Sitra bulletin no 3 2014 by Sitra

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bulletin THE MAGAZINE FOR HOUSING WITH CARE, HEALTH AND SUPPORT

expertise, training & consultancy in housing with health, care & support

2014 – NO.3

Vibrant Communities

No More Throw Away People

Older People’s Strategy

Community Link Service

The Primary Care Community Link Service www.sitra.org

Do we really make a difference?

Peer Courts

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Contents 03 04

CEO’s Comment Vibrant Communities: Transforming services through creativity Chris Gage, Managing Director of Ladder to the Moon discusses how creative events help to achieve active, vibrant and personalized services.

Spice Time Credits: No More Throw Away People David Russell, the Head of Health and Social Care at Spice, describes how they strive to transform public services and communities in the UK by building a system of Time Credits.

Cover Story

The Primary Care Community Link Service Joanne Pickard of the charity Porchlight, describes their new and exciting service working alongside GP surgeries across Kent, that aim to reduce pressure on general practitioners by addressing low level mental health needs at home.

The Primary Care Community Link Service

Do we really make a difference? John McFadyen, the Director of Support of Response Organisation, discusses how Sitra consultancy helped to demonstrate the value of their intensive care services, beyond national and local targets.

Peer Courts: Restorative justice for young people by young people Mark Walsch describes how his Winston Churchill Memorial Fellowship in the USA helped to transform criminal justice system at home.

A High Cost to Pay Senna Eswaralingam of Homeless Link’s discusses their recent research into the impact of benefit sanctions on homeless people.

Sitra Training

Sitra Staff Chief Executive Vic Rayner Deputy Chief Executive Lisa Harrison Policy Officers Geoffrey Ferres Sue Baxter Policy and Research Co-ordinators Dani Cohen Burcu Borysik Roselee Molloy Business Development Manager Tim Parkin (interim)

Contracts Officers Anna Robertson Wendy Green Business Support Lana Lewis Sarah Pink (Maternity leave) Georgina Gorton Head of Finance & Central Services Berihu Mohammed EU Funding and Finance Officer Ray Naicker Finance Assistant Alison Quinn

Research Assistants Alice Cheatle Geni Johnson Stefania Papadopoulou Office Co-ordinator Gill Cotton Central Support Monica Antolin Communication Assistant Luke Smith Apprentice Sharelle Hunte

If you would like to receive the bulletin in large print or in other accessible formats, email post@sitra.org

Contributors

Sitra Offices

To discuss advertising opportunities within the bulletin, please email post@sitra.org

London 3rd Floor, 55 Bondway London SW8 1SJ Telephone: 020 7793 4710 Fax: 020 7793 4715 Birmingham BVSC, 138 Digbeth, Birmingham B5 6DR Telephone: 0121 678 8891 Email: geoffreyf@sitra.org Southampton Fairways House, Mount Pleasant Road, Southampton SO14 0QB Telephone: 023 8023 0307

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

Submissions and queries If you have any comments, queries or suggestions, a letter for publication or wish to submit a news story or article please contact us via one of the methods opposite.

expertise, training & consultancy in housing with health, care & support

Health & Social Care Partnership, part of Sitra

www.hscpartnership.org.uk

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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

Freshening up…….. Following on from our #changemakers theme, this edition picks up on the issues of renewing and freshening up approaches to the delivery of housing with health, care and support. Fresh new ways of thinking about the critical work of the sector are helpful in terms of opening up a dialogue with new commissioners of services, and with potential new partners. Porchlight have been leading the way in joining up their work with the priorities and needs of health commissioners, and have given their floating support service what could be viewed as a ‘brand overhaul’ – enabling them to demonstrate the importance and value of the work they do to both new commissioners and new users of their services. This edition also provides insight to how a new look at an old concept – that of non financial exchange via Time Credits – offers a revolution in the way that organisations can think about reward and remuneration strategies for service users. The inspiring Spice have built on Edgar Khan’s seminal work – No More Throw Away People – and breathed fresh life into Time Credits – offering for the first time a UK wide platform for gaining and exchanging credits. I love this idea, and Sitra are working with Spice to think about how we can take forward this approach to broaden our training offering to a wider community audience.

Vic Rayner Chief Executive Email: vicr@sitra.org

However, the fresh faced Bulletin does not stop there! There are articles talking about new ways of thinking about quality from the Centre for Housing and Support and new approaches to working with Older People from Orbit Charitable Trust. Response, a mental health charity based in Oxfordshire, reflects on the value of having a fresh pair of eyes reviewing their services and Senna Eswarlalingham of Homeless Link gives an overview of their new research into the impact of benefit sanctions on homeless people. Those of you who attended the Sitra conference will have been introduced to Ladder to the Moon, an inspiring training organisation, who brings creativity and innovation to transform services through creativity. As part of our ongoing work in keeping our training offer fresh, Sitra have formed an active partnership with Ladder to the Moon to encourage organisations to try out this new approach with training and learning. In order to achieve this, we are offering a number of their courses which provide training to enable staff to apply their creative approaches in their own settings. Check out our website for more details – and hope to see you there. I hope that you will enjoy hearing from Mark Walsch – bringing learning from the US about the development of Peer Courts – a welcome return to our focus on coproduction. Peer courts are billed as restorative justice for young people by young people. The learning from his fellowship is influencing the development of an operational peer court model at Hampshire Community Court. Finally – this edition focuses on a fresh new bit of jargon to hit the sector – that of ‘specified’ accommodation – and unpacks the terminology with a practical summary of the changes. This coincides with a series of seminars being offered in partnership between Sitra, Homeless Link, NHF and Women’s Aid – bringing our members up to speed.

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

Keep up to date with our Blog Keep up with developments and add to the debate at Sitra CEO’s blog at www.sitraceo.wordpress.com

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Vibrant Communities:

Transforming services through creativity Chris Gage, Managing Director of Ladder to the Moon discusses how creative events help to achieve active, vibrant and personalised services. At Ladder to the Moon, we provide workforce and service development that enables housing, health and care organisations to develop active, vibrant, personalised services. Our organisational and workforce development services are delivered by creative care professionals, trainers and coaches, with a focus on leadership, creativity and wellbeing.

and possibility: there is nothing to get right or wrong. This is in contrast to a lot of task-focused, process-driven work that can be the norm, and it creates a rich learning environment around longterm conditions. Because everyone (staff and tenants) has a great time, creative events enable everyone to see each other with more personality and more dignity, deepen connection and communication, improve customer satisfaction and raise levels of staff engagement.

At Sitraâ&#x20AC;&#x2122;s annual conference in March, we were delighted to report on the success of our Vibrant Communities programme in housing settings. The Vibrant Communities approach uses creative community events as a training tool and a catalyst for change.

Case study: partnership, enablement, quality of life

Creative events are powerful because they create an experience that is about relationships, emotion

In 2013, Hanover Housing Association commissioned us to run a 2-month Vibrant Communities

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programme in their Olive House Extra Care scheme (LB Hammersmith and Fulham). Hanover staff in extra care -and increasingly in retirement housinghave raised challenges in supporting the wellbeing of tenants, especially those with dementia. In response, we worked to:

Build Build community and partnership working

Develop Develop staff communication and a culture of support and enablement

Improve

Improve the quality of life for isolated individuals, particularly those living with dementia

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The Vibrant Communities programme supported staff and tenants to coproduce a creative community event, using training and mentoring. The tenants and staff decided to recreate the classic musical The Sound of Music and then premiere it with an Oscars ceremony.

Building community and partnership working The programme caused Olive House tenants, Hanover’s estate management and the Housing 21 care staff team to work more closely among themselves and with the adjoining local authority resource centre. “There were lots of crossed boundaries where our normal areas of work joined together to do the events and by doing that we were joining our tenants and the day centre and they were getting to know each other and forming friendships.” Sue, Hanover, Estate Manager Staff reported a better working relationship with increased understanding of the roles, functions and approach of each partner organization and of individual members of staff. “I’ve thought about how I request things and how I might be interpreted.” Lenka, LB Hammersmith and Fulham, Support Worker This resulted in increased effectiveness of joint working, increased ability to reflect and undertake joint problem solving and greater mutual support, particularly at former stress points such as mealtimes and events.

Improved quality of life for older people “The tenants were a bit ’sit back and wait to be entertained’… now they are taking the lead and actually doing things.” Geraldine, Care Manager, Housing 21

Tenants and service users were very engaged through the project. They supported the Ladder to the Moon team to meet other tenants who did not leave their flats, and were involved in making decisions about the film, singing, acting out scenes and making props, bringing their own creativity and ideas to each opportunity. Tenants took part that staff said did not usually take part in anything, and there were sustained outcomes for particular isolated individuals.

Brenda’s experience Until a recent illness, Brenda, who is living with dementia, had played central role in Olive House, including showing prospective tenants around. However, a period of time in hospital had affected her mood. The Vibrant Communities programme helped change this. “Brenda has not stopped talking about Ladder to the Moon. She has definitely lightened, she’s a much happier lady. You only have to start a conversation with her about film making and she will tell everyone how much she enjoyed the event, especially sharing with her family: she is sending the movie to Australia to her family.” Sue, Hanover, Estate Manager Brenda is now more confident and a member of the new Tenants Committee.

“Since we did Ladder, we’ve formed a tenant’s committee, which I have been trying to encourage for probably two years. People who generally wouldn’t be involved, including Brenda, are part of it. That’s been a real positive change.” Sue, Hanover, Estate Manager

Brian’s experience At first unsure, Brian took a leading role in the film shoot, recreating the love scene between Maria and Captain Von Trapp from the Sound of Music. Through the programme Brian’s confidence grew and he became increasingly involved in community life. “I didn’t think at first I would like it. But gradually as we progressed it became better, I’ve become better. My Oscar is in pride of place in my house. My carers talk to me about it and they are surprised about what we’ve done.” Brian “Brian, the programme really changed his life. He still has bad days but he can overcome them very easily compared to before. He picks up the phone now, he speaks with his carers. He has spoken to his family. He’s more involved with the community, more involved at home, more involved in his own care …… going to the dentist, getting his hair cut, going for a coffee.” Phil, Support Worker

To download the full Olive House project report and see video of the project, visit www.laddertothemoon.co.uk/Casestudies Sitra are delighted to be partnering with Vibrant Communities to train staff deliver creative projects in their services. Our Activity Leaders Course, for those with responsibility for activities or social engagement, builds understanding of how creative approaches enhance wellbeing and relationship-centred care. It also equips participants to involve and inspire their colleagues in providing meaningful occupation and quality of life for the people they support. Our Vibrant Service Leaders course brings together managers and senior teams to explore creative approaches to leadership and whole service development. Through coach input, reflection and practical exercises, the day explores the opportunities for vibrancy in care settings and how creative leadership can access these. For details visit www.sitra.org/training

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Spice Time Credits:

No More Throw Away People David Russell, the Head of Health and Social Care at Spice, describes how they strive to transform public services and communities in the UK by building a system of Time Credits. Currently public service provision in the UK is struggling to meet the long term needs of citizens and this is particularly evident in the health, housing and care sectors. At Spice we recognise that managing the needs of a changing society will require significant changes to the existing systems, and to the way that individual citizens and communities engage with professionals, services and institutions. Spice is working with communities and public services to redefine value and achieve meaningful change by empowering citizens. We work with partners in public services, charities, businesses and community groups to encourage people to take a more active role in their service and communities.

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It’s a two way street This change is fostered using a tool called Time Credits: for each hour you give, you earn one Time Credit, which can then be spent on a variety of cultural, leisure and learning opportunities. For example, Time credits can be earned by helping to run the day service one normally attends or by taking part in facilitating a peer support group.1 hour of volunteering equals to 1 Time Credit, 2 hours for 2 Time Credits, and so forth. Then, that one Time

“

Credit could be used for swimming at the local pool for an hour and two Time Credits can be used to watch a film at the cinema. You give an hour, you get an hour. Time Credits are a social currency that values everyone’s time equally. This simple transaction has the potential the transform the housing, support and care by recognising the skills and abilities of those usually seen as passive recipients. Further to this, spend activities can open up a world of new experiences from heritage, to

Time Credits are a social currency for communities based on the principles of coproduction.

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adult learning, theatre, sport, leisure and trips fostering new relationships and building on ambitions and choices.

they never would have been able to achieve without them. One of our Council partners captured the mood when he said: “We’ve certainly engaged far more people

through time credits more productively than was ever the case through schemes that attracted much more funding and much more profile”.

Involving the many

Peter’s Story

Time Credits excite and reengage those already involved but crucially also attract new people to being involved. In fact over 51% consist of people who had either never volunteered or not volunteered regularly before Time Credits were introduced. Everyone’s time is equal and all skills and abilities are valued in the system. Once Time Credits are introduced we often hear that the challenge in services is how to capitalise on people’s desire to contribute and give time. We view this as a fantastic opportunity to coproduce new activities, groups and systems built around people’s assets, ambitions and choices. This requires managers and staff to work in new ways and to think differently about ‘users’ and to engage with the wider community. We have a range of bespoke training and support packages for organisations to make this shift in skills and approach.

Peter is from King’s Lynn and volunteers at the West Norfolk Community Bank (part of the Norfolk Credit Union) as part of the West Norfolk Time Credits programme. Following periods of depression and a breakdown Peter lost his job and spent time in prison and ended up being homeless following release. He was invited to volunteer when he went to join the credit union while a tenant of Genesis Housing Association locally. This is his story:

Time Credits, if integrated into service planning and objectives, have the potential to shift entrenched cultures, encourage widespread and flexible pathways to involvement, and open up a range of community activities for people to enjoy and share with family and friends. The impact doesn’t stop there: 64% of participants in Spice projects report an improved quality of life, 49% feel more confident and 52% can afford to do new things. Organisations too feel the difference with 75% of participating organisations reporting a positive impact on their objectives within six months. From Local Authorities, Health and Social Care providers, Housing Providers and Schools right through to small community groups, there is a shared sense that Time Credits have allowed them to do things

“I had lots of skills that were going to waste. I needed to be with people, and I wasn’t having any contact with them. The Credit Union couldn’t exist without volunteers, so to be able to say thanks is a really good thing. It’s saying, ‘we appreciate your time, so we’ve joined this scheme. I would still be in that place if I hadn’t started to volunteer. It gave me something to feel valued about. Volunteering is a good way to challenge yourself, to change your situation. It adds another side to volunteering – it supports that social and networking side of it that you don’t usually get outside of a workplace. It gives volunteering an added dimension…it makes it a richer experience. It’s opened up new opportunities to me. I do things now I wouldn’t have done otherwise, like going to the gym regularly, because I wouldn’t have been able to afford it. It’s opened up social avenues – I’ve now got a group of ‘nodding acquaintances’ at the gym, which helps you to anchor yourself, to anchor your place in society, and your sense of identity. “It’s had an impact on both sides. I’ve also been able to thank people who are helping me out [through gifting Time Credits to friends and family]. It’s nice to be able to give things to people and Time Credits have enabled me to do that. I’m giving my family show tickets booked with Time Credits for Christmas, and without that I wouldn’t have been able to give them anything…I’m going to take my son to watch a football match – I remember doing the same thing with my dad at about that age.”

You can download e-learning tools from Sitra’s 2014 Conference ‘Change Makers’, including the joint Spice and Look Ahead Presentation on our website: http://bit.ly/Sitra2014

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Moving Towards an Older People’s Strategy Orbit Charitable Trust report from their research exploring options for joint work between social housing providers and older people organisations to provide excellence in housing and care for the most vulnerable older people. In late 2010, Orbit Charitable Trust, an independent charity working to improve the quality of life of older people, engaged Riseborough Research & Consultancy Associates to carry out a research project called “Housing and care for the most vulnerable older people: what can social housing providers and older people organisations do together?” The work consisted of a programme of research and policy work using the format of ‘Inquiry’ and giving it a wide appeal. We investigated the needs of older people with dementia; mental illness and selected health related problems and the different ways in which organisations could join forces to respond to those needs. The findings provided detailed insights into the roles social housing providers could play in shaping and delivering future services. One of the key outcomes was to show how organisations can change their ways of delivering service by putting the customer at the heart through person centred working. However, we saw the outcomes as the beginning, not the end of the story and, in conjunction with Orbit Group, embarked on a follow-up

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project which aims to provide support to smaller and non-specialist housing associations to help them develop effective services for older tenants, particularly those suffering from dementia, to have a better quality of life living in their own home. The starting point was a national survey, for which we received 88 replies from the 294 organisations emailed, a response rate of 30%. The survey showed that a majority of respondents do not have an Older People’s Strategy and, worryingly, 59% of those without a Strategy did not intend to draw one up. Of even greater concern, only 8% of all respondents have a Dementia Strategy in place.

A number of those who responded said they would be willing to work with us further, so we invited people from eight associations to a leaning day at the end of September, attend by Jeremy Porteus of the Housing LIN and Esther Watts of the Alzheimer's Society. The write-up of the day was included in our report published to coincide with the Housing LIN conference in February. The report has a checklist to establish whether an organisation is dementia friendly and a quick guide to developing a strategy. It also sets out how Orbit Heart of England is developing its approach and services.

Orbit are working with five associations to track how they change their approach to services to meet the needs of people with dementia and will be publishing a follow-up report in the Autumn showing their experiences. It will also contain good practice papers covering: ➤ ➤ ➤ ➤ ➤ ➤

Training staff in helping people with dementia Designing dementia-friendly homes Exploring assistive technology Developing a dementia strategy Appointing a dementia champion Joining a local dementia action alliance

For more information please visit www.orbit-research.org.uk

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The New Service Excellence Standards The Centre for Housing and Support reports from the research looking into the future of quality standards to ensure excellence in housing, support and care sector. To mark the 20th year of The Centre for Housing and Support (CHS), a research was commissioned to develop the future of the long established Code of Practice within the current and developing housing, care and support sector. Among the key considerations was the new commissioning environment which requires taking a radical new approach to accreditation. With the rise in new service delivery models, such as consortia arrangements, integrated care and support contracting, non-traditional services such as Family Intervention Projects and non-regulated delivery under the personalisation agenda, it was clear that the Code of Practice had some exciting challenges to face. The research showed that a new approach needed to: 1. Be applicable to as wide a potential market as possible; 2. Be flexible enough to be used (with some modification) by a range of service types; 3. Deliver multiple benefits: a. as a quality improvement tool b. as a repository for complex data/evidence c. with the capability to submit relevant data to regulators d. (ideally) support providers in making tender or other submission to commissioners; 4. Be specific enough to gain the support and endorsement of commissioners and regulators, yet flexible enough to avoid the provider needing to enter data/evidence more than once; 5. Be robust enough to challenge and stretch providers without diverting precious resources away from service delivery;

including intensive housing management, Family Intervention services and registered and unregistered care services; Electronic evidence management and assessment, encouraging providers to be as creative as possible in collecting real and robust information that showcases the quality of services; An annual review process that is far less resource intensive than the old Code of Practice, whilst remaining thorough and robust.

6. Offer good value for money! The new Code of Practice renamed The Service Excellence Standards changes the emphasis from evaluating the quality of the inputs used in service delivery to assessing the quality of the service by its impact or outcomes for its customers. The outcomes were developed out of the research and in response to the specific requirements of legislation and regulation in both support and social care. CHS undertook wide scale consultation on the Standards across provider, regulator and commissioner groups. The priority for the new Standards is strengthening the customer voice in service accreditation: CHS strongly believes that customers are the experts in evaluating services, and that the blend of customer feedback against the achievement of commissioner influenced outcomes would offer the most authentic proof of service quality. The new Standards also reflect the wide range of service delivery types, and successfully use the best outcome measures from support and personal care, whilst providing a separate set of Standards for intensive (or additional) housing management. The new Service Excellence Standards incorporate: An achievement progression that supports providers in continuously improving services; A flexible set of standards that are applicable to all delivery models and types of care and support,

CHS believes while accreditation is very important, front line staff should not be unnecessarily diverted from service delivery and into spending too much time on evidence gathering. Instead we promote ‘Smarter Regulation’: The new Service Excellence Standards will accredit exactly what each service delivers, by using a flexible set of outcome measures; Providers will collate evidence of day-to-day practice, not produce information specifically for the accreditation; We encourage providers to “recycle” evidence produced for other accreditation awards, where it is relevant to the Service Excellence Standards requirements; The Assessor will collate evidence during visits to services. We are currently speaking to commissioners to pilot a joint accreditation scheme to reduce the impact on service delivery and resources. The Standards continue to be monitored and reviewed by a Practitioner Working Group, consisting of active representatives from a wide range of organisations, including large and small housing providers, Local Authorities, Housing Associations and customers.

For further information contact CHS on 01905 727272, email standards@chs.ac.uk or visit www.chs.ac.uk

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The Primary Care Community Link Service Joanne Pickard of the homelessness charity Porchlight, describes their new and exciting service working alongside GP surgeries across Kent, that aim to reduce pressure on general practitioners by addressing low level mental health needs at home. The Primary Care Community Link Service (PCCLS) is a partnership between Porchlight, Kent County Council and local GPs. The service aims to reduce pressure on GPs by enabling people to address low level mental health issues, predominantly those of circumstantial needs, at home. The service covers all clinical commissioning areas in Kent. 16 Porchlight staff, spread over the region, will assist a large number of surgeries and individuals in the next two years. They will provide support and advice in a range of areas including debt, housing, health, drug and alcohol issues, education, training and volunteering, community involvement and confidence.

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Porchlight are working alongside GPs in order to identify people whose needs are better addressed beyond the surgery and to make dedicated support professionals accessible to them. It is our conviction that intervention and support will result in a reduction in repeat visits, and in turn will save money to public purse. Most importantly, PCCLS will be instrumental in enabling individuals move forward positively in their lives, and therefore will create significant social value. Whilst the value of comprehensive care GPs provide for individuals is recognised across stakeholders, the need to reduce the pressures on their resources is indisputable.

Additionally, many individuals that cannot be helped by a GP service continue to make repeat appointments, and this is currently only increasing the demand on the existing resources whilst achieving limited positive outcomes. The PCCLS is a targeted response to this: It focuses on reducing those repeat visits by establishing the often non-medical roots of the problem. Porchlight staff work closely with clients to establish what support they need to solve their problem, connecting them where necessary with further longer-term support services, and working with them to gain confidence to address any future issues.

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The service is completely free and can last for up to 8 weeks. It is open to adults living in Kent who feel that their circumstances have affected their mental health and well-being. Referral is mainly through GPs, but can also be made directly to the charity’s 24-hour helpline or by paper referral form. Porchlight has also set up drop-ins across the county to further help people access the service. Whilst the service is closely linked to GPs and their surgeries, clients can be met wherever they feel comfortable – at the surgery, in the community or in their own home. From the first meeting, clients and their support worker work together to produce a focused personal

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The PCCLS is a fantastic opportunity to help a wide range of people with diverse problems, to prevent homelessness and to support GPs in reducing their workload. The service benefits the community; the tailored support we give ensures the cost of social problems is reduced. There is a focus on multi-agency work; we do not want the PCCLS to replace other services but rather that agencies can continue to thrive alongside the PCCLS.

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Paul Easterbrook, Community Service Manager

support plan, which includes a clear description of exiting the service, i.e. what will happen at the end of their eight-week programme. It is not the intention of the service to address significant long-term needs, so much as to prevent cases from becoming more serious. Many vulnerable people are often ‘lost’ to support services after their initial referral. Although it has been established they need further support, many fail to fill in the correct forms. With no one service responsible for the welfare of the client exactly at the point when it is most needed, vulnerable people can fall through the net. The PCCLS fills this gap through the short, sharp, intensive nature of the support provision. PCCLS liaise with other services to ensure that the right kind of support is arranged, that the first appointment for the client has been appropriately booked with a named person. That the is prepared and has access to everything to get to the appointment, including support in person if needed. The initial appointment is seen as an opportunity to build the client’s confidence and to ensure the client thereafter is confident and comfortable enough to go to the next one. Thereby, PCCLS ensures that support ‘sticks’. Clearly the experience of short, focused support is already having a positive affect on those who use it.

One client said she felt ‘very empowered by the support given, and now I can face challenges and can deal better with confrontation. My confidence has increased tenfold and I felt extremely well supported throughout. I’ve even recommended the service to a friend.’ Another demonstrated the breadth of the effect short intervention can make: “The service has made me feel better and given me hope and more confidence. I’m calmer and less agitated when dealing with others. This has made such a difference in my outlook when I think about my housing situation and my relationship. The money I received from the DLA has made a difference financially to me and my partner, and relieved some of the pressure on us.” The most cited feedback is that clients wish they could be supported for longer than 8-weeks to achieve more. Early indications show the PCCLS support leaves them ready to engage, enthusiastic about making changes, and ready to move forwards in their lives; evidence that the PCCLS is accomplishing what it set out to achieve. Kent County Council is backing the service and CCGs are ensuring GPs are fully aware of its benefits. The future for the PCCLS as a beacon for innovation looks to be very bright – just what the doctor ordered.

Sitra can help health and social care organisations by • Anticipating and actively working on emerging priorities • Disseminating information, good practice and guidance • Acting across locality, regional, and organisational boundaries to facilitate engagement, integration and coproduction • Providing two way communication between the Department of Health and senior leaders giving access to key national learning and feedback • Leading, facilitating or supporting integrated projects and resolving issues specifically commissioned by partners • Providing bespoke support or acting as a critical friend for the design or implementation of policy or to accelerate progress. To find out more, please email Dani Cohen danic@sitra.org

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Do we really make a difference? John McFadyen, the Director of Support at Response Organisation, discusses how Sitra consultancy helped to demonstrate the value of their intensive care services, beyond national and local targets.

Response Organisation is mental health charity offering a broad range of housing and support services across Oxfordshire and beyond, from independent houses/flats with ‘floating’ support (provided by sister organisations) to 24-hour staffed projects. We work in partnership with Oxfordshire Mind on some supported housing schemes and we have a close working relationship with the floating support providers and the pooled budget joint commissioning manager. Response’s intensive housing and support service delivers an accommodation-based service with high levels of support to 79 people across the three sites in Oxford. The service is funded through the Supported to Independent Living pathway pooled fund, which has a funding mix of Supporting People, adult social care and NHS funding. Earlier internal scrutiny suggested high level of longer term need across the intensive projects, which could result in unrealistic

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expectations around the likelihood and the speed of residents moving into independent living. As a provider who welcomes learning and development, we are keen to ensure we meet local and national targets and fulfil the residents’ needs. We therefore commissioned Sitra to assess the intensive housing with support against both the national mental health strategy and the commissioning priorities within Oxfordshire. Furthermore, our housing with support services were assessed against the Supporting People Quality Assessment Framework (QAF) which takes an outcomes-focused approach. Methodology Sitra has taken a three-pronged approach to evaluation, which involved resident surveys across the three sites, interviews with stakeholders who inform the decisions around NHS and adult social care commissioning for mental health in Oxfordshire, and quantitative data analysis on resident outcomes.

Data analysis covered: The Centre for Housing Research (CHR), which collates data on residents at the points of entry to and exit from for all Supporting People (SP) funded services PSOCC, The Response Organisation internal recording system, which tracks residents support plans and provides quarterly monitoring data to the commissioners Recovery Star outcomes, which are for internal use by residents and staff. Findings: The service Response’s intensive housing projects provide an accommodationbased service to people with high morbidity and high support needs; mainly schizophrenia and bipolar disorder with dual diagnosis a growing feature of presenting difficulties. Many of our residents have lived in institutional care for years with some requiring repeated periodic readmissions to acute mental hospital care.

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The Response intensive service had been initially designated as a short-term, accommodation-based service in the Supporting People sense of a service where typically residents would stay for no more than two years. However, when compared against national datasets for these services, this was clearly a case of mis-categorisation (See Table-1). This also meant that Supporting People throughput data had been applied, in retrospect, inappropriately. For example, as Rowan House had not been Supporting People funded, there had been no data available on its clients on the basis of ‘moving on’. In fact the County Council’s Social Care Pathways Team had assessed onethird of residents already as having no prospect of this outcomes. It was therefore little wonder the service was struggling to achieve the higher throughput expected of short-term services, and for two reasons: Many of its clients did not fit within the short-term category in the first place Even some of those wishing to move on to more independent living could not have accessed long-term housing and support services in the community to enable that to be sustainable. Findings: Resident survey The most compelling outcome of this research was that there was a general consensus amongst all residents interviewed of being satisfied with the service; with not one single negative score from the residents’ assessments and with satisfaction ranging from zero to +1.08 (on a scale of -2 to 2). This demonstrates a positive appreciation of Response’s service across all questions across all sites. This is an unusual result in satisfaction research and – whilst never being complacent – one of which Response should rightly be proud.

Table 1: Mental health characteristics of Response intensive service residents and Short term SP services nationally Response

Nationally

Economic status of long-term sick or disabled

100%

68%

Being Community Mental Health Team (CMHT) referrals

100%

33%

Being under the Care Programme Approach (self-defined)

100%

18%

Being under the Care Programme Approach (CMHT-defined)

100%

36%

The most direct one was whether Response aided their recovery, which had an average score of 0.7, which is relatively high. Even higher than this was the view that staff that gave residents hope of getting better to some degree (0.9). Furthermore, there was clear evidence that Response offered opportunities to take responsibility for their health and wellbeing, helped and supported them to manage their self-care, and supported them to positively deal with issues around identity and self-esteem. These provide a good match to the national mental health strategic priorities of good mental health and demonstrate a positive experience of care and support. Findings: National strategy Response has achieved good results from the data examined, which has been substantiated through the results of the resident survey and were seen to be achieving against outcomes in many key areas. Against the national strategy the data on both outcomes and satisfaction shows that Response is delivering in all the areas of the national strategy, with perhaps weaker evidence on stigma and discrimination. However, the research also suggests there will be some room for improvement in other areas; all scores from residents were positive but were within the range of average to good, rather than good to excellent.

against a number of targets within the local strategy, most notably, financial management and physical health (accepting the small element of conflicting data on this outcome), stable housing (depending on the measure used) and employment and work-like activity, although numbers are small; however variations across sites suggest that there is a need to further consider reasons for such site based variations.

Sitra consultancy uses a variety of methods to demonstrate economic and social value of the housing support services, and to make sure the services benefit users and meet local priorities. For more information, please contact Wendy Green wendyg@sitra.org

Findings: Local strategy Results from the resident survey and the data sets interrogated, again show Response delivering

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Peer Courts:

Restorative justice for young people by young people Mark Walsh, describes how his Winston Churchill Memorial Fellowship in the USA helped to transform criminal justice system at home. For almost 50 years now the Winston Churchill Memorial Trust have funded 1000 Churchill Fellows to travel the world to gain knowledge and skills to benefit their communities back in the UK. The fellows are from all walks of life and include a variety of projects that benefit young people, working age adults, science and technology, education and the arts. In 2013, I was awarded a fellowship under the Penal and Prison Reform category, and spent six weeks in the USA studying the Youth Criminal Justice system and programmes known as Peer Courts. During my Fellowship, I acted as a visiting Fellow at the University of Portsmouth’s School of Law and since returning, I have been able to present my learning to the Sectary of State for Justice Lord Chancellor Chris Grayling, Chief Constables and Police and Crime Commissioners. We now began to develop an operational Peer Court model believed to be the first in the UK- at the Hampshire Community Court.

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If I had to sign post the road of what led me to WCMT’s door, I would say peer pressure! Many people experience peer pressure point in their lives, seldom yielding to positive behaviour. Peer pressure is particularly problematic when it induces criminal behaviour. This became most apparent to me whilst working as a city centre beat officer based out of Portsmouth Central Police Station. I consulted young people about the reasons why they had and have continued to commit crime despite acknowledging the consequences. One of the striking findings of that consultation was that all of the young people stated ‘peer pressure’ as the leading factor influencing their behaviour. If one were to review the criminal justice process for young people at the early stages offending, it would be apparent that young people are finding it difficult to build rapport with people they deal with, simply because they cannot relate to them. We all value the opinions of people

we can relate to more than of those we do not. So perhaps the key to understanding compliance and motivation lies in these relationships. If peer pressure gets young people into trouble, can peer pressure lead them out? Are young people more responsive to people they can relate to? And if so, would including young people in the problem solving and decision making processes result in procedures that are easier to understand and therefore easier to comply with? My fellowship taught me that we need to develop mechanisms that empower young people and encourage them to get involved at low-level, but by no means of lowimportance. Young people should be part of the solution to the offences that are dealt with at the criminal courts. There are already few practices in place in the UK, which empower members of the community to

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become involved in the criminal justice system. For example, members of the jury in Crown Court and our Magistrates in Youth and Magistrates Courts are community members. In the Youth Offending Team, panel members are again dedicated volunteers from the community, who come together to help set contracts for referral orders. More recently we are seeing an increased use of Neighbourhood Justice Panels. While these practices are valuable, there still is not adequate representation of young people in the criminal justice system. In 2013, only 4% of Magistrates for example were described as under the age of 40. In 2007, there was an attempt in Preston to establish a Peer Panel but this has never become fully operational and unfortunately no data is available to understand what worked and what did not. This is why I undertook my research in the USA, to investigate the practice in a number of states that have been running Youth, Teen and Peer Court programmes for over 20 years. Peer Court programmes in the USA build on the very sentiments shared by the young people I consulted with around peer pressure, lack of understanding and ability to relate. I visited New York, Montgomery County just outside of DC, Los Angeles and San Diego in California

and Clark County in Nevada – all of which had different but strong programmes. I also visited Miami where I obtained the views from the wider legal community, including The Public Defender’s Office and The Department of Juvenile Services. Talking to a variety of people and witnessing these programmes in operation were irreplaceable experiences. By and large, Peer Courts work as diversion programmes and offer an alternative to formal prosecution by a criminal judge. The majority of programmes are still mainly overseen by an adult criminal justice professional; however the balance of power is redistributed to young people, who can serve as Peer Juries, Advocates, Bailiffs and Clerks. Uniquely young people are held to account, for what is often their first offence, by other young people. In this way, Peer Courts reverse the negative effects of peer pressure. As one respondent in San Diego suggested Peer Courts are seen to be reversing the reflex of ‘just another adult judging me who has no idea of what it is like to be a young person today’. Respondents expressed they can related to other young people and concepts of restorative and procedural justice

adopted have positive impacts on their actions. Peer Court programmes work with on average 80% compliance rates from those young people that have been through the process. Independent studies also show that Peer Courts impact on recidivism positively. And they save money: A cost benefit analysis of the programme reported that Peer Courts saved the state of Florida $70 million of tax payers’ money in 2010. These programmes need to be adapted at large scales to work most successfully. However, my research suggests that the principles of the Peer Court model can be adapted to the existing UK criminal justice system. Recently, Simon Hayes, the Hampshire Police and Crime Commissioner commissioned an adaptive model to be piloted for 3 years. The aim is to establish a system of giving messages on acceptable and unacceptable behaviours to young people, by young people, and reduce reoffending rates. Since this will be the first time the model has been tested in the UK for non-charged outcomes, evaluation will be key and we are working with the University of Portsmouth to develop an effective evaluation strategy.

You can find Mark Walsch’s Churchill paper on Peer Courts on http://www.wcmt.org.uk/reports/1194_1.pdf

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A High Cost to

PAY There are certain conditions attached to receiving Jobseeker’s Allowance (JSA) or Employment and Support Allowance (ESA). Conditions such as attending advisory interviews, training or work-related activities, and applying for jobs are in place to increase claimants’ chances of finding work. If the claimant does not meet the conditions sanctions can be applied in the form of stopping benefit payments for a period of time. The Government intends sanctions to motivate claimants to fulfil their responsibilities to look for work. Homeless Link’s members expressed increasing concerns about benefit sanctions, particularly since the Government introduced changes in late 2012, increasing the period of time claimants could be sanctioned for. We carried out research in mid-2013 to assess the extent and impact of benefits sanctions on homeless people.1

The extent of sanctions Sanctions appear to be disproportionately affecting homeless people. In our survey of homelessness service providers,

Senna Eswaralingam of Homeless Link’s discusses their recent research into the impact of benefit sanctions on homeless people.

1 in 3 homeless people using services claiming JSA and nearly 1 in 5 claiming ESA had received a sanction – a higher prevalence than all benefit claimants. We found that young homeless people are more likely to receive sanctions, and so do those with

mental health issues, substance misuse and learning difficulties (Figure 1). The research suggests meeting the conditions is more difficult for people with support needs. Hence the particular difficulties for homeless people, who are more likely to have mental health or substance misuse issues than the general population: Homeless Link’s SNAP survey in 2013 suggests 30% of homeless service users have mental health issues and 28% have

Figure 1: Who is being sanctioned? % of survey respondents that said the majority of a client group has been sanctioned Young people (<25) People with substance misuse issues People with mental health issues People with learning difficulties Older people (>50) 0

10 20 JSA claimants

40 50 ESA claimants

Source: Homeless Link sanctions survey; N = 33 to 45

See Homeless Link, A High Cost to Pay, (2013): http://bit.ly/1qfOeO7 Homeless Link, Survey of Needs and Provision, (2013): http://bit.ly/1e7mmtG 3 Share of general population with mental health issues is for people with mental health disorders in 2007, which includes those experiencing anxiety and depression. See Mental Health Network, Key facts and trends in mental health, (2011): http://bit.ly/1lHFGxq Figure for drug misuse is for England and Wales. See Home Office, Crime Survey for England and Wales, (2013): http://bit.ly/1ioQ2OG 1 2

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drug issues.2 In comparison, around 18% of the general population have a mental health issue and 8% have used illicit drug in the last year.3 Services also reported the sanctions process was not well understood, with claimants unclear about consequences of not complying with benefit conditions. This is likely one of the reasons why homeless people are commonly sanctioned for not following a formal instruction to find work. One surveyed service provider commented: “It would be useful, from the outset, that claimants be made aware of the requirements and the circumstances where they may face a sanction. Many of your residents do not understand why they have been sanctioned and have stated that they would of acted differently had they of known the potential consequences of not fulfilling a certain requirement.”

The impact of sanctions Sanctions have a profoundly negative impact on homeless people. Our research found that sanctions left many homeless people unable to pay service charges at support services which are not covered by Housing Benefit such as laundry, food and showers. While sanctions should not affect entitlement for Housing Benefit, our research found that homeless claimants commonly ran into rent arrears, and evictions were common because they did not notify the local authority of their circumstances, and subsequently lost their Housing Benefit. Indeed, surveyed services said Housing Benefit problems were the main effect of sanctions on their service and around one half had evicted more homeless people as a result (Figure 2). One service provider said: “We are not evicting people who have been sanctioned and who are accumulating service charge arrears. This may change. The sanctions regime is affecting our organisational income as well as the residents’ income.”

Figure 2: Impact of sanctions on services % of service providers that reported an impact 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Housing Benefit problems

Service charge arrears

Rent arrears

Increased evictions or notices to quit

Source: Homeless Link sanctions survey; N=39

Homeless people are also experiencing considerable financial issues. Nearly all surveyed services said sanctioned homeless people borrowed to get by, usually from friends and family to avoid the strict repayment schedules of hardship payments. More than half of services said some homeless people were committing survival crime, such as shoplifting, after being sanctioned. Many homeless people experience food poverty because of sanctions, often using food banks to meet their immediate needs. However, food banks are not a long-term solution, with a large number limiting support to emergency provision for a few days. Interviews with homeless people also highlighted their financial difficulties with several borrowing from friends and family after being sanctioned. One young man said arguments over the money that he borrowed from his mother after being sanctioned contributed to him becoming homeless. There is also evidence that financial insecurity from sanctions is worsening any mental health and substance misuse issues they may have. For people trying to move on with their lives, sanctions appear to be hindering their progress.

Sanctions are not achieving their aim Sanctions do not appear to be motivating homeless people to

comply with benefit conditions and seek work: Only 8 of the 45 surveyed service providers said their service users were more motivated to work, while only 3 said service users were better engaging with the Jobcentre Plus. One service provider said: “Sanctions have increased the gap between [homeless] service users and the Jobcentre’ this has subsequently alienated service users from employment.”

What needs to be done? More needs to be done so that sanctions do not cause hardship to homeless people, but instead motivate them to find work. In particular, Government should ensure that benefit conditions take into account homeless people’s support needs, and that the sanctions process is clearly communicated to each individual.

With funding from the London Housing Foundation, Sitra together with SHP staff and clients have co-produced new tools to support homeless people faced with the challenges of welfare benefit reform. Pulling Together website provides a multitude of free resources and training materials: http://www.pullingtogether.org.uk/

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Housing Benefit for supported housing: What you need to know Geoffrey Ferres of Sitra and Sue Ramsden of National Housing Federation summarise the changes introduced by the Housing Benefit and Universal Credit (Supported Housing) Regulations 2014. The Government has published new set of regulations to protect supported housing projects that have been at threat from either the household benefit cap or arrangements for housing costs in Universal Credit. Regulations 2014 introduce four new categories of ‘specified accommodation’ where help with the rent is excluded from both of these changes. 1. Exempt accommodation The ‘exempt accommodation’ definition remains as written in 1995 and only covers claimants in accommodation where the landlord also provides the claimant with care support or supervision- even if through a subcontractor. Accommodation which meets this definition has considerable protection from Housing Benefit calculated on less than the full rent (minus ineligible service charges) and is also exempt from household benefit cap, Social Housing Size Criteria and Universal Credit housing costs arrangements. 2. Supported housing where the landlord does not provide the care, support or provision The second category of ‘specified accommodation’ is similar to ‘exempt accommodation’ except, the landlord (or the subcontractor) is not responsible for providing the claimant with care, support or provision. The claimant must

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also have been ‘admitted’ to the accommodation’ in order to meet a need for care, support or supervision’– so it only applies to people who have moved into supported accommodation, not people in general needs accommodation who are later given a package of care or support. This category only covers claimants with the same landlords as exempt accommodation so it does not help claimants whose landlord is either a housing authority or private ‘for profit’ individual or organisation. 3. Domestic violence refuges The third category of ‘specified accommodation’ covers accommodation provided not only by the same landlords as the first and second categories but also by a local housing authority. The accommodation must consist of a building or part of a building that is used wholly or mainly for nonpermanent accommodation of people who have left their homes as a result of domestic violence. The definition of domestic violence is the same as in other social security legislation. It includes controlling and coercive behaviour and different kinds of abuse.There is no

requirement that the claimant needs or receives any care, support or supervision. 4. Housing authority non-selfcontained supported housing (such as hostels) The Government has finally agreed to extend protection from Universal Credit housing costs and the household benefit cap to housing authority supported housing – but only if the claimant’s accommodation is not self-contained. The regulations use the expression ‘hostel’ but that expression has a long and complicated definition in the Housing Benefit Regulations which ends up covering more accommodation than most people expect. The definition of a hostel is that it must be a building (other than a care home): ‘in which there is provided for persons generally or for a class of persons domestic accommodation, otherwise than in separate and selfcontained premises, and either board or facilities for the preparation of food adequate to the needs of those persons, or both’ ‘Self-contained’ is generally understood to mean the claimant must have in their own premises

The regulations were laid before Parliament on 20 March and can be found on the legislation website http://www.legislation.gov.uk/id/uksi/2014/771 5 For further information about the definition of exempt accommodation, see Sitra’s brief here: http://www.sitra.org/documents/exempt-accommodation-briefing 4

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facilities for eating, sleeping, cooking – unless, perhaps, all meals are provided- and washing – of the person, not just a toilet and a hand basin of the claimant’s own. The result is a lot of supported housing may qualify, with the exception of the very oldest forms of sheltered housing where tenants share bathrooms.

B. How is “specified accommodation” protected from the impact of recent benefit changes? 1. Household benefit cap The changes to the Housing Benefit Regulations come into force on 10 April 2014. From that date people who claim Housing Benefit in respect of “specified accommodation” will be ignored for the purposes of the benefit cap – as is already the case with “exempt accommodation”. 2. Size criteria There is no change. The three new categories of “specified accommodation” are not protected from the social

housing size criteria (the “bedroom tax”) because Housing Benefit is assessed under normal Housing Benefit rules for social housing unlike “exempt accommodation” where the size criteria do not apply.

accommodation’.

At present Universal Credit is only ‘live’ in nine Jobcentres across Britain – Ashton-under-Lyne (Tameside), Bath, Hammersmith, Harrogate, Inverness, Oldham, Rugby, Warrington and Wigan with Shotton (North Wales) going live soon.

The new regulations include an amendment to Universal Credit regulations to add the three new categories of “specified accommodation” alongside the existing definition of “exempt accommodation”. So from 3 November 2014 anyone living in one of the three new categories of “specified accommodation” will not be able to claim housing costs through Universal Credit. He or she will be able to claim Housing Benefit under existing rules. This will mean that any income from Housing Benefit will not be taken into account in the calculation of the overall benefit cap and the tenant can choose to have their benefit paid direct to their landlord.

In these areas a very small number of people have claimed Universal Credit and subsequently moved into “exempt accommodation”. Housing costs for those living in ‘exempt accommodation’ cannot be met through Universal Credit and must be paid through Housing Benefit instead. A tenant can still receive Universal Credit but has to make a separate claim for Housing Benefit to cover the cost of the rent in the ‘exempt

Prior to 3 November 2014 tenants of the three new categories of “specified accommodation” who are awarded Universal Credit will get help with their rent via the rent element of Universal Credit which means: It will be assessed and paid calendar monthly in arrears into a claimant’s bank account -unless in each case Alternative Payment Arrangements are requested and agreed- and the household benefit cap will still apply.

3. Universal Credit The changes to the Universal Credit regulations come into force on 3 November 2014.

The Care and Support Conference 2014 Manchester 3rd July and London 9th July We will pack exciting content and great networking opportunities in to just one day – a must attend event for housing associations providing health, care and support. Choose your preferred location to hear regionalised discussions specifically relevant to you. Workshops you won’t want to miss include: 1 Talking health – making an impact. Learn how to partner with or pitch to the right part of the NHS for your organisation 2 Welfare reform – learning from the frontline. Hear how local authorities are responding to the localisation of the social fund 3 Improving the offers for older people. Discuss different methods in responding to change in design, delivery and support

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Sitraâ&#x20AC;&#x2122;s

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Innovative Courses Experienced trainers from across the sector deliver: Mental Health Drugs and Alcohol Workplace Skills Resilience Health, Care & Support Housing Management Skills and Issues Service Provision Benefits, Money and Debt Health and Safety

And many more! Download your copy of our New Training Guide today! www.sitra.org/training/training-guide or call 020 7793 4713 for a copy by post expertise, training & consultancy in housing with health, care & support