Sitra bulletin 2013 no 5 final by Sitra

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bulletin THE MAGAZINE FOR HOUSING WITH CARE, HEALTH AND SUPPORT

2013 – NO.5

Bringing Personal Budgets Together

A new journey of liberation

Personalisation for providers and commissioners

Personalised approaches to support rough sleepers

SKILLSHARE WEEK – A personalised approach to tackling homelessness www.sitra.org

European Partnership

A country divided

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Contents 03 04

CEO’s Comment Andrew van Doorn and Lucie Stephens : Up2Us Bringing Personal Budgets Together

Cover Story

Tina Wathern: A new journey of liberation Recognition and inclusion of older LGBT groups

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Sue Baxter: Personalisation for providers and commissioners John Bowden: Skillshare Week A personalised approach to tackling homelessness

Rachel Coffey: Personalised approaches to support rough sleepers Ray Naicker

SKILLSHARE WEEK – A personalised approach to tackling homeless

Innovation and capacity building for personalisation across Europe

Kayley Worsley: Love Your Vote

Andy Meakin: From thinking to doing: Early lessons from PbR

Adam Knight-Markiegi A country divided

Sitra Training Guide

Sitra Staff Chief Executive Vic Rayner Deputy Chief Executive Lisa Harrison Policy Officers Adam Knight-Markiegi Geoffrey Ferres Sue Baxter Policy and Research Co-ordinators Dani Cohen Burcu Borysik Business Development Manager Kathleen Egan

Contracts Officers Anna Robertson Wendy Green Business Support Lana Lewis Sarah Pink Helen Northover Head of Finance & Central Services Berihu Mohammed Finance Officer Ray Naicker Finance Assistant Alison Quinn

Office Co-ordinator Gill Cotton Central Support Monica Antolin Interns Roselee Malloy Alice Cheatle Hannah O’Donoughe Jordan Gerlack Georgina Gorton

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Editorial To contact the editor please email burcub@sitra.org

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Charity Reg No 290599 Company Reg No 1869208 ISSN 0956-6678 Sitra is partly funded by DCLG.

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CEO’s Comment

Getting Personal This edition is full of great information about how the world of housing support has taken up the mantle of personalisation. It focusses on the policy debates, good practice case studies and research into personalisation. I am really pleased to see a full report on Up2Us. I sat on the steering group for this interesting work around the potential for the use of personal budgets for joint purchasing in housing projects for a number of years. The report highlights some of the key successes of the work, but also gives invaluable insight into the challenges of working this way – particularly raising the familiar focus on culture change. Sharing resources and information continues as a theme, with news of The Customer Journey Toolkit is one of the great products to come out of the Personalisation Steering Group, facilitated by Sitra on behalf of the DCLG. The customer journey is an online interactive tool to help organisations and customers to understand what and how they could personalise services. Make sure after you have read the article – you give it a try on http://lifeyouwant.org.uk/sitra! The Bulletin also highlights the time critical work of ‘Skillshare week’ – bringing together clients to share skills to support the maintenance of independence. This continues the theme of recent Bulletins which have focussed on strengths and assets based approaches to working with individuals – turning the ‘needs’ agenda on it’s head.

Vic Rayner Chief Executive Email: vicr@sitra.org

The provision of services for older Lesbian, Gay, Bisexual and Transgender people is the theme of Tina Wathern’s article. We know that services for ‘older’ people are being driven up the policy agenda, however, there are real risks that high level policy responses are not recognising equality and diversity issues and that even policies which appear to have equality at their heart – such as personalisation – must address issues around gender and sexuality in their application. Data is never far from the pages of the Sitra Bulletin, and we are continuing our focus on the lessons learned from the Sitra data work. This edition takes a look at the regional profiles of spend and performance for housing related support. As ever, we are keen to hear how you are using the tool, and I have been meeting a wide range of members recently who have been putting the data to good use. Please do take a look at the full tool at http://tiny.cc/spdata, and follow up with my colleagues for more information. This Bulletin can’t go to bed, however, without mention of the launch of our exciting European project. Sitra is leading a 14 partner bid to develop European Wide Housing related support competences. I attended the kick off meeting for this in Brussels last week, and our European partners are keen to hear about work in the UK and don’t forget that all Sitra members get access to great support from our collaboration partner EASPD – a great source of information on best practice for work with people with disabilities across Europe. About Sitra Sitra is a membership organisation championing excellence in housing, support and care. Membership benefits include discounts on all services and events, access to free advice, an annual subscription to the bulletin and regular briefings on key policy developments in the sector. Sitra works with local and central government to ensure that the needs of its members are recognised, understood and met by resource providers. If you would like to join Sitra please contact the Membership Administrator on 020 7793 4710 and ask for an application form, or download one from www.sitra.org Content ©2013 SITR (Services) Ltd except where stated, All right reserved. All images © individual photographers & illustrators. Opinions expressed by individuals writers are not necessarily those of Sitra or the magazine’s Editorial Team. E&OE. Design: Aquatint BSC 020 8947 8571 www.aquatint.co.uk

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Up To Us – Buying things together to achieve personalisation in housing care and support Andrew van Doorn from HACT and Lucie Stephens from nef reflect on the up2us project which sought to stimulate and create a space for innovation in housing care and support HACT worked alongside nef in Up2us project which focused on achieving personalisation in housing care and support by enabling people to pool their money, to do and buy things together. The project wanted to understand:

Kent, and Knowsley. They were mostly led by housing associations, operated in diverse local contexts, with a broad range of people and involved a number of different partners including, local authorities and voluntary and community organisations.

The project ran in six areas – Barking & Dagenham, Oxfordshire, Norfolk, Kensington & Chelsea,

The activity in each area was codesigned and co-produced with people who receive care and

support. The up2us approach was designed to be ‘bottom up’ and partners were expected to demonstrate a culture of coproduction. HACT and the local housing associations put £60K on the table for each area over two years and the housing associations and local authorities seconded staff to facilitate them. A number of major challenges stood in front of the pilots – how could you bring people together to share the costs of their care and support, especially if spread over large geographical areas? What would they want to buy together? How do you build the confidence and skills of people to take greater control? What techniques, like participatory budgeting, could be used? How do commissioners and managers share power and decision-making with the end user? And how are front line staff empowered to experiment and take risks alongside people? A variety of practical activities emerged including: l Building a community networking web portal that brings together local people, local knowledge and local resources

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l l

Residents organising shared activities in extra care housing and playing a role in commissioning future services Setting up a user-run cooperative with members planning and taking part in activities at weekends, and in the evenings Jointly buying gym equipment Jointly commissioning shared overnight support

The up2us pilots demonstrated that Housing Associations and Local Authorities can support ways of doing things that start from the bottom up. At times, however, working in this way was at odds with the prevailing culture and ethos. Often policies and procedures were pulling staff in the opposite direction, as they were trying to work with people in more personalised ways. When organisations were successfully supporting and nurturing service user-initiatives they were: l Taking an asset based approach to the people who used the organisations services. Identifying and using people’s skills and knowledge increased the resources available to tackle problems and develop solutions. l Focusing on the outcomes that a new way of working could generate. The pilots set out with a clear aim, to support people to pool budgets, but didn’t prescribe how this would be achieved. By working collectively people were able to take responsibility for developing new ideas and delivering change.

Staff time was focused on facilitating and supporting this, rather than delivering results themselves. Learning from existing local activity. In each area it was possible to find examples of people already coming together to do things or buy things together. Talking to these groups gave the pilots valuable insight at the early stages of their own development.

What became clear was the quality of the front line staff was key. A strong problem solving approach was critical, as was having supportive managers willing to let-go of power and not allow their anxieties about change to dictate things. Although funding was available, much of what they did was achieved within existing resources, just deploying them in different ways. The desire to experiment, learn from this and build confidence to move forward became a powerful process to achieve larger change within a constrained resource base. In these times of austerity it is easy to assume that innovation can be too expensive and disruptive, that it is more efficient to focus on core services. The up2us pilots demonstrated that innovation in practice is often about small scale change that can be supported by adjusting or redirecting existing resources. But to work in this way requires change on the part of providers and local authorities, and it is vital to reorient policies and procedures to

Most people involved with up2us reported that it had helped them to make new friends, to make more choices about what they do, to learn new things, undertake more activities and trips. The majority of people said they wanted to remain involved and would recommend up2us to their friends and family.

support small, informal activity. The following questions might help organisations move towards a more enabling environment for co-production. l Do you understand what people can do as well as what they can’t? l Are your employees able to support people to support each other? Do you help people to make connections with others who share an interest or skill? Is there support for people to get online and make virtual connections as well as face to face ones? l Is your approach to risk management fit for purpose? Do your staff feel held back by real or presumed concerns about risk management? l Are staff aware of the benefits of doing and buying things together? Are there opportunities for people to collectively plan or is staff time directed towards one to one interactions? l What existing resources can be used to support people to do things and buy things together?

TLAP worked with Sitra and Disability Rights UK to find out where councils are taking practical steps to improve people’s experiences of accessing personal budgets and direct payments, including how councils are changing the way they provide information and advice, undertaking selfassessments, providing help with planning support, working in coproduction with people who use services, families and carers and getting the right systems in place to make the best use of scarce resources. Read the report on ‘Unwinding Red Tape of Personal Budgets’ on our website: http://www.sitra.org/news/ unwinding-the-red-tape-ofpersonal-budgets/

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A new journey of liberation: Recognition and inclusion of older LGBT groups Tina Wathern LGBT Older Person's Co-ordinator at Stonewall discusses the need to engage older LGBT groups for truly personalised housing with care. Set against a backdrop of postDilnot world, engaging and involving older LGBT groups in the development of housing with care remains to be on an opportunistic, sometimes ad hoc basis. While much of the current debate about care and housing is centred around personalisation, older LGBT people do not feel considered in the wider housing debate and can feel that they are missing out on choices that are available to other sections of the older population. In addition to the housing challenges that face us all as we age, there are particular challenges that face older LGBT people, who are more likely to live alone and less likely to have children or extended family networks they can call on for support. Some are reluctant to explore support from formal housing, health or social care providers because of a historic fear of discrimination.

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Invisibility breeds contempt? There is a risk that a lack of data about the real housing needs of older LGBT people, as a consequence of ignorance, marginalisation and discrimination, could be misinterpreted as evidence of an absence of real needs. You may ask, why hide or want to be hidden? Fear of homophobic response, fearful of services being taken away from you and worries about harassment all play a part in the dynamic of disclosure. Historically, many LGBT people have experienced criminalisation in law, been stigmatised by society, condemned by religious authorities and pathologised by medical practitioners. Put those people into a place where they are faced with an uncertain future, feeling vulnerable making decisions about housing,

The situation is complicated further if the people we are trying to see are not only hidden but hiding

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potentially living in an environment of homophobia and harassment – For some, returning to the closet may seem the only way. In a recent Stonewall survey, 73% of older LGB people said they wouldn’t feel comfortable disclosing their sexual orientation to care staff. The coming out process is not a ‘one off’ event and often an LGBT person makes the decision to tell or not on a daily basis – whether it’s the bank, the GP or any number of other organisations or people we come into contact with, we are continually risk assessing who we tell. Using inclusive language when completing forms is fundamental, for example refer to a ‘contact’ person rather than ‘next of kin’; ask about partners, not husbands and wives; include civil partnership in relationship status. Our concepts of family may include ex-partners and friends as extended or chosen family. This is relevant when families of origin may have rejected people and relationships may be strained and distant. These considerations can help to provide a safe inclusive environment. For some organisations the stumbling block is often the feeling that sexual orientation is a private matter and the blurring of sexual orientation with the

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physical act of intimacy creates an environment in which providers feel uncomfortable and unable to respond appropriately. In The Coming of Age, Simone de Beauvoir reminds us how society tends to attribute non-subject status to older people, among other things, because of their exclusion from erotic possibilities. There is a lesson here for housing. The sector needs to recognise

that sexual orientation and gender identity do not disappear on retirement. Increasingly, a generation of older LGBT people who have lived their lives as out and proud citizens, will demand that their wants and needs are seen and provided for by their service providers – and that will be the beginning of a new journey of liberation for us all in housing with care.

A Case Study A 68 year old lesbian was harassed out of the house she owned in a Derbyshire village by local people who verbally abused her, vandalised her camper van and spread untrue gossip about her. She moved to sheltered accommodation in Hackney and was determined to keep her sexuality under wraps at her new home until she fully trusted people. She compared her first 12 months in London as ‘like having a split personality’ and acknowledges that she was lonely and isolated and felt down quite often; ‘I couldn’t really tell them anything about myself. I could talk about the past and my children, but I couldn’t say anything about the real me. It was almost like speaking a different language. A year into her new life as a tenant of one of England’s largest retirement housing providers, she received something through her door which would change things for other LGBT tenants and staff in the organisation. The organisation’s marketing department asked residents to specify which magazines they read, and this included the lesbian magazine Diva. It turned out the Housing Association was conducting a customer profiling exercise as part of wider work on equalities and not ‘fishing’ for information as she had first thought. When this was explained to her it gave her an opportunity to tell the marketing team how low and isolated she was feeling, and also a space to disclose her sexual orientation. After this she found herself talking at a tenants’ forum about how it felt to live as a lesbian in sheltered housing.

Sitra offers a range of training and consultancy services that support providers to ensure the services meet the aspirations and needs of LGBT customers. Contact Anna at annar@sitra.org for our bespoke in-house training packages on equality and diversity and personalisation.

Fast forward four-and-a-half years and she now chairs their LGBT group, which provides support and guidance to tenants and staff and acts as a sounding board on LGBT issues for the organisation. It has 50 members, around two fifths of whom are staff and has been involved in developing training for employees. She feels that being at the forefront of a growing LGBT forum has transformed her life, giving her a social network of other gay residents with whom she has a ‘double affinity’. It has not been all smooth sailing and she feels there is still an undercurrent of homophobia but she is confident that if she had a problem where she was living it would be dealt with and says that it feels safer now.

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Personalisation for providers and commissioners

Personalisation means individuals having maximum choice and control over the public services they require and commissioners, providers and service users need to work together to achieve the best results, writes Sitra’s Sue Baxter. Sitra continues to work with the DCLG on embedding personalisation in the housing related support (HRS) sector. I would like to publicise one of the resources developed thus far and let you know about some upcoming work. The DCLG facilitates a working group on personalisation comprising practioners, commissioners and policy makers. The group has identified three main areas of focus; market management, co-production and provider transformation. I was delighted to host the sub group on provider transformation and would like to thanks its members for all their hard work.

range of services from crisis to longer term, accommodation based to floating support, covering a spectrum of clients. We also needed something that took account of where providers were in implementing personalisation. Albeit a challenge it became apparent that, whatever the service, there were commonalities in the path clients took from finding out about services through redesigning their support or moving

on. Thus the concept of the customer journey was born which developed into an interactive tool kit, following a customer’s journey through a service testing out how personalised the user’s personal or organisation approach is. The customer journey identifies that the common junctures (below) experienced by all clients, allow an organisation/individual to reflect on their approach to personalisation.

Customer Journey One of the main concerns of the group was to use members’ expertise to producing tangible products that could practically assist HRS providers to move forward in extending client choice and control. We needed a product that could be used by organisations and individual staff in a diverse

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Plan investment: This local data can also help plan investment and it supports good commissioning to meet local priorities. It is also useful to show the value for money of services to colleagues in social care, health and criminal justice. Raise your profile: At a wider level, the data helps show the impact of investing in preventative services for vulnerable people. This will help raise the profile of housing support nationally, including to government departments and ministers. There are marked differences according to client group, service type and length of stay, and by local authority. Weâ&#x20AC;&#x2122;ll delve into the data over the coming weeks and will be reporting on different aspects online. The customer journey identifies that the common junctures (below) experienced by all clients, allow an organisation/individual to reflect on their approach to personalisation. l l l l l

Finding out about services Finding out if the service achieves their outcomes Designing personalised support Getting on with their life Reflecting on what has been achieved and what still needs doing

The tool asks a number of different questions, some more challenging than others, designed to get users thinking and discussing changes to improve choice and control. It gives helpful suggestions and directs those using it to resources, including examples of what others have done. The user can dip in and out maybe just concentrating on one area to audit e.g. designing personalised support. It is versatile enough to be used at team meetings or management away days enabling organisations to take the personalisation challenge and action plan for improvement.

Sitra website, so our challenge to you is to use it to audit your practices and make changes.

What is coming up? Whilst the customer journey can assist providers individually identify where they are in extending choice and control, we have not got robust intelligence on the implementation of personalisation across the HRS sector to date. The DCLG has commissioned Sitra to scope the sector response to implementing personalisation. We will be contacting all HRS commissioners to identify how they are responding to the challenges of offering clients in their locality more choice and control, how personalised current services commissioned are they

current and what the scope is, for further development of personalisation across the sector. The study will ascertain commissionersâ&#x20AC;&#x2122; perspectives on the (perceived) benefits of different forms of personalisation, including personal budgets and any barriers which may prevent its wider adoption with recommendations as how these can be overcome. It is anticipated this will give us a wealth of information to share with the sector not least case studies highlighting innovation and good practice. We also hope this will enable us to identify some of the challenges and opportunities in commissioning personalisation which will assist cohesion in commissioners, providers and clients moving this agenda forward.

If you are interested in taking part in the personalisation research, please contact Burcu Borysik burcub@sitra.org or sueb@sitra.org For the latest updates about personalisation, please visit our personalisation microsite www.sitra.org/personalisation

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Skill Share Week: A personalised approach to tackling homelessness John Bowden describes how Threshold’s Skillshare week helped people who are homeless to acquire skills and confidence to gain and maintain their independence With heart-warming speeches, cheers, applause and smiles all round, homeless people in Tameside gathered in the beautiful surroundings of Hyde Park, collecting awards for their efforts during a week of independence, confidence and skills building. The week was ‘Skillshare’, a programme of activity to provide people living in supported housing schemes with the opportunity to develop themselves and gain the skills and confidence needed to live independently. Part of the Threshold charity’s ‘GREAT lives’ initiative, Skillshare forms part of a new approach to tackling homelessness in Tameside at a time when money is tight, and welfare reform is putting some individual budgets under strain. At a time of reduced council budgets, services for homeless people in many areas have simply been reduced, with five out of ten homelessness services seeing funding reduced in 2012. But in Tameside there is instead a renewed focus on prevention, making sure that tenancies are successful first time round, and that the newly housed are socially included, contributing to their new communities. This reduces the

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likelihood of those who’ve been effected by homelessness needing to go through the system a second or third time. All of those who’ve taken part in Skillshare have reported a significant rise in how confident and independent they’ve felt at the end of the programme compared to the beginning. Ed is one of those who has been through the Skillshare week and GREAT lives programme. Shortly afterwards he was able to move out of his supported accommodation and into a rented home where he now lives independently and acts as a mentor to support other customers. ‘Skillshare was really important in helping me move out into my new home. I’d lived in a supported scheme for 18 months, and at

times it can be depressing. People say that the longer you stay in it, the less likely you are to be able to move out – a bit like how a period out of work makes it harder to get a job. Skillshare gave me the confidence to move. Now I’m volunteering to help others in a similar situation to the one I was in.’ Skillshare’s strapline is ‘It’s all about YOU!’ and each day of the week is allocated with a different area of personal development. Monday, titled ‘Responsible YOU!’ focussed on allowing those taking part to meet and get to know themselves as well as each other preparing for the week ahead, whilst Tuesday had a community focus, with advice on how to be a good neighbour as well as a good tenant. This was helped by Tameside Business in the Community and New Charter who

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Skillshare has helped me to think about where I am and what I’m doing with myself. I’m now feeling much better about myself and am looking at volunteering and other activities I could do to start building my life back.

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helped out with the sessions, inspiring those present with ideas for work, training and volunteering activities. Later a trip to Stalybridge charity 2nd Generation Furnishings showed how to properly furnish a home on a low budget or even for free, while also giving an idea of possible voluntary work. Wednesday focussed on practical skills, with painting and decorating, ironing and cooking – with St Peters Partnership and the New Charter Building Company. Thursday was spent focussing on mental wellbeing with Tameside, Oldham and Glossop Mind helping with therapeutic activities such as growing herbs and stress-relieving exercises. Steve Goslyn, Chief Executive of Threshold, the homelessness charity behind Skillshare, believes the success story behind the programme is the involvement of so many organisations in Tameside pooling their own skills to work together. ‘One of the great things about Skillshare is to see how people on the programme develop to support each other during the week. But it is equally about staff from the different supporting organisations working together closely, combining their expertise. Tameside, Oldham and Glossop Mind, St Peters Partnerships, Greater Manchester Probation

Service, Business in the Community, New Charter Homes and soccer scouting group Pass2Pro’s Giving Back Foundation have all taken part and made a huge contribution to a fantastic week.’ Jo Parry from St Peters Partnerships said: ‘On the Wednesday, Skillshare participants worked with the experts from New Charter Building Company’s painting team to redecorate the LEAP Community Hub at Cavendish Mill in Ashton. The hub offers vital services to families and the community, so we want it to be as welcoming as possible. The redecoration has made an enormous difference to the centre, and seeing everyone get stuck in and learn new skills at the same time was brilliant. One of the participants taking part is now applying to become a LEAP volunteer.’ This was echoed by John Gall from Pass2pro, who was so inspired by Skillshare that he took part in the painting and refurbishment of a supported housing scheme shortly after the Skillshare week. ‘We had a great time at Skillshare, and seeing people who’ve had such a difficult time regain their confidence again is remarkable. We’re already looking forward to the next one and are offering any support we can to great lives in the meantime.’

The benefits of Skillshare are most felt by the customers who took part, and want to move out of supported accommodation to live independently. Many of those customers have now drawn up resolutions, and contacted different organisations to help further their journeys, signing up to new courses available at the Skillshare careers fair which took place on he Friday. Karl, who went on the course said it had helped him to reorganise his life and become more in control of it. ‘Skillshare has helped me to think about where I am and what I'm doing with myself. I'm now feeling much better about myself and am looking at volunteering and other activities I could do to start building things back. I’m also hoping to move into my own place soon and I’ve now decided to help out with Great Lives and stay involved to give something back’. Threshold’s Andrew Atherton hopes these achievements mark the beginning of customer pathways to independence. ‘Skillshare hosts a broad range of activities and they won’t all be for everyone, but it’s shown strong ideas, services and activities to help people go forward. The whole week was about – developing skills, confidence and feel better to be able to move on to the next stages’

Every month Sitra gives positive voice to the sector by showing examples of good practice and innovation. If you are a member and have news to share, please contact Burcu burcub@sitra.org You can read our members’ stories on our website www.sitra.org/members/stories

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Personalised approaches to support rough sleepers Rachel Coffey, Research Manager at Homeless Link, discusses how services are using personalised approaches to support rough sleepers on the street. Meet Nick. Homeless since he was a teenager, he’s been sleeping on Manchester’s streets on and off for the last ten years. Now 41, he’s been through most of the support that services are able to give him. He doesn’t like staying in a hostel because being around other drinkers makes him want to use alcohol again. He got a flat once but was evicted because he had no support to manage his bills. What he’d like is to have his own place and maybe work towards getting a building job, which he used to enjoy. There are people like Nick in all our cities. People who have been homeless for a long time but don’t ‘fit’ the support typically on offer. When offered services that don’t help them – and feeling they aren’t listened to – some would rather not engage with support.

So how can we better support people like him? Homeless Link was commissioned by Broadway to explore how services are using personalised approaches to support rough sleepers off the street. We wanted to find out about the different approaches used as well as what made them work. We carried out five in-depth studies of services across the counties which were trialling innovative approaches to tackling long-term rough sleeping or supporting people with complex needs. We talked to the people who set up the projects, the staff who worked in them, and crucially to the people using them – to understand how we can re-think this type of support.

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Delivering personalised services is about changing attitudes, not following a model. They have to start with what people want to do, not what it suits a service to offer, for personalisation to lead to real change.

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What we learned took us back to the basics. People told us they wanted to be given a choice, not shoe-horned into the nearest service. They needed to feel listened to and asked for their opinion. One person said: “At first, I could not believe that I was asked what I wanted to do… Having choices feels quite different for me, normally it’s ‘this is the way you have to do it’ rather than ‘what do you want to do?’” And personalised support can play a central role in engaging longterm rough sleepers with existing statutory and voluntary agencies. Working to engage people, without creating a parallel system, was central to improving the system itself. Homeless Link’s research was commissioned by Broadway and funded by the Oak Foundation. The research report and related guidance will be published in Autumn 2013.

can across England s es sn es el m o h r essness-2012-13/ port services fo el p m su o d h fan -o le ve fi ti ta ro reven rg/news/p The profile of p p://www.sitra.o tt h te si eb w r u be viewed on o

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Innovation and capacity building across Europe Sitra’s first EU project application approved for funding, announces Sitra’s Ray Naicker. In January 2013, Sitra in partnership with 13 organisations based across 9 EU countries including EASPD won the bid for a project within the Leonardo da Vinci Transfer of Innovation 2013 call. The project start date is 1st October 2013 and will run for two years. The project is called European Core Learning Outcomes for Integration of Support and Housing or ELOSH European Core Learning Outcomes for Integration of Support and Housing was developed in response to reports published by the European Expert Group on the Transition from Institutional to Community Based Care and CEDEFOP (European Centre for the Development of Vocational Training).1 This is an on-going process in the EU and to achieve this, the project will identify and strengthen key staff competences across the housing and support sector and seek to improve services in the face of policy and societal changes. There is a strong link between personnel and the successful development and maintenance of quality services in the community. The availability of trained personnel to work in the community will affect how quickly new services can be put in place. Most importantly, well-trained and motivated personnel can ensure that institutional practices are not replicated in community settings. This chapter outlines a process of workforce development that countries can follow while moving from institutional to communitybased services in order to sustain the provision of quality services in the community.

Giving service users voice and choice In addition, Sitra firmly believe that service user empowerment and participation is an increasing priority for all services in the housing and support sector. The project will transfer innovative learning outcomes and training materials that have been developed by Sitra and will be underpinned by and promote co-production principles. Partners will blend and adapt these innovative learning outcomes and materials to create an adaptable European pack. The European pack will be tested in 7 countries by housing and support providers, working with training providers and service users. Hence, principles of co-production is recognised as central to ELOSH amongst all partners and will be firmly embedded to develop and stimulate growing demand for this type of CVET across the European Union.

Capacity building across Europe The project will be split into six work programmes to deliver a series of pre-defined objectives and will take will ultimately the form of a training pack which will also be available as

an online resource for a wider audience. The project will evaluate learning and identify next steps for embedding outcomes in relevant European, national and regional systems and processes. It will be undertaken by a consortium of partners at EU and national level, including providers of housing and support services for vulnerable groups; providers of training for frontline staff and managers in these services; service users; and research institutions. The outcomes could also be adapted to train a range of related stakeholders such as local, regional and national level policymakers and funders. Vic Rayner, CEO of Sitra says: Sitra are delighted to be leading on this innovation exchange. We have been providing core training on supported housing for nearly 30 years and are delighted to have the opportunity to build on this experience with our European partners. We are particularly pleased that the principles of coproducttion are integrated throughout the bid, and that the work on developing both the competences and the associated training will be developed with service users at the heart of the process.

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The project will address the need for Continuous Vocational Education and Training (CVET) on the integration of support and housing for vulnerable people; driven by two key processes in the sector: deinstitutionalisation and personalisation.

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© European Expert Group on the Transition from Institutional to Community-based Care, November 2012 http://deinstitutionalisationguide.eu/wp-content/uploads/2012/12/2012-1207-Guidelines-11-123-2012-FINAL-WEB-VERSION.pdf

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LOVE Your Vote Kayley Worsley PR and Communications Officer at Dimensions reports on Dimensions’ Love Your Vote campaign that aims to change the low participation of people with learning disabilities in elections. Everyone has an opinion on politics. Love it or hate it, you have an opinion. People with learning disabilities feel the same. Yet a recent survey by learning disability support provider Dimensions found that just 10% voted in the last election. This disengagement from the electoral system needs to be addressed on a national scale so that the population as a whole can be represented at government level says Dimensions. This is why the organisation is running its Love Your Vote campaign in partnership with the Houses of Parliament Outreach Service. Reasons behind the low number of voters in the learning disability community could include people not understanding how political parties communicate or people with learning disabilities not knowing they have a right to vote. Steve Scown, Chief Executive of Dimensions, said: “This is especially disappointing as vulnerable people rely more heavily on the Government to safeguard their needs and stand

up for their rights than others without any disability.”

Personalisation: Safeguarding and choice People with learning disabilities rely upon government setting policies that ensure they are safeguarded and enabled to lead high quality lives with personalised support. The government’s personalisation policy states that people should be able to choose their own support while ensuring best practice is adopted, to ensure another Winterbourne View scandal is never repeated. Yet people with learning disabilities rarely exercise their right to choose which MP to represent them in Parliament.

Knowledge, experience and expertise This is despite the fact that disabled people are the true experts in how cuts and changes

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It really needs to be recognised that people with learning disabilities have a voice and want to be part of their community.

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to the social care sector affect their lives. They know how their budgets have been affected and will notice any changes in the support they receive and choose. Steve Scown explains: “Those who support people with learning disabilities, as well as the Houses of Parliament, have a duty to educate. Unlike most of the population, people with learning disabilities are unlikely to be educated about politics and so would not have the confidence to go to a polling station. They don’t understand the jargon and need to be given the right information to make an informed choice of their own as to whether they want to vote or not. If they knew more about the voting process and the way Parliament works, they may be much more inclined to get involved.” Just this summer, Steve met a person supported by Dimensions who has a keen interest in politics. Steve explains: “He was very knowledgeable about what’s happening in his local community, especially in terms of funding cuts. But he told me he felt frustrated because he just didn’t know how to go about ensuring that the right people heard his opinions.” He adds: “It really needs to be recognised that people with

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learning disabilities have a voice and want to be part of their community. They want to feel empowered and have the confidence to use their right to vote and play their part in helping shape their country. They can’t do this without knowing the facts about how the electoral system and Parliament operates.”

Inclusion and representation If more people with learning disabilities voted, not only would they be exercising their right as a person living in a democracy, but they would also be voting for a party or person who they feel will represent them and their peers’ best in Parliament. Steve said: “But it’s also important to remember that politics doesn’t interest everybody and people should never be pressured to vote if they don’t want to. But I do feel that people should be given the right information to make an informed choice as to whether they want to vote or not. This is not about party politics – simply about getting people to

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Beyond voting, if people with learning disabilities were more engaged with the electoral system in general, they may be spurred on to lobby their MPs and campaign for a more effective voice to give them the chance to genuinely influence the social care agenda.

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understand the process of parliament and how their vote makes a difference.”

Dimensions and Love Your Vote Dimensions supports about 3,000 people with learning disabilities and people who experience autism. The organisation is currently running the Love Your Vote campaign in partnership with the Houses of Parliament Outreach Service to increase awareness and increase the number of people who vote, in a bid to engage people in helping to shape the future of their country and local communities. The Love Your Vote campaign will start with a series of workshops around the country for people with learning disabilities. This is the first time that a provider has directly worked with the Houses of Parliament in this way to explore and explain, using easy read materials, to hundreds of people with learning disabilities, exactly why and how they can vote and lobby their MPs. Dan Weston of Sheffield, who has learning disabilities and is supported by Dimensions, hasn’t voted before because he didn’t know about the process. He said: “I am looking forward to learning more about Parliament and voting – I think people should vote. It’s important. I will go to a workshop and I hope to learn a lot.” Steve adds: “Ensuring that people have a say over who makes decisions is essential to democracy. We need to get the number of people with learning disabilities who vote to go up so that they can be represented nationally.”

Love Your Vote was launched at the Houses of Parliament on the 28th October. Sir Robert Rogers, Clerk of the House of Commons, said: “The House of Parliament's Outreach Service involvement with the Love Your Vote workshops aims to raise awareness of how Parliament works and to empower and enable adults with learning disabilities to be active participants in our democracy and to ensure that their voices are heard by decision makers, including MPs and Peers. It's clear that people with a learning disability are not as engaged in political life as we would like them to be. The Love Your Vote campaign has provided Parliament Outreach with an excellent opportunity to reach out to this group, raise awareness about the work of Parliament, and to encourage people with a learning disability to get involved in the political process.”

Details of workshops can be found at www.dimensions-uk.org/loveyourvote To find out further information email loveyourvote@dimensions-uk.org and follow Dimensions on Twitter @DimensionsUK #loveyourvote

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From thinking to doing: Early lessons from PbR pilots Andy Meakin, Sitra associate and independent consultant, discusses some of the early findings of the SP pilot PbR programme. Payment by Results (PbR) is becoming established as a new mantra of many commissioners and it is scrutinised by proselytisers, agnostics, and unbelievers. However, there remains evidence of the impact that PbR in practice remains elusive.

“From thinking to doing: Early lessons from the Supporting People payment by results pilot areas“ is the first of two scheduled reports from ekosgen. The report aims to provide practical guidance for providers and commissioners.

The Department for Communities and Local Government (DCLG) appointed ekosgen to evaluate the Supporting People pilot PbR programme which began in 2011.

Firstly, why PbR? All contracting models are driven by an underlying performance anxiety. Commissioners are

anxious about getting the outcomes they want at a price they can afford. Providers are anxious about getting a fair price that covers the cost of their activities and rewards their achievements. In traditional contract models, performance management is mainly about efficient delivery of the specified activities. It is a machine analogy.The underlying assumption is that a more efficient machine necessarily means a

Figure F igure 1: 1: P Performance e rfo rm a n c e a anxiety nxie ty a and nd co contracting ntracting model mod de l Commissioners may be anxious to avoid their resources going here without visibility

Providers may be anxious to avoid delivering these objectives without proper recognition

Commissioner’s business objectives

Contracted objectives

Provider’s business objectives

Contracting model should reduce these anxieties by focusing on mutually shared objectives

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more effective product or outcome. But this assumption ignores two key variables: people and organisations. In short, people and organisations are all different and dynamic. They make a poor raw material for either the components of a machine or its products. In PbR, rather than designing the inputs and activities of the machine, commissioners design and specify the desired outcomes. The PbR model is then developed so that there is mutual benefit in the delivery of these outcomes. PbR is then mainly about effectiveness. In this way, delivery models regulate themselves flexibly over time to deliver the most efficient or optimal outcomes. This diminishes reliance on an activity-based specification and reduces mistrust along with its associated bureaucracy. Well, that’s the theory.

Key lessons learnt What key learning does the pilot programme offer commissioners and providers through the ekosgen report? l

Be aware of the potential for PbR terms to increase ‘gaming’ and put in place measures to minimise the risk Various terms are used to describe behaviours that arise out of unintended incentives that work against mutual advantage in contracts. Examples include ‘cherry picking’, ‘creaming’, and ‘parking’. These are where providers focus effort, contrary to commissioner intentions, on clients with less complex needs. However, these behaviours are far from peculiar to PbR models. Nor are gaming behaviours confined to providers. Commissioners and referral agencies may also display selection bias. This may be favourable or hostile to the interests of a provider.

Have a clear rationale for PbR contracts As a commissioner, it is important that you are clear about why you favour a PbR model and what difference it will make. For example, is it an innovative service model, improved outcomes, quality, value for money, risk transfer, and/or market diversification or a combination of these? As a provider, if it is not already clear, consider asking the commissioner to spell out their reasons for adopting a PbR model. Ask what the benefits are for the provider and service users. Throughout the process, refer back to the stated rationale to ensure that the PbR model remains consistent with the stated objectives.

Consider roles and responsibilities in developing and overseeing PbR contracts There appears to be a broad consensus that developing a PbR model in isolation is a high risk enterprise. As such, many of the pilot areas worked with providers, service users, and other stakeholders to develop their models. In some, these relationships have continued in to the delivery phase with partnership boards to oversee delivery. This recognises that some of the outcomes are not entirely in the hands of providers and rely on the positive participation of others.

A well designed PbR model and procurement process will identify and militate against these common gaming temptations. l

When considering whether to bid for a PbR contract, think through both the opportunities and risks of doing so In their report of 2012, the Audit Commission stated that “PbR carries extra risks … and requires higher level

commissioning skills than more traditional approaches”, page 6. It would be wise of both commissioners and providers to conduct a skills audit and provide appropriate training before entering in to a PbR contract. In addition to careful financial and performance modelling, examples of what organisations could consider include: the balance of core funding vs. results-based funding, their preparedness in terms of ICT infrastructure and skills, organisational culture, record keeping (particularly in relation to evidencing paid outcomes), and any effects on staff appraisal processes.

From theory to practice Some see PbR as a panacea and extol its virtues with evangelical zeal. But, if anyone believes PbR can sweep away bureaucracy to focus solely on service user outcomes they will be disappointed. In their 2012 report, the Audit Commission stated that commissioners would continue to collect process measures. Indeed, remembering that quality is about process rather than outcomes, would people have confidence in commissioners that did not? The underlying message from both ekosgen and the Audit Commission is that moving PbR from theory to practice is anything but simple. That’s my experience too. While there may well be significant opportunities to change the nature of contractual relationships away from process and towards outcomes there are also substantial risks. These risks are apparent on both sides of the contract and require careful assessment. In relation to PbR, for the time being the most rational position remains that of the open-minded but nonetheless sceptical agnostic.

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A country divided: Regional profiles of preventative and support services We’ve already collected and published data on housing support services across England in 2012-13. Here Adam Knight-Markiegi compares data regionally. Having published data on housing support services, we’re now uncovering what it shows us. This time we look at the picture across the English regions. Not every council has provided data, so to ensure we have data from enough councils in each area, we’ve combined the North East and North West regions and East Midlands with the East of England.

High costs in London The average annual cost per unit across England was £1,332 in 2012-13, according to the data submitted. But this varies considerably at a regional level. The highest was London at £2,183, well over two times that of the lowest region, the West Midlands at £897. This is largely due to the high number of community alarm services included in the West Midlands data though not for London. But it’s also down to the Region

higher average prices for most types of services in London. For example, floating support cost £1,598 per client in the West Midlands but £1,844 in London.

Varying performance When looking at the performance of services, again there are differences. The utilisation of services, how full they are, varies from 54% in the East Midlands and East of England combined to 101% in the South East. The low figure in eastern England is affected by rock bottom scores in Derbyshire, where the average utilisation was recorded as just 1.2%. This may reflect the fact that the authority had commissioned services using payment by results and had focused its monitoring on outcomes rather than performance. The throughput (how many clients

were passing through services) also spans a large chasm, from 105% in London to 558% in the South West. These high figures come from some very short-term services. For example, a temporary homelessness service in Bristol was showing a throughput of 1,215%. This is off the scale, until you realise it converts to an average stay of 29 days, which then seems feasible. There was much more consistency in the ‘maintaining independence’ scores, all very close to the national average of 98%. However, the data for ‘gaining independence’ again differed. The lowest was 74% in the South East and highest of 90% in the West Midlands.

Common needs Across the country, the needs identified were very common. The

Unit cost Utilisation

Utilisation

Throughput

Maintaining independence

Gaining independence

North East and North West

£1,590

98%

129%

98%

76%

Yorkshire & Humber

£1,003

92%

106%

98%

85%

East Midlands and East of England

£1,221

54%

117%

98%

79%

West Midlands

£897

94%

120%

98%

90%

South East

£1,508

101%

133%

98%

74%

South West

£1,695

85%

558%

98%

82%

London

£2,183

92%

105%

99%

89%

England average

£1,332

87%

170%

98%

80%

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top five were: l maximising income (71% of clients); l choice and control (60%); l settled accommodation (58%); l contact with family and friends (57%); and l maintaining accommodation (53%).

England and in almost every region. In contrast, a very high proportion of clients achieve support with assistive technology but a low proportion – just 16% across England – need help with this area.

These were the most common needs identified in each of the regions too, although the order sometimes varied. For example, settled accommodation was the second most popular need in Yorkshire & Humber and the West Midlands, though third nationally.

The five least successful outcomes across England were: l Paid work (28%) l Undertake work-like activities (65%) l Substance misuse (66%) l Training and education (68%) l Settled accommodation (75%)

With a backdrop of welfare changes, maximising income will continue to be important. As housing support services aim to support independence, it’s hardly surprising that help to find settled housing or maintain it appeared in the top five.

Like the top outcomes achieved, there is a lot of consistency for the worst outcomes across the regions. Paid work is by far the lowest in all areas, average 28% across England and getting as low as 23% in the North East and North

Achieving outcomes

Needs and outcomes in England

Like the identified needs, there is also a lot of accord with the outcomes achieved. Across England, the top five achieved were: l assistive technology (96% of clients with this identified need); l contact with external services (93%); l maximising income (92%); l contact with family and friends (92%); and l choice and control (90%). Also like identified needs, the top five outcomes achieved virtually mirrored these in all regions, though often in a different order. The two exceptions to this were that in London and the South East help with risk of harm from others fared better than choice and control. The cross-over between identified needs and outcomes achieved is encouraging. We see this with maximising income, contact with family and friends, and choice and control, which appear in the top five needs and outcomes across

Weaker outcomes

West combined. But other economic wellbeing or training outcomes performed relatively badly across the country. Curiously, managing debt performed relatively badly in the northern parts of the country, featuring in the worst five outcomes achieved for the North East and North West combined and for Yorkshire & Humber but not in the other regions. So the picture of housing support services is varied across the English regions. There is much more consistency in the needs and outcomes than the cost of services and their performance. You can find a profile for each region on our website, bit.ly/SPdata1. In future you’ll also see other write-ups, eg by client group and service type.

Maximising income Managing debt Paid work Training and education Develop leisure & cultural learning Undertake work-like activities Establish contact with family & friends Contact with external services Physical health Mental health Substance misuse Assistive technology Maintaining accommodation Settled accommodation Compliance with statutory orders Self-harm problems Causing harm to others At risk of harm from others Choice and control 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

n Identified need

n Outcome achieved

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Sitra Training

Assertiveness

Working with people with complex needs

20th November in Southampton

22nd November in London

You will learn: • The effects of shyness and indecisiveness onto your others • How to gain clarity about what you want • An understanding of how to express yourself clearly, openly and directly • How to learn to fully listen to others

At the end of this course, you will be able to: • Identify individuals with complex needs • Appreciate how some of these needs may render an individual vulnerable or at risk • Understand how risk can be identified, managed and minimised • Formulate culturally appropriate strategies for managing complex needs individuals in a variety of settings • Understand the current and emerging policy on supporting people with complex needs • Access resources (community, health, and social) that can be used to improve quality of life and optimise recovery band outcomes for customers

Welfare reform and exempt accommodation

Suicidal behaviour

25th November in Southampton

4th December in London

At the end of this briefing, you will learn: • How supported housing might be effected by ‘bedroom tax’, benefit cap and Universal Credit • The Government’s respond to the abuse around the current ‘exempt accommodation’ rules • Sitra’s recent research project on Housing Benefit for people of working age in supported and sheltered housing. • The Government’s plans for switching help with older people’s rents from Housing Benefit to Pension Credit

At the end of this course, you will be able to : • Identify myths and facts about suicide • Gain increased awareness of the incidence and profile of suicidal behaviour • Be aware of the signs and signals of suicidal behaviour • Identify risk factors for suicidal behaviour • Identify helpful responses to presentations of suicidal behaviour • Be aware of sources of help

Prices

Key

New prices with increased discount for members: Half-day: Sitra members £55/Non-members £89 One-day: Sitra members £89/Non-members £149 For a full list of forthcoming courses please visit our website

Courses suitable for new workers suitable as part of an induction programme Courses suitable for frontline staff, also suitable as refresher courses for managers Courses suitable for new managers or frontline staff moving into management Courses suitable for experienced and senior managers Courses suitable for local authority commissioning and monitoring staff

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