development work in the borough 7d. MENTAL HEALTH; pilot the Psychologically Informed Environment approach to create a designated service for women with complex needs around trauma, substance use and homelessness. 8a. LEARNING DISABILITY; deliver more in-borough alternatives to residential care, to enable independence and inclusion 9b.OLDER PEOPLE;build 200 units of Extra-Care provision in the borough by exploring the potential for redevelopment of existing sheltered schemes for this purpose. 9c.OLDER PEOPLE/YOUNG PEOPLE; explore the reconfiguration of one sheltered scheme into supported housing for young parents as an intergenerational service
Further Reading Supported Housing Review Needs & Gaps Analysis State of the Borough Profile Haringey Joint Strategic Needs Assessment Haringey Health in All Policies Approach Housing LIN report on Building Housing and Care for older LGBT+ people. Housing LIN pages on designing and building housing for learning disabled adults haringey.gov.uk
